A. Ferrández Longás

Estudio transversal español de crecimiento 2008. Parte II: valores de talla, peso e índice de masa corporal desde el nacimiento a la talla adulta

En las sociedades desarrolladas existe una aceleracion secular del crecimiento. Entre los anos 2000 y 2004 hemos valorado el crecimiento en una poblacion caucasica espanola procedente de Andalucia, Barcelona, Bilbao y Zaragoza y hemos comparado los resultados con estudios espanoles realizados antes de 1988 en poblaciones caucasicas de Bilbao (BIB 88) y Cataluna (CAT 87). Sujetos y metodos Estudio transversal que valora el peso, la longitud y el indice de masa corporal (IMC) en 32.064 sujetos (16.607 varones y 15.457 mujeres) desde el nacimiento a la talla adulta: a) 5.796 son recien nacidos a termino (2.974 varones y 2.822 mujeres) hijos de madres sanas, de gestaciones unicas; b) 23.701 son ninos y adolescentes (12.358 varones y 11.343 mujeres) de 0,25 a 18 anos de edad ambos inclusive, y c) 2.567 son adultos jovenes (1.275 varones y 1.292 mujeres) de 18,1 a 24 anos de edad. Todos estaban sanos, eran de raza caucasica y sus padres, de origen espanol. La distribucion percentilada, el valor z-score y el diseno de las graficas se ha realizado segun el metodo LMS. Resultados Se expresan los valores de la media, desviacion estandar, coeficiente de Skewness y percentiles desde el nacimiento a la edad adulta, en intervalos de 0,25-0,50 anos. Existe un dimorfismo sexual y un incremento en los valores de peso y talla de todos los percentiles respecto a los estudios BIB 88 y CAT 87. Los valores de los percentiles 3, 50 y 97 de la talla adulta son superiores en 1,8, 1,4 y 3,3 cm respecto a BIB 88, y en 2,5, 3,3 y 3,8 cm respecto a CAT 87 en los varones, y 3,5, 2,5 y 4,2 cm respecto a BIB 88 y 3,5, 3,1 y 3,9 cm respecto a CAT 87 en las mujeres. Los correspondientes valores de peso son 5,4, 6,2 y 11,7 kg superiores a los de BIB 88 y 6,7, 6,3 y 10,1 kg superiores a los de CAT 87 en los varones y 1,7, 2,2 y 8,3 kg superiores a los de BIB 88, y 1,8, 2,4 y 3,6 kg superiores CAT 87 en las mujeres. Los respectivos incrementos en el IMC son 2,0, 1,4 y 3,9 respecto a BIB 88 y 0,1, 0,2 y 5,3 respecto a CAT 87 en los varones y 0,9, 0,4 y 3,7 respecto a BIB 88 y 1,8, 0,1 y 4,0 respecto a CAT 87, en las mujeres. Los valores del IMC de 25 y 30 en la edad adulta corresponden a los percentiles 80 y 97 en los varones y 85 y 97 en las mujeres. En ambos sexos los valores de la talla media adulta son similares a los observados en otros estudios longitudinales y transversales espanoles recientes y a los observados en estudios europeos y americanos, aunque inferiores a los de la poblacion alemana, sueca y holandesa. Conclusiones Con relacion a estudios espanoles previos, existe una aceleracion secular de peso y talla, con un incremento desproporcionado en los valores del IMC correspondientes al percentil 75 o superiores, y de forma marcada en los del percentil 97. Este estudio muestra la necesidad de actualizar periodicamente los datos de referencia utilizados en la valoracion del crecimiento durante la infancia y adolescencia.

Estudio transversal español de crecimiento 2008. Parte I: valores de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional

Introduccion La edad gestacional, el peso y la longitud al nacer son factores relacionados con la morbilidad y mortalidad en el periodo neonatal y en la vida adulta. Sujetos y metodos Valoracion del peso y la longitud vertice-talon al nacer, en 9.362 recien nacidos vivos de raza caucasica (4.884 varones y 4.478 ninas) y de gestaciones unicas (26-42 semanas de edad gestacional), nacidos entre 1999 y 2002 en el Hospital Materno-Infantil Vall d’Hebron de Barcelona y en el Hospital Materno-Infantil Miguel Servet de Zaragoza. Resultados Valores de la media y desviacion estandar, y distribucion percentilada del peso y de la longitud en los recien nacidos de ambos sexos segun su edad gestacional. Existe un incremento progresivo con la edad gestacional y un dimorfismo sexual a partir de la semana 30 de gestacion con diferencias estadisticamente significativas entre ambos sexos para ambos parametros (p Conclusiones Existe un dimorfismo sexual en el peso y la longitud de los recien nacidos pretermino y a termino. Estos parametros cambian con el tiempo y deben ser revisados periodicamente.

Estudios españoles de crecimiento: Situación actual, utilidad y recomendaciones de uso

The child growth assessment is useful not only for the follow up of children health but also for social purposes, as an indicator of the equity advances in the world. In Spain there has been a long tradition in carrying out growth studies. During the last decade five Spanish research groups have conducted studies among the population of Andalucia, Barcelona, Bilbao, Madrid and Zaragoza. They have combined their data and have produced the «Transversal Spanish Studies 2008 and 2010» and the «Longitudinal Spanish Study 1978/2000». These studies have showed that in Spain the regional differences on growth have disappeared, and that this has had a secular trend in the last decades. The Spanish adult height has approached to other European and American countries, still below some Centre and North European countries. There are some differences between the Spanish growth studies and the multicentric World Health Organization (WHO) growth study. This is due, among other reasons, to the different criteria that are used for the sample selection. In Spain the studies are based on the «population» criteria, whereas the WHO study is based on the «socioeconomic» and «nutritional» criteria. Currently for the Spanish population is appropriate to use, as standard reference, the Spanish multicentric studies, which are the transversal as well as the longitudinal studies. Due to the recent secular trend, it would be convenient to carry out, in the future, prospective transversal growth studies, methodologically homogeneous, representatives of the different Spanish regions, and preferably made every ten to fifteen years.

Physical repercussions of childhood-onset Growth Hormone (GH) deficiency and hGH treatment in adulthood

The aim of this study was to evaluate the physical condition of young adults with childhood-onset growth hormone deficiency (GHD) before and after 6 months of hGH therapy. Ten men and three women, aged 22.3 +/- 3.3 years, previously treated with hGH for 8.6 +/- 4.07 years at a dose of 0.5 IU/kg/week with a minimun of 2.5 years without treatment at the time of study, were studied. Nine patients presented isolated GHD and four patients had combined pituitary hormone deficiencies; they were treated with hGH at a dosage of 0.125 IU/kg/week for the first month and 0.25 IU/kg/week for the following 5 months. The tests performed were: exercise test, heart rate, rating of perceived exertion, blood lactate analysis, jump test and hand grip. Body composition was also analyzed using Holtain Body Analysis. Skinfold thickness was measured at four sites (triceps, biceps, subscapular and suprailiac). After 6 months of treatment a significant increase in lean body mass (42.0 +/- 7.72 to 46.2 +/- 8.01 kg, p = 0.004) and decrease in fat mass (19.6 +/- 10.01 to 16.1 +/- 10.79 kg, p = 0.01) were observed. The initial physical condition of these patients was lower than expected, and improved after treatment with an increase in maximum oxygen consumption from 2.0 +/- 1.2 to 2.33 +/- 0.68 l x min(-1) (p = 0.01). Maximum heart rate increased significantly from 189 +/- 14.8 to 193 +/- 11.7 beats x min(-1) (p = 0.03). No modifications were observed in anaerobic threshold (4 mmol x l(-1)). Only slight, non-significant increases were observed in jump and strength tests. We conclude that a) adults with childhood-onset growth hormone deficiency present a deficient physical condition and lower than expected for age and sex; b) this condition improves after 6 months of treatment, particularly in the aerobic aspect; c) changes observed in strength tests were discrete and of little significance; and d) the increase observed in lean body mass plays an important role in these changes. Further studies investigating GH action on maximum oxygen consumption are required, once its basic mechanism of action has been determined, either in the heart or peripheral factors.

Talla baja idiopática: definición y tratamiento☆

La talla baja es el motivo de consulta mas frecuente en las consultas de endocrinologia pediatrica. Diferentes entidades nosologicas se caracterizan por una disminucion de la velocidad de crecimiento y una talla anormalmente baja. Unas estan bien caracterizadas; otras corresponden a la denominada talla baja idiopatica (TBI). Esta abarca a los ninos que presentan un crecimiento por debajo de –2 DE de los valores de la talla media correspondiente a los ninos de su poblacion de similar edad y sexo, en los que se han descartado las causas conocidas de talla baja. No incluye a aquellos ninos que presentan unicamente un retraso constitucional del crecimiento y el desarrollo. Diferentes ensayos clinicos demuestran la eficacia del tratamiento con hormona de crecimiento (rhGH) para que estos ninos consigan un crecimiento recuperador. Por ello, la TBI debe considerarse como una entidad que se debe tener en cuenta en el diagnostico de un paciente con talla baja y patron de crecimiento anomalo que puede beneficiarse del tratamiento con rhGH.

Phenotypic analysis and growth response to different growth hormone treatment schedules in two siblings with an inactivating mutation in the growth hormone-releasing hormone receptor gene

Mutations in the GHRH receptor (GHRHR) gene (GHRHR) are emerging as a common cause of familial isolated growth hormone deficiency (IGHD) type IB. The use of gonadotropin-releasing hormone (GnRH) analogues has been advocated as a tool to delay puberty in patients with isolated GH deficiency (IGHD), allowing longer time for the beneficial effect of exogenous human GH (hGH) treatment on growth. We describe two male siblings with IGHD due to a homozygous missense GHRHR mutation who, because they were started on hGH therapy at different ages, presented with different height SDS at the onset of puberty and therefore had different predicted target heights. The shorter brother was treated with GnRH analogue plus hGH for 3 years, whereas the other brother received only hGH. Despite different predicted heights at the onset of puberty, they attained similar final heights. We conclude that in patients with IGHD, GnRH analogue treatment should be considered to delay puberty and obtain a maximal growth response if hGH treatment is started in late childhood and the predicted height at puberty onset is below the genetic target.

Artículo especialEstudios españoles de crecimiento: situación actual, utilidad y recomendaciones de usoGrowth spanish studies: the current situation, their effectiveness and recommendations for their use

The child growth assessment is useful not only for the follow up of children health but also for social purposes, as an indicator of the equity advances in the world. In Spain there has been a long tradition in carrying out growth studies. During the last decade five Spanish research groups have conducted studies among the population of Andalucia, Barcelona, Bilbao, Madrid and Zaragoza. They have combined their data and have produced the «Transversal Spanish Studies 2008 and 2010» and the «Longitudinal Spanish Study 1978/2000». These studies have showed that in Spain the regional differences on growth have disappeared, and that this has had a secular trend in the last decades. The Spanish adult height has approached to other European and American countries, still below some Centre and North European countries. There are some differences between the Spanish growth studies and the multicentric World Health Organization (WHO) growth study. This is due, among other reasons, to the different criteria that are used for the sample selection. In Spain the studies are based on the «population» criteria, whereas the WHO study is based on the «socioeconomic» and «nutritional» criteria. Currently for the Spanish population is appropriate to use, as standard reference, the Spanish multicentric studies, which are the transversal as well as the longitudinal studies. Due to the recent secular trend, it would be convenient to carry out, in the future, prospective transversal growth studies, methodologically homogeneous, representatives of the different Spanish regions, and preferably made every ten to fifteen years.