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.
