Out of a total of 8136 children registered in the Kabi Pharmacia International Growth Study, 12 have been reported to have diabetes either before or during treatment with growth hormone (GH). Two of these have non‐insulin‐dependent diabetes mellitus (NIDDM), of whom one had risk factors for the development of his condition, namely gross obesity and familial occurrence of NIDDM. One is a rare case of McCune‐Albright's syndrome with insulin‐dependent diabetes mellitus (IDDM), and 9 other patients have IDDM. Of these 9, 6 have idiopathic GH deficiency. In 8 of the 9 patients with IDDM, the condition was diagnosed before GH therapy was commenced, at ages ranging from less than 2 years to 16 years. The association is probably fortuitous, however, as the onset of IDDM in 7 patients was immediately before or during puberty, as often occurs in IDDM in general.
To test the hypothesis that growth hormone (GH) insensitivity is responsible, amongst other mechanisms, for impaired growth in uraemic children, insulin‐like growth factor I (IGF‐I), IGF‐II, IGF binding protein‐1 (1GFBP‐1), IGFBP‐2 and IGFBP‐3 were measured by radioimmunoassay in normal control children, in patients with end‐stage renal failure (n = 51) and in patients with preterminal chronic renal failure (n = 11) and the production rate of IGF was calculated. A unique pattern of normal IGF‐I and IGF‐II levels and markedly increased levels of all three IGFBPs was present in uraemia. Measurement of free IGF‐II binding capacity, and affinity cross‐linking experiments showed that the excess immuno‐reactive IGFBP was able to bind IGFs. To explain the excess of unoccupied IGF binding sites in uraemia, a mathematical model was developed which describes the production of IGFs and their interaction with IGFBP. Calculations of IGF secretion rates suggested that production of IGF is two orders of magnitude lower in uraemic children than in control children, despite normal GH secretion. It is concluded that in uraemia there is a relative GH insensitivity with respect to IGF production.
The possible benefits and disadvantages to the older infant of breast-feeding being continued after the introduction of solid foods are reviewed. The limited evidence from industrialised countries suggests that prolonged partial breast-feeding has little influence on child health and growth. In contrast, in poor areas of the developing world, the continuation of breast-feeding for 1-2 years after the introduction of other foods appears to have several major benefits. These include the supply of nutrients, the delivery of protective, digestive and trophic agents, and extending the period of infertility in the mother. Partial breast-feeding after 6 months is associated with reduced severity of infectious diseases particularly in severely malnourished individuals. There is no evidence that partial breast-feeding plays a causal role in poor growth performance. In poor areas of the developing world, breast-feeding, together with the provision of adequate amounts of other foods, should be encouraged for the first two years of life.
Well‐controlled, comparative studies suggest that in “food rich” or “resource rich” environments, ethnic minority status is not an independent risk factor for malnutrition. In England, Australia, and the United States, nutrient intake, nutritional status measures and growth are comparable between children of ethnic minorities and non‐minority children of similar economic status. Children of recent immigrants are an exception to this generalization, suggesting that recent arrival in a new environment is a risk factor for malnutrition. Family‐level studies of intraethnic diversity are required to develop more sensitive and specific profiles of risk factors for malnutrition.
Protein energy malnutrition (PEM) during early childhood is very often associated with edema. In fact, the well‐known Wellcome classification of PEM from 1970 is based upon the reduction in weight in relation to age and whether edema is present or absent. In this presentation our knowledge of the disturbance in fluid and electrolyte homeostasis as seen in PEM will be reviewed. The implication of this disturbance for the treatment of acute dehydration in children with PEM will also be discussed.A balanced fluid and salt homeostasis is the prerequisite of physiological compartment volumes and efficient nutritional supply. Under physiological conditions water requirement is related to the requirement of salt at the same time as water balance is regulated by antidiuretic hormone.
Studies in children fed alternative diets showed that anthropometric parameters and the intake of energy and nutrients by macrobiotic children deviated most from current norms. Therefore weaning practice, growth and haematological status were investigated in 3 age‐cohorts of macrobiotic fed infants between 4 and 18 months of age and a control group. A mixed longitudinal design was used for this study. Main findings were a growth retardation which was strongest in the second cohort (8–14 months of age) and related to a diet low in energy density, fat and protein. Haematological data revealed very low vitamin B12 concentrations with consequently low values of haematocrit and red blood cell count and higher values of mean corpuscular volume and mean corpuscular haemaglobin mass in the macrobiotic group. High folate concentrations also seemed to be a consequence of Vitamin B12 deficiency. Iron deficiency was found in 15% of the macrobiotic group vs. no infants in the control group. Nutritional recommendations acceptable within the macrobiotic philosophy are discussed.
This paper provides an overview of the diagnoses of patients entered in the Kabi Pharmacia International Growth Study (KIGS). By May 1991, data from a total of 5377 children treated with growth hormone (GH) were included in the main database. Of these children, 2691 were classified as having idiopathic GH deficiency (GHD), 866 as having GHD of known origin, and 1820 as having other causes of short stature. The majority of patients with idiopathic GHD have no history of perinatal trauma. In the patients with GHD of known origin, 137 were congenital cases and 729 acquired GHD. The largest number of congenital cases (114) belonged to the group of central malformations (e.g. septo‐optic dysplasia and empty sella syndrome). Of the cases with acquired GHD, 73% were associated with tumours or leukaemia. Other causes of short stature include 12 groups of diagnoses, with more than 150 cases in four of them (idiopathic short stature, 635; defined syndromes with chromosomal aberrations, 337, of which 304 were Turner's syndrome; defined syndromes without chromosomal aberrations, 157; intrauterine growth retardation without stigmata, 366). Analysis of the KIGS data allows modern GH therapy for GHD to be compared with older treatment modalities. The study offers the advantage of larger numbers of cases than can be achieved in individual trials and allows assessment of the use of GH therapy for GHD of comparatively uncommon causes.
A prospective investigation of the course of breast-feeding was carried out in a group of 51 healthy, well educated Swedish women during the period three days to 18 months after delivery. The aims were to investigate the incidence, causes and consequences of perceived breast milk insufficiency (transient lactation crises), by relating this phenomenon to the infant's breast milk consumption and growth, and to the course of breast-feeding. It was found that every second mother experienced transient lactation crises on at least one occasion (the crisis group). The crises were mostly caused by emotional disturbances in the mothers (e.g. anxiety, stress and discomfort), or by the infant's refusal to suckle, by unmotivated crying, or by illness. Within the crisis group no significant difference was found between the infants' intake of breast milk during the crises compared with control measurements one week later. Nor had the crises any immediate impact on the growth of the infants. A comparison between the mothers with crises and those who did not experience any crises, revealed that the breast milk consumption among the infants in the crisis group was lower throughout with significant differences at three and five months. The infants in the crisis group also had a significantly lower weight at two, three, four and nine months, although both groups were above the NCHS mean. The reasons for initiating breast-feeding differed between the two groups. The crisis group tended to give infant-related reasons to a higher degree than the mothers in the non-crisis group who more frequently mentioned mother-related motives. The mothers with crises also showed a greater ambivalence during the lactation period and terminated the breast-feeding somewhat earlier. Consequently they also introduced taste portions and started the weaning significantly earlier. Some general findings revealed a wide variation in breast milk consumption, not only between infants but also in the same infant from one occasion to another. The total energy intake was almost the same for the partially breast-fed infants, receiving breast milk plus supplementary food, and those who were exclusively breast-fed. Although most mothers in both groups initiated the weaning in accordance with general recommendations, a wide variation was also found in the length of the weaning period. In some cases it lasted for more than five months.
Acta PaediatricaVolume 80, Issue s372 p. 5-16 Neuroendocrine Control of Growth Hormone Secretion G. S. TANNENBAUM, Corresponding Author G. S. TANNENBAUM From the Departments of Pediatrics, Neurology and Neurosurgery, McGill University and Neuropeptide Physiology Laboratory, McGill University-Montreal Children's Hospital Research Institute, Montreal, Quebec, Canada(G.S.T.) Neuropeptide Physiology Laboratory McGill University-Montreal Children's Hospital Research Institute 2300 Tupper Street Montreal Quebec H3H 1P3 CanadaSearch for more papers by this author G. S. TANNENBAUM, Corresponding Author G. S. TANNENBAUM From the Departments of Pediatrics, Neurology and Neurosurgery, McGill University and Neuropeptide Physiology Laboratory, McGill University-Montreal Children's Hospital Research Institute, Montreal, Quebec, Canada(G.S.T.) Neuropeptide Physiology Laboratory McGill University-Montreal Children's Hospital Research Institute 2300 Tupper Street Montreal Quebec H3H 1P3 CanadaSearch for more papers by this author First published: January 1991 https://doi.org/10.1111/j.1651-2227.1991.tb17962.xCitations: 38AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume80, Issues372January 1991Pages 5-16 RelatedInformation
An increasing number of women with inherited metabolic disorders survive, conceive and have children. In order to safeguard the health of the mother and the developing embryo, fetus, and newborn during pregnancy, delivery, and the neonatal period it is necessary to be aware of the range of metabolic disorders, the risks to mothers and children, and appropriate management strategies. The roles of the Paediatrician, Obstetrician and Dietitian in the management of Maternal Hyperphenylalaninaemia and phenylketonuria are reviewed.
ABSTRACT. As a model of the growth hormone (GH) dependence of growth in prepuberty and puberty, the growth of 182 children (93 boys, 89 girls) who survived in first remission for treatment of acute lymphoblastic leukaemia was examined. Chemotherapy regimens, including intrathecal methotrexate, were similar in all patients, but CNS treatment differed, in that one group received 2400 cGy cranial irradiation, while the other received 1800 cGy. There was a significant decrease in height SDS during prepuberty, which was equivalent in both sexes, whereas there was a much greater decrease in pubertal growth in girls than in boys. Girls treated with the lower dose regimen of cranial irradiation had their onset of pubertal maturation significantly advanced, to a mean of 9.9 years (p < 0.001). Previous studies have indicated that the duration of puberty is shortened by GH treatment in patients with idiopathic multiple pituitary hormone deficiency or isolated GH deficiency (GHD). To determine whether an increase in the dose of GH administered during the adolescent growth spurt would improve final height, a prospective randomized trial was performed in 32 children (25 boys, 7 girls) with isolated GHD treated with a GH dose regimen of 15 IU/m2/week as daily s.c. injections. At the onset of the pubertal growth spurt, the patients were randomized either to an unchanged dose or to 30 IU/m2/week. There was no significant change in height velocity with the doubled dose of GH, but there was a trend in the advancement of pubertal maturation which was considered to be dose related. It is suggested that these findings are of relevance to the treatment of GHD in puberty, especially in girls with early or precocious puberty occurring as a consequence of low‐dose cranial irradiation. It is concluded that optimum final heights may not be achieved in these patients without the therapeutic manipulation of the onset and/or duration of puberty.
We review selected aspects of the interactions between protein and energy in human metabolism and nutrition. Following a short account of the underlying metabolic basis for the effects of energy on protein metabolism, the contribution made by whole body protein turnover to the metabolic rate is discussed, including the relationship between protein turnover and energy metabolism at different phases of life. The effects of changes in energy metabolism and intake on the nitrogen economy of the host are also reviewed briefly and we explore the relationship between amino acid oxidation and requirements for indispensable amino acids. Interactions between energy and protein metabolism need to be investigated in greater detail and also they must be considered in relation to further attempts to establish more precisely energy and amino acid requirements of people under various circumstances.
Five hundred and thirtytwo pregnant women were interviewed about their psychosocial health at the beginning of pregnancy. According to various factors including alcoholism, mental disease and criminality among the women and their husbands the families were divided in three groups of different degrees according to psychosocial stress. The pregnancies, deliveries and the 497 live‐born children in these families have been investigated with prospective methods. Data concerning the psychological development and psychiatric health of the child were attained by interviewing the mother and evaluating the child during visits to home (age 1 and 4). The physical health and development of the children has been followed by prospective data achieved from the child welfare centers. At one year of age 452 of the children (226 boys, 226 girls) and at four‐five years of age 412 of the children (202 boys, 210 girls) were evaluated by the Griffith's Development Scales. Findings from these evaluations can now be related to a number of factors concerning the psychosocial situation, pediatric riskfactors etc. With the prospective, longitudinal methods used in this project interesting results concerning sex differences related to the mental development have been found. At one year of age girls had higher scores than boys on the Griffiths‐subscale measuring hearing‐and‐speech abilities. At four years of age several significant differences between the sexes were found. Girls had more “even” Griffiths‐profiles and scored higher than boys in several Griffiths‐subscales. The greatest differences at four years of age were found concerning personal‐social function and eye‐hand‐coordination. Boys seem to be specially vulnerable to the psychosocial situation in their homes as the Griffiths‐results at four years of age are lower among boys from homes with psychosocial stress compared to other boys. It should be very interesting to follow and study what these sex differences mean concerning future development, the occurrence of psychopathology and school difficulties.
During the first few days of life, the ill premature infant is usually subjected to acute semistarvation because the provision of nutritional support is considered cumbersome and unnecessary. However, the absence of readily recognizable adverse effects of semistarvation does not rule out the existence of significant short-term adverse effects, nor does it rule out possible adverse sequelae in the long run. Similar concerns pertain to the later neonatal period, during which nutritional deprivation is less severe but of longer duration. Evidence is presented that qualitative malnutrition, characterized by inadequate intake of protein and relatively excessive intake of energy, is common with current feeding regimens and is responsible for increased body fat deposition in growing small premature infants.
Acta PaediatricaVolume 80, Issue s379 p. 79-82 Regulation of Growth Hormone Binding Proteins in Human Plasma M.-C. POSTEL-VINAY, Corresponding Author M.-C. POSTEL-VINAY From U344, INSERM, Hôpital Necker-Enfants Malades, Paris, France(M.-C.P.-V.) U344 INSERM Hôpital Necker-Enfants Malades 75743 Paris Cedex 15 FranceSearch for more papers by this authorM. FONTOURA, M. FONTOURA From U344, INSERM, Hôpital Necker-Enfants Malades, Paris, FranceSearch for more papers by this author M.-C. POSTEL-VINAY, Corresponding Author M.-C. POSTEL-VINAY From U344, INSERM, Hôpital Necker-Enfants Malades, Paris, France(M.-C.P.-V.) U344 INSERM Hôpital Necker-Enfants Malades 75743 Paris Cedex 15 FranceSearch for more papers by this authorM. FONTOURA, M. FONTOURA From U344, INSERM, Hôpital Necker-Enfants Malades, Paris, FranceSearch for more papers by this author First published: December 1991 https://doi.org/10.1111/j.1651-2227.1991.tb12050.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume80, Issues379December 1991Pages 79-82 RelatedInformation
Acta PaediatricaVolume 80, Issue s372 p. 19-25 Neuroendocrine Control of the Onset of Puberty: Secretion of Gonadotrophin-Releasing Hormone from Rat Hypothalamic Explants J.P. BOURGUIGNON, J.P. BOURGUIGNON From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorA. GERARD, A. GERARD From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorL. FAWE, L. FAWE From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorM. L. ALVAREZ-GONZALEZ, M. L. ALVAREZ-GONZALEZ From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorP. FRANCHIMONT, P. FRANCHIMONT From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this author J.P. BOURGUIGNON, J.P. BOURGUIGNON From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorA. GERARD, A. GERARD From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorL. FAWE, L. FAWE From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorM. L. ALVAREZ-GONZALEZ, M. L. ALVAREZ-GONZALEZ From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this authorP. FRANCHIMONT, P. FRANCHIMONT From the Department of Paediatrics and the Radioimmunoassay Laboratory, Centre Hospitaller Universitaire, University of Liège, Liège, BelgiumSearch for more papers by this author First published: January 1991 https://doi.org/10.1111/j.1651-2227.1991.tb17963.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume80, Issues372January 1991Pages 19-25 RelatedInformation
Acta PaediatricaVolume 80, Issue s372 p. 92-95 Paracrine and Autocrine Regulation of Insulin-Like Growth Factor I P. CHATELAIN, Corresponding Author P. CHATELAIN INSERM U 307, Hôpital Debrousse, Lyon, France the Department of Paediatrics U.E.R. Alexis Carrel, Lyon, France(P.C.) INSERM U307 Lyon FranceSearch for more papers by this authorD. NAVILLE, D. NAVILLE INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorO. AVALLET, O. AVALLET INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorA. PENHOAT, A. PENHOAT INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorC. JAILLARD, C. JAILLARD INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorP. SANCHEZ, P. SANCHEZ INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorJ. SAEZ, J. SAEZ INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this author P. CHATELAIN, Corresponding Author P. CHATELAIN INSERM U 307, Hôpital Debrousse, Lyon, France the Department of Paediatrics U.E.R. Alexis Carrel, Lyon, France(P.C.) INSERM U307 Lyon FranceSearch for more papers by this authorD. NAVILLE, D. NAVILLE INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorO. AVALLET, O. AVALLET INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorA. PENHOAT, A. PENHOAT INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorC. JAILLARD, C. JAILLARD INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorP. SANCHEZ, P. SANCHEZ INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this authorJ. SAEZ, J. SAEZ INSERM U 307, Hôpital Debrousse, Lyon, FranceSearch for more papers by this author First published: January 1991 https://doi.org/10.1111/j.1651-2227.1991.tb17979.xCitations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume80, Issues372January 1991Pages 92-95 RelatedInformation
