Wioleta Umławska

Growth retardation and delayed puberty in children and adolescents with juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common joint disorder in developing children. Juvenile idiopathic arthritis is difficult to diagnose and treat. In some patients, signs and symptoms can be frustratingly inconsistent, contradictory or idiosyncratic. Short stature in patients with JIA is usually due to reduced growth in the lower extremities, and only rarely due to reduced growth in the spinal column. In some studies, children with JIA were found to have infantile body proportions. Puberty is delayed in children with JIA. In children with chronic arthritic disorders, there is a strong correlation between the activity of the disease and the age of puberty. The main goals in reducing growth retardation in children with JIA are promoting timely remission and reducing the duration and dosage of corticosteroid treatment. It is important to regularly monitor physical development. Further improvements to the treatment protocol depend on continued interdisciplinary research involving paediatricians, rheumatologists and clinical anthropologists.

Growth and nutritional status in children and adolescents with cystic fibrosis

Background: Growth retardation, delayed puberty and malnutrition are frequently observed in children suffering from cystic fibrosis. Aim: The aim of this study was to estimate growth and nutritional status in children with cystic fibrosis on the basis of body proportions and body mass index. Subjects and methods: Anthropometric data were collected from the medical histories of 62 patients treated in three cystic fibrosis treatment centers in Poland. Anthropometric parameters were expressed in terms of standard deviations away from age-specific and sex-specific reference means reported for the population of Poland. Two-way analysis of variance was used to determine whether the type of cystic fibrosis transmembrane conductance regulator (CFTR) mutation is correlated with age at the time of diagnosis and with body proportions. Results: The type of mutation was significantly correlated with height, weight and transverse chest width. Growth retardation was greater in subjects diagnosed before they were 3 years old than in subjects diagnosed later. The children had infantile body proportions. Their legs were short and their trunks were long in comparison to their height. Almost 40% of the subjects suffered from malnourishment. Conclusion: Further study is needed to determine how growth in children with cystic fibrosis is affected by clinical practice and socio-economic factors.

Physical development in children and adolescents with bronchial asthma

Bronchial asthma is the most common chronic disease in children of developmental age. Data from the auxological literature indicate that children with disturbances in growth may also suffer from atopic disorders. The aim of the present study was to evaluate somatic growth in children with bronchial asthma using anthropological methods. The study was carried out using anthropometric measurements and information on the severity and course of the disease on 261 children with bronchial asthma. Mean body height was lower than in healthy peers and about 5% of subjects were short. Mean BMI and skinfold thicknesses were significantly higher and lean body mass was lower in the study group. Seventeen percent of the children were overweight or obese, and 8% were underweight. Body build was more robust in the girls examined. Longitudinal studies will help determine to what degree the disease itself directly affects physical development, and to what degree treatment does.

Adipose tissue content and distribution in children and adolescents with bronchial asthma.

BACKGROUND The excess of adipose tissue and the pattern of adipose tissue distribution in the body seem to play an important role in the complicated dependencies between obesity and risk of developing asthma. The aim of the present study was to determine nutritional status in children and adolescents with bronchial asthma with special emphasis on adipose tissue distribution evaluated on the basis of skin-fold thicknesses, and to determine the relationships between patterns of adipose tissue distribution and the course of the disease. METHODS Anthropometric data on height, weight, circumferences and skin-fold thicknesses were extracted from the medical histories of 261 children diagnosed with asthma bronchitis. Values for children with asthma were compared to Polish national growth reference charts. Distribution of subcutaneous adipose tissue was evaluated using principal components analysis (PCA). Multivariate linear regression analyses tested the effect of three factors on subcutaneous adipose tissue distribution: type of asthma, the severity of the disease and the duration of the disease. RESULTS Mean body height in the children examined in this study was lower than in their healthy peers. Mean BMI and skin-fold thicknesses were significantly higher and lean body mass was lower in the study group. Excess body fat was noted, especially in girls. Adipose tissue was preferentially deposited in the trunk in girls with severe asthma, as well as in those who had been suffering from asthma for a longer time. The type of asthma, atopic or non-atopic, had no observable effect on subcutaneous adipose tissue distribution in children examined. CONCLUSIONS The data suggest that long-treated subjects and those with severe bronchial asthma accumulate more adipose tissue on the trunk. It is important to regularly monitor nutritional status in children with asthma, especially in those receiving high doses of systemic or inhaled glucocorticosteroids, and long-term treatment as well.

Evaluation of factors related to bone disease in Polish children and adolescents with cystic fibrosis

PURPOSE The aim of the study was to evaluate factors related to bone formation and resorption in Polish children and adolescents with cystic fibrosis and to examine the effect of nutritional status, biochemical parameters and clinical status on bone mineral density. MATERIALS AND METHODS The study group consisted of 100 children and adolescents with cystic fibrosis with a mean age 13.4 years old. Anthropometric measurements, included body height, body mass and body mass index (BMI); bone mineral densitometry and biochemical testing were performed. Bone mineral density was measured using a dual-energy X-ray absorption densitometer. Biochemical tests included serum calcium, phosphorus, parathyroid hormone and vitamin D concentrations, as well as 24-h urine calcium and phosphorus excretion. Pulmonary function was evaluated using FEV1%, and clinical status was estimated using the Shwachman-Kulczycki score. RESULTS Standardized body height, body mass and BMI were significantly lower than in the reference population. Mean serum vitamin D concentration was decreased. Pulmonary disease was generally mild, with a mean FEV1% of 81%. Multivariate linear regression revealed that the only factors that had a significant effect on bone marrow density were BMI and FEV1%. There were no significant correlations between bone mineral density and the results of any of the biochemical tests performed. CONCLUSIONS Nutritional status and bone mineral density were significantly decreased in children and adolescents with cystic fibrosis. In spite of abnormalities in biochemical testing, the factors that were found to have the strongest effect on bone mineral density were standardized BMI and clinical status.

Growth and development of children and youth with impairment of sight

Abstract1.Analysed children and youth with impairments of sight in comparison to normal peers indicated a deficit in height and weight.2.Blind children are shorter than partially sighted children.3.The girls with impairments of sight matured earlier then their peers from Wroclaw. More severe the impairment of sight is, earlier the age at menarche4.The girls with acquired defects (in 80% preterm borns), though the shortest, matured the earliest from all studied girls. The age at menarche is a feature more likely to be influenced by the impairment factor and the severity impairment of sight than somatic features.

A cross-sectional study of growth, nutritional status and body proportions in children and adolescents at a medical center specializing in the treatment of cystic fibrosis in Poland

Introduction Malnutrition, delayed growth and delayed puberty are commonly seen in children with cystic fibrosis. The aim of this study was to evaluate growth, nutritional status and body proportions in children and adolescents suffering from cystic fibrosis. Material and methods The evaluation was based on 19 somatic measurements and indices calculated from these measurements. Somatic development was evaluated in relation to several factors connected to the clinical picture or the course of the disease. Anthropometric data were extracted from the medical histories of 41 boys and 48 girls diagnosed and treated at the Institute of Mother and Child in Warsaw (Poland). Mean values for somatic parameters and body build indices for the children suffering from CF were compared to those for the reference group. Results The results revealed that growth in these children was significantly delayed in comparison to that seen in the healthy population (Z-score = –0.56, p < 0.001). Nutritional status was also adversely affected (Z-score = –0.85, p < 0.001). The children suffered more from a deficit in muscularity than in adiposity (Z-score = –0.75 and Z-score = –0.34, p < 0.01, respectively). This was especially true for boys. The children had infantile body proportions and defects in trunk and chest structure. Conclusions The factors that most affected somatic development were infection by Pseudomonas aeruginosa and the time at which the disease was diagnosed. Chronic infection by P. aeruginosa and type of CFTR mutation were the factors that most affected pulmonary function parameters.

Growth, Nutritional Status, and Pulmonary Function in Children with Chronic Recurrent Bronchitis.

Bronchitis is a common health problem in children. Frequent bronchitis in infancy increases the risk of developing chronic respiratory diseases. The aim of the study was to assess the level of growth and the nutritional status in children and youths with special regard to the level of body fatness assessed by measuring skin-fold thickness. Relationships between somatic development, pulmonary function and the course of the disease were also explored. The study was carried out using anthropometric and spirometric measurements and also information on the severity and course of the disease in 141 children with chronic or recurrent bronchitis. All of the subjects were patients of the Pulmonary Medicine and Allergology Center in Karpacz, Poland. The mean body height did not differ significantly between the children examined and their healthy peers. However, the infection-prone children had excessive body fatness and muscle mass deficiency. The increased level of subcutaneous adipose tissue occurred especially in children with short duration of the disease, i.e. a maximum of 1 year. The functional lung parameters were generally normal. The presence of atopic diseases such as allergic rhinitis or atopic dermatitis did not impair the course of the childrens somatic development. Also, long-term disease or the presence of additional allergic diseases did not impair lung function in the examined children. Taking appropriate preventive measures is recommended to achieve and maintain normal body weight in children who receive therapy due to bronchitis.

Physical growth of preterm girls with visual impairment

Physical growth of preterm girls with visual impairment The aim of this study was to estimate pubertal age and to assess the level of physical development of preterm girls with defective vision. The study material - anthropometric data (body height and weight, BMI) and information on the age of menarche were collected from 155 subjects with defective vision (partially sighted and blind). Median age at menarche was estimated by probit analysis. The girls, ranging in age from 7-18 years, attended Centers for Blind and Partially Sighted Children in Wroclaw and Cracow (Poland). 22% of the subjects were prematurely born, were born with low birth mass and their sight defect diagnosed as retinopathy due to prematurity (ROP). The girls with ophthalmic impairments were shorter and lighter than their age peers from the reference data. Blind girls reached pubertal age 2 months earlier than the partially sighted (Me=13.31 and Me=13.44) and, the preterm subjects entered puberty 6 months earlier than the full-term girls, irrespective of degree of defect (Me=12.93 and Me=13.42, respectively). The results suggest that earlier puberty is associated with visual impairment. The results show also that irrespective of the degree of defect, preterm girls reach menarche significantly earlier than those who were full-term. It seems possible that mechanisms responsible for earlier puberty in the preterm subjects and with low body mass play an important a role in sexual maturation in girls with sight dysfunction. There appears to be a need to pursue further studies in this sphere. Celem opracowania była ocena poziomu rozwoju fizycznego dziewcząt z dysfunkcją narządu wzroku urodzonych przedwcześnie. Badania dotyczyły 155 osób dziewcząt w wieku 7-18 lat będących uczennicami Ośrodków Szkolno-Wychowawczych Dzieci Niewidomych we Wrocławiu i w Krakowie. Pośród badanych 37% stanowiły osoby niewidome, a 63% osoby niedowidzące. Wykonano pomiary wysokości i masy ciała oraz obliczono wskaźnik masy ciała BMI. Wiek menarche ustalono metodą status quo, pytając badane dziewczęta o obecność lub brak miesiączki. Wśród badanych, 22% stanowiły dziewczęta urodzone przedwcześnie (między 26 a 35 tygodniem ciąży), przebywające po porodzie w inkubatorze, a ich wada wzroku była następstwem retinopatii wcześniaków. Dane pomiarowe poddano zabiegowi standaryzacji względem grupy referencyjnej. W obliczeniach wykorzystano test t-Studenta, test Wilcoxona według Gehana oraz test χ2. Dziewczęta z wadami wzroku okazały się istotnie statystycznie niższe i lżejsze od swoich widzących rówieśniczek z grupy porównawczej. Odchylenia in minus były większe w przypadku wysokości ciała aniżeli masy ciała, dziewczęta z dysfunkcją narządu wzroku cechowała więc bardziej krępa budowa ciała (tab. 2). Nie zaobserwowano istotnych statystycznie różnic w wartościach rozpatrywanych cech pomiędzy dziewczętami urodzonymi przedwcześnie i w prawidłowym terminie (tab. 5). średni wiek menarche badanych wyniósł 13,35±1,95. Dziewczęta niewidome miesiączkowały prawie 2 miesiące przed niedowidzącymi (odpowiednio 13,31 i 13,44 lat), zaś urodzone przedwcześnie - 6 miesięcy przed urodzonymi w terminie (12,93 i 13,42 lat) (tab. 3, 4). Redukcja okresu prenatalnego w przypadku badanych dziewcząt przyczyniła się do powstania wady wzroku, ale wydaje się, że nie pozostała bez wpływu na ich rozwój postnatalny, a zwłaszcza stosunkowo wczesny wiek pokwitania. Uzyskane wyniki wskazały bowiem, iż niezależnie od stopnia nasilenia wady wzroku, dziewczęta urodzone przedwcześnie miesiączkowały istotnie wcześniej od urodzonych w terminie. Niewykluczone więc, iż mechanizmy związane z wcześniejszym pokwitaniem urodzonych przedwcześnie i z niską urodzeniową masą ciała odgrywają w przypadku dziewcząt z dysfunkcją wzroku równie ważną rolę, jak rozpatrywany zazwyczaj w badaniach, stopień nasilenia wady wzroku.

A Link between Nutritional and Growth States in Pediatric Patients with Functional Gastrointestinal Disorders

Objective To investigate nutritional status and growth status of pediatric patients with functional gastrointestinal disorders (FGIDs) and to examine the relationship between nutritional status and linear growth in these children. Study design In total, 102 pediatric patients diagnosed with functional constipation (FC), irritable bowel syndrome (IBS), or functional abdominal pain (FAP) in years 2013‐2015 were subjected to anthropometric measurements. Anthropometry comprised body height, leg and trunk lengths, body weight, mid‐upper arm circumference, and 3 skinfold thicknesses. Body fat percentage was obtained with bioelectrical impedance analysis. Indices of the nutritional status and body proportions were calculated and adjusted for age and sex. Results Excessive body weight and excessive fatness were the most common in children with IBS. Being underweight was most common in children with FAP, but fat deficiency was similarly frequent in the FAP and in FC groups. Short stature was the most common in children with FC. Children with IBS were the best nourished and the tallest for age and sex due to increased trunk length. Body height and linear body proportions adjusted for age and sex were positively associated with body weight and body fatness in the total sample. Conclusions Children with FGIDs present various linear growth abnormalities that are associated with body weight and body fatness. Although excessive body weight and body fat are common in children with IBS, pediatricians should be aware of the risk of malnutrition in children with other FGIDs.