Circadian Characteristics of Plasma Cortisol in Children with Standard and Short Stature

Cortisol (CT) concentrations (in mUg/dl) were determined by radioimmunoassay in plasma obtained at about 3-hr intervals during a 24-hr sampling span from 42 boys and 13 girls of short stature (2–4 standard deviations below their peer group mean), and from a reference group of 11 boys and 10 girls with standard stature, before any treatment were administered to the former. Subjects were 11.20 0.37 years of age at the time of study, and were living on a diurnal waking (～07:30 to ～22:30), nocturnal resting routine during sampling, consuming the usual hospital diet. Circadian rhythm parameters were computed separately for each group by the single and population-mean cosinor Tits of a 24-hr cosine curve. A comparison of circadian parameters indicates a statistically significant difference in acrophase (>P =0.033) between short and standard children, as well as added differences in rhythm-adjusted mean (M; P=0.011) and (P =0.035) between boys and girls of short stature. These differences, as well as any other added information from relevant marker rhythms, should be taken into account for the time-specification of therapy before treatment starts in children of short stature.     

Multiple Component Analysis of Plasma Growth Hormone in Children with Standard and Short Stature

Growth hormone (GH) concentrations (in ng/ml) were determined by radioimmunoassay, in plasma obtained at about 3-hr intervals during a 24-hr sampling span, from 42 boys and 12 girls of short stature (2-4 standard deviations below their peer group mean), and 13 boys and 9 girls of standard stature. Subjects had 11.20 0.37 years of age at the time of study, and were living on a diurnal waking (∼07:30 to ∼22:30), nocturnal resting routine during sampling. Analysis of these data by single and population-mean cosinor methods as well as by analysis of variance revealed circadian and ultradian prominent components characterizing most groups. Accordingly, a multiple component analysis was undertaken for data of each group separately, as well as for all subjects. A comparison of circadian parameters indicates similar characteristics between short and standard children, whether one compares boys [P=0.674, 0.371 and 0.749 for comparison of rhythm adjusted means (M), amplitudes (A) and acrophases (), respectively], girls (P=0.993,0.914 and 0.397), or all children (P=0.859,0.712 and 0.865). Differences are found, however, in circasemidian characteristics as well as in the prominent 8-hr ultradian component documented for the short but not for the standard children. These ultradian components should be taken into consideration in the design and later evaluation of a time-specified treatment of children of short stature.     

Spontaneous growth hormone secretion in healthy prepubertal children of normal stature.

To evaluate the dynamics of growth hormone (GH) secretion in healthy prepubertal children of normal stature, we determined spontaneous GH secretion by measuring GH every 30 min in 21 Japanese subjects, age: 5.4 +/- 2.3 (1.6-10.6) years; height: -1.4 +/- 1.1 (-1.98-1.77) SD. The 24-h mean GH concentration was 4.8 +/- 1.5 ng/ml. The 24-h mean GH was similar in boys and girls (mean +/- SD: 4.8 +/- 1.7 vs 4.7 +/- 1.1 ng/ml). No correlation was found between chronological age and the 24-h mean GH. The 24-h mean GH was closely correlated with GH pulse amplitude (r = 0.94; P less than 0.001), but not with the number of GH pulses. The 24-h mean GH was also highly correlated with 3-h mean GH after sleep and 3-h peak GH after sleep (r = 0.86; P less than 0.001 and r = 0.72; P less than 0.001, respectively). Our data suggest that in healthy prepubertal children of normal stature, (1) spontaneous GH secretion is independent of sex and age, (2) the amount of spontaneous GH secretion is controlled by pulse amplitude, not by number of pulses. (3) 3-h mean GH and 3-h peak GH after sleep might represent 24-h total spontaneous GH secretion.     

Estimating height from arm span measurement in Malawian children

Arm span and standing height were measured in 289 boys and 337 girls aged 6-15 years who were free from physical deformities which can affect stature or arm span. The arm span exceeded height in all age groups of boys and in older girls. At the age of 7, 11 and 12 years girls were significantly taller than the boys and had longer arm span while at the age of 15 years, the trend was opposite. The mean difference between the two anthropometric parameters for boys was 5.45 +/- 4.21 cm (t = 3.556, p < 0.001) and for girls was 4.94 +/- 4.96 cm (t = 3.542, p < 0.001). Correlation coefficient between height and arm span measurements for Malawian boys was 0.983 and for girls was 0.986. Height, arm span and height-arm span difference increased with age of children while height to arm span ratio decreased. The gender difference in height-arm span differences was only significant at the age of 15 years. Multiple regression and cross validation were performed. Height of Malawian children of both sexes can be estimated from equation: Height (cm) = 15.756 + (0.168 x age) + (0.839 x arm span) (SEE = 0.760, R2 = 0.988).     

Growth hormone treatment in short Japanese children born small for gestational age

Recent reports have shown that high-dose growth hormone (GH) treatment in short children born with small for gestational age (SGA) resulted in a pronounced acceleration of linear growth. We describe the results of multicenter trials of recombinant human GH (rhGH) treatment in short SGA children in Japan. Two clinical studies were performed and the results were combined. Study 1 comprised 104 SGA children and study 2 comprised 61 SGA children. The patients were divided into three groups: group 1 consisted of 20 patients (13 boys and 7 girls) who received rhGH 25 microg/kg per day six or seven times per week in the first year and 50 microg/kg per day in the second year and thereafter; group 2 consisted of 48 patients (28 boys, 20 girls) who received rhGH 45/50 microg/kg per day; group 3 consisted of 44 patients (28 boys, 16 girls) who received 90/100 microg/kg per day. The mean increments in height SDS were 0.46, 0.67 and 0.94 SD in boys and 0.49, 0.79 and 0.93 SD in girls in groups 1, 2 and 3, respectively. The mean increment in height SDS at 2 years in group 3 was significantly greater than that in group 1, but it was not significantly different from that in group 2 in boys and girls. Our data demonstrated that high-dose GH administration significantly improved height velocity and height SDS in short SGA children. Additional studies are necessary to optimize a long-term GH treatment regimen and combined luteinizing hormone releasing hormone analog treatment for final height. Careful observation is also necessary to assess the metabolic effects of high-dose GH, especially on carbohydrate metabolism.     

38年来济南、青岛儿童少年生长的长期变化

本文分析了济南、青岛1962—2000年7—18岁儿童少年生长发育的长期变化趋势。38年间,济南市7—18岁男女生身高平均增长15 48cm(男)、12 09cm(女),体重平均增长15 76kg(男)、10 01kg(女),胸围平均增长7 88cm(男)、4 10cm(女);青岛市7—18岁男女生身高平均增长17 12cm(男)、13 19cm(女),体重平均增长16 98kg(男)、10 46kg(女),胸围平均增长6 72cm(男)、3 05cm(女)。青岛市男女生身高的增长幅度显著大于济南。     

Physiological growth hormone secretion in children with short stature and intra-uterine growth retardation

31 prepubertal children with short stature [mean height standard deviation score (SDS) -2.84] and low birth weight (mean -2.82 SDS) were studied. Mean age was 6.0 years and mean height velocity SDS was -0.76. Patients were classified as having either the clinical characteristics of Russell-Silver syndrome (RSS) (4 F, 13 M) or not (4 F, 10 M). All children had an overnight profile of spontaneous growth hormone (GH) secretion. 4 children achieved a maximum GH concentration of less than 20 mU/l. 9 children with RSS secreted only one large GH peak during the night. Most of the non-RSS group had normal GH pulse frequency but 3 boys had a fast-frequency pattern. Abnormal GH secretion may contribute towards growth failure in children with low birth weight/RSS.     

Association of pharmacological tests and study of 24-hour growth hormone secretion in the investigation of growth retardation in children: analysis of 257 cases

Growth hormone (GH) secretion can presently be investigated by several methods: pharmacological provocative tests, study of 24-h GH secretion, measurement of somatomedin-C (Sm-C)/insulin-like growth factor (IGF) I, and the growth hormone-releasing hormone (GHRH) test. In order to compare the results obtained, these methods were used in 257 children with growth retardation (169 boys, 88 girls). Their height SD was -2.7 +/- 0.2, chronological age 11 3/12 +/- 1 6/12 years, and bone age 8 4/12 +/- 1 4/12 years. Mean growth velocity was 4.5 +/- 1.5 cm/year. One hundred and thirty-eight boys and 80 girls were prepubertal, and 31 boys and 8 girls were pubertal (B2 G2). All children underwent the study of 24-h GH secretion (n = 257) and pharmacological provocative tests (two tests, n = 213; one test n = 44). Sm-C/IGF I was measured in prepubertal children (n = 131), and a GHRH test was carried out (n = 153). In addition, the mean integrated concentration of growth hormone secretion (IC-GH) was assessed in a control group of 23 children and was found to be 5.4 +/- 1.2 ng/ml/min. The IC-GH in the group as a whole was 2.6 ng/ml/min. The mean maximum peak during pharmacological tests varied considerably according to the test used, ranging from 7.8 ng/ml for the arginine test to 17.1 ng/ml for the glucagon and betaxolol test. The maximum peak and the 24-h IC-GH were not significantly correlated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Adult outcome of normal children who are short or underweight at age 7 years.

OBJECTIVES--To evaluate the adult growth outcome (at age 23) of children who are short or underweight at age 7 years in whom no identifiable pathological cause exists for their poor growth. DESIGN--Longitudinal follow up of a birth cohort. SETTING--The national child development study (1958 birth cohort) of Great Britain. SUBJECTS--523 children with a height or a weight below the fifth centile at age 7. Of these, 70 (13.4%) were excluded because they had a longstanding illness that could account for their poor growth. The remaining 453 subjects, who were followed to age 23, provided the base group from which those with additional data, such as parental height, were obtained. RESULTS--55/174 (31.6%) boys who were short at age 7 became short men; 60/211 (28.4%) girls who were short at age 7 became short women. Among boys who were underweight at age 7, 46/160 (28.7%) were still underweight at age 23, while 61/200 (30.5%) girls underweight at age 7 became underweight women. Having short parents did not increase the probability of being small as an adult. Children with delayed puberty were as likely to remain small as those in whom puberty was not delayed. CONCLUSIONS--One in three normal children who was short or underweight at age 7 became a short or underweight adult. This informs the management of short children and may be valuable when prolonged growth hormone treatment for short stature is being considered.     

One repetition maximum prediction models for children using the OMNI RPE Scale

This investigation developed statistical models to estimate one repetition maximum (1 RM) muscular strength using submaximal ratings of perceived exertion (RPE) as predictor variables. Ten- to 14-year-old girls (n = 35) and boys (n = 35) performed two sets (10 repetitions) of biceps curl (BC) and knee extension (KE) exercise using weights approximating 30% and 50% 1 RM. RPE was assessed during the final repetition of each set using the children's OMNI Resistance Exercise Scale (0-10). Sex-specific statistical models predicted 1 RM using RPE derived from both sets of BC and KE exercises. For both girls and boys, RPE ranged from 3.7 to 6.6 for BC and 4.1 to 7.2 for KE. Group mean 1 RM was (a) girls: BC, 7.44 kg, KE, 13.25 kg and (b) boys: BC, 9.19 kg, KE, 16.24 kg. One repetition maximum prediction models for girls were significant (P < 0.01) for BC (r = 0.87) and KE (r = 0.89). One repetition maximum prediction models for boys were significant (P < 0.01) for BC (r = 0.89) and KE (r = 0.87). The RPE predictors were practical and accurate measures, making the 1 RM models potentially applicable when assessing large numbers of children in short time periods.     

Prevalence of severe growth hormone deficiency.

Four hundred and forty-nine short children, who were all over 2-5 standard deviations below the mean height for age, were identified by screening the heights of 48 221 6- to 9-year-old children in three Scottish cities. Most were screened for growth hormone deficiency (GHD). The prevalence of severe GHD in this sample may have been as high as 1 in 4018, much higher than reported. The findings suggest that present referral patterns may account for the delayed or missed diagnosis of the condition in girls or children with less severe short stature.     

Weight loss and the effect on stature in children during a residential intervention program

Weight loss is generally high in residential weight-loss programs but the effect of a large weight loss on linear growth is not known. We report the weight loss and the influence on linear growth in a large group of children during a residential weight-loss program focusing on nutrition and physical activity. In a longitudinal noncontrolled intervention study of 990 overweight children (540 girls) attending the weight reduction program from 1990 to 2001 for about 11 weeks (age: 10-14 years, mean BMI-standard deviation score (SDS) at enrollment: 2.83) weight and height were measured initially and after end of treatment. Weekly measurements of height and weight were performed on 138 children. The children lost on average 9.4 kg, reduced their BMI by 4.5 kg/m(2) and BMI-SDS by 0.98. In a multiple regression analysis (P < or = 0.001) weight loss was higher in boys than girls (1.7 kg), higher if the weight was higher at admission (-0.192 kg/kg at baseline) and was positively associated with duration of stay (-80 g/day). Initially the boys' BMI-SDS was higher than the girls' BMI-SDS (P < or = 0.05) but after 8 weeks of treatment the boys had lower BMI-SDS than the girls. There was no negative effect on linear growth during the treatment; on the contrary, linear growth accelerated during the stay as the average increase in height was 2.38 cm corresponding to 11.4 cm/year. In conclusion the children lost close to 1 kg/week during the stay without any negative effect on linear growth. The cause of the linear growth acceleration needs further investigation.     

Prepubertal Asians have less limb skeletal muscle.

Skeletal muscle mass in prepubertal Asian children has not been examined previously. The aims of this study were to test the hypotheses that 1) prepubertal Asians have less appendicular skeletal muscle (ASM) mass compared with African-Americans and Caucasians, and 2) ASM is less in prepubertal Asian girls compared with Asian boys. ASM was estimated by using dual-energy X-ray absorptiometry in healthy prepubertal girls (n = 170) and boys (n = 166). The results showed that, after adjusting for age, height, and body weight, 1) Asian girls and boys had less amounts of ASM than African-Americans (P < 0.001); 2) Asian girls had less amounts of ASM than Caucasian girls (P = 0.004); 3) there was a trend towards less ASM in Asian compared with Caucasian boys (P = 0.07); 4) and Asian girls had significantly less ASM than Asian boys (P < 0.001). This study indicates that skeletal muscle mass as a fraction of body weight is smaller in Asian compared with African-American and Caucasian children.     

Patrilineal family values,family planning and variation in stature among Taiwanese six-year-olds

It has been argued that patrilineal joint family systems tend to bias family planning decisions in favour of sons. A simple model suggests that in such societies, any given son will be more highly valued by his parents (1) the fewer his brothers and (2) the earlier his birth is in the brother series. A daughter's value will be greater (1) the fewer brothers she has and (2) the earlier her birth is relative to other sisters. This study first addresses the extent of son preference as inferred from family composition data for 772 Taiwanese first-graders born in the mid-1970s in two socioeconomically distinct communities in Taipei, Taiwan. It then uses linear regression to consider whether the model criteria help account for statural variation among children in each study area when controlling for differences in measurement age, parental education and housing. With respect to family composition and gender preference, available evidence was consistent with previous surveys. While better-educated parents in the more affluent study area had significantly fewer children (p < 0.0005) and were more willing to stop without a son, girls there, as in the less affluent area, were still significantly more likely than boys to belong to large sibships (p < or = 0.005). Evidence from mean height of males and females partially accords with hypothetical predictions. In the less affluent area, the interaction effect of male birth order and the presence of younger siblings was significantly associated with mean stature (p = 0.002). Males without brothers were 2.0 cm taller than males with either an older or a younger brother (116.3 +/- 0.5 cm vs 114.3 +/- 0.4 cm). Males who had both younger and older brothers, but often no sisters, were about as tall, however, as those without brothers. A similar, but less pronounced, pattern was found among males in the more affluent area, but only among those who had sisters. These boys were also consistently shorter than boys without sisters (115.6 +/- 0.6 cm vs 117.7 +/- 0.6 cm; p = 0.001). Patterns of mean female stature did not clearly support the hypothesis. Girls in the more affluent area were relatively tall and did not show significant variation. Results among less affluent girls showed significant contrasts, but not necessarily in the predicted direction.     

Growth curves of children with Down syndrome.

Growth curves of 105 children with Down syndrome (50 boys and 55 girls) were established. At birth height, weight and head circumference of Down syndrome children were lower than these parameters in controls. This delay remained stable until puberty. For weight there was no clear-cut pubertal growth spurt. For stature, the prepubertal growth spurt occurred earlier (at the age of 11 years in boys and 9 1/2 years in girls) than in controls but was less marked. As a result, Down syndrome patients had a short stature with a quite normal weight. These reference curves, available since prenatal diagnosis of Down syndrome is performed routinely, are helpful for monitoring normal and abnormal development in Down syndrome patients.     

Cortical bone loss and measurements of the second metacarpal bone: II. Hypodense bone in postwar Guamanian children

Hand-wrist radiographs from 326 Guamanian children (180 boys and 146 girls) were evaluated for total width, medullary width, length, and combined cortical thickness of the second metacarpal. Bone measurements as well as standing height and weight were compared to similar published data from U.S. mainland black, white, and Mexican-American children. The results demonstrated that the second metacarpal bones of Guamanian boys and girls of all age groups (5–17 years) have a narrower width and shorter length with less combined cortical thickness than any of the other groups. Guamanian children also weighed less and were of shorter stature than their black, white, or Mexican-American counterparts. These results agree closely with those comparisons between Guamanian and U.S. mainland white adults published earlier. It is not possible from the present data to ascertain whether these differences were due to genetic variability or nutritional deficiency.     

Gender-specific growth patterns for stature,sitting height and limbs length in Croatian children and youth (3 to 18 years of age)

In a cross-sectional study of growth, 5,155 children (2,591 females, 2,564 males) from the town of Zagreb (Croatia) were measured. Four traits of linear dimensionality (stature, sitting height, arm and leg lengths) were studied in the age span of 3 to 18 years. A significant average annual increase of all four anthropometric parameters were observed up to 14 and 15 years of age in girls and 16 years of age in boys, showing that girls had a shorter growing period. In the prepubertal period until 9 years of age, gender differences were negligible. At the age of 10, boys were overgrown by girls in all parameters due to the earlier onset of puberty in girls. The growth gains for girls, when compared with those for boys, show a different pattern across variables. The female growth advantage remained in a two years period for the limbs length, but in a three year period for stature and the longest, for 4 years, for sitting height. The male predominance in size had an onset at the age of 13 for the limbs and in the age of 14 for stature and sitting height. The patterns of sexual dimorphism in stature and sitting height during growing years are similar to those observed in other populations of Europe. Growth of Croatian children and youth is very similar to that of the tallest European populations.     

Application of Body Mass Index According to Height-Age in Short and Tall Children

Background

In children with either delayed or accelerated growth, expressing the body mass index (BMI) to chronological age might lead to invalid body composition estimates. Reference to height-age has been suggested for such populations; however its validity has not been demonstrated.

Methods

Anthropometric data of healthy children were obtained from the German KiGGS survey. We selected three samples with different height distributions representing short stature (mean height SDS: -1.6), normal stature (height SDS: 0), and tall stature (height SDS: +1.6), and compared BMI-for-age and BMI-for-height-age between these samples across the paediatric age range. Differences between samples were tested using Kruskal-Wallis one-way analysis of variance and permutation tests.

Results

At a given age, BMI was distributed towards lower values in short, and towards higher values in tall subjects as compared to a population with average height distribution. Expressing BMI to height-age eliminated these differences in boys with a short stature from 4 years to 14 years of age, in tall boys from 4 to 16 years, in short girls aged 2-10 years or tall girls aged 2-17 years.

Conclusion

From late infancy to adolescent age, BMI distribution co-varies with height distribution and referencing to height-age appears appropriate within this age period. However, caution is needed when data about pubertal status are absent.     

Assessment of the physical development and physical fitness of children and youths with simple body height deficiency

The aim of this work is an analysis of the process of growth and an assessment of the physical fitness of children and youths with short stature. The material contains results of a long-term investigation of the growth of boys and girls with the diagnosis: simple body height deficiency (hypostatura simplex). The investigation was carried out in Swietokrzyskie Province, Poland, in the years 1980-1997. It comprised 471 individuals: 143 girls aged 5-18 years and 328 boys aged 5-19 years. A different degree of the skeleton age is connected with a different dynamic of growth of short-stature girls and boys. Pubescent increase in the rate of growth occurs in individuals with a considerable retardation of the bone age later, particularly among boys. The growth process lasts longer in them, therefore, the final body height is achieved later and it is greater in individuals whose bone age is concordant with the calendar age. The level of physical working capacity of short-stature children does not show any significant difference in comparison with that in individuals with correct body height, and relative values of the indicators of physical fitness, related to body mass, are even higher in short-stature children. Individuals with a greater body height deficiency are characterised by a lower level of physical fitness.     

Weight growth in infants born to mothers who smoked during pregnancy.

OBJECTIVE--To determine whether maternal smoking during pregnancy causes impairment in growth after birth. DESIGN--Longitudinal study. SETTING--Six medical university centres of six towns of north, central, and south Italy. SUBJECTS--12,987 babies (10,238 born from non-smoking mothers, 2276 from mothers smoking one to nine cigarettes a day, and 473 from mothers smoking > or = 10 cigarettes a day) entered the study. MAIN OUTCOME MEASURES--Difference in weight gain between children born to smoking mothers and those born to non-smoking mothers. Weight was measured at birth and at 3 and 6 months of age. Maternal smoking habit was derived from interview on third or fourth day after delivery. RESULTS--Compared with children born to mothers who did not smoke during pregnancy, the birth weights of children born to mothers who smoked up to nine cigarettes a day were 88 g (girls) and 107 g (boys) lower; in children born to mothers who smoked > or = 10 cigarettes a day weights were 168 g and 247 g lower. At six months of age for the first group the mean weight for girls was 9 g (95% confidence interval -47 g to 65 g) higher and for boys 64 g (-118 g to -10 g) lower than that of children born to mothers who did not smoke. The corresponding figures for the second group were 28 g (-141 g to 85 g) lower for girls and 24 g (-136 g to 88 g) lower for boys. CONCLUSIONS--The deficits of weight at birth in children born to mothers who smoked during pregnancy are overcome by 6 months of age. These deficits are probably not permanent when smoking habit during pregnancy is not associated with other unfavourable variables (such as lower socioeconomic class).