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1.
Repercussions of inborn errors of immunity on growth.
Goudouris, ES, Segundo, GRS, Poli, C
Jornal de pediatria. 2019;:49-58
Abstract
OBJECTIVES This study aimed to review the literature on the repercussions of the different inborn errors of immunity on growth, drawing attention to the diagnosis of this group of diseases in patients with growth disorders, as well as to enable the identification of the different causes of growth disorders in patients with inborn errors of immunity, which can help in their treatment. DATA SOURCES Non-systematic review of the literature, searching articles since 2000 in PubMed with the terms "growth", "growth disorders", "failure to thrive", or "short stature" AND "immunologic deficiency syndromes", "immune deficiency disease", or "immune deficiency" NOT HIV. The Online Mendelian Inheritance in Man (OMIN) database was searched for immunodeficiencies and short stature or failure to thrive. DATA SUMMARY Inborn errors of immunity can affect growth in different ways, and some of them can change growth through multiple simultaneous mechanisms: genetic syndromes; disorders of the osteoarticular system; disorders of the endocrine system; reduction in caloric intake; catabolic processes; loss of nutrients; and inflammatory and/or infectious conditions. CONCLUSIONS The type of inborn errors of immunity allows anticipating what type of growth disorder can be expected. The type of growth disorder can help in the diagnosis of clinical conditions related to inborn errors of immunity. In many inborn errors of immunity, the causes of poor growth are mixed, involving more than one factor. In many cases, impaired growth can be adjusted with proper inborn errors of immunity treatment or proper approach to the mechanism of growth impairment.
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2.
Environmental enteric dysfunction and child stunting.
Budge, S, Parker, AH, Hutchings, PT, Garbutt, C
Nutrition reviews. 2019;(4):240-253
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Abstract
In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.
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Biomarkers of GH action in children and adults.
Schilbach, K, Olsson, DS, Boguszewski, MCS, Bidlingmaier, M, Johannsson, G, Jørgensen, JL
Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society. 2018;:1-8
Abstract
Growth hormone (GH) and IGF-I levels in serum are used as biomarkers in the diagnosis and management of GH-related disorders but have not been subject to structured validation. Auxological parameters in children and changes in body composition in adults, as well as metabolic parameters and patient related outcomes are used as clinical and surrogate endpoints. New treatment options, such as long acting GH and GH antagonists, require reevaluation of the currently used biochemical biomarkers. This article will review biomarkers, surrogate endpoints and clinical endpoints related to GH treatment in children and adults as well as in acromegaly.
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Nutritional status and dietary intakes of children amid the nutrition transition: the case of the Eastern Mediterranean Region.
Nasreddine, LM, Kassis, AN, Ayoub, JJ, Naja, FA, Hwalla, NC
Nutrition research (New York, N.Y.). 2018;:12-27
Abstract
The Eastern Mediterranean Region (EMR) is undergoing social and economic changes that may impact the nutritional status of children living in its countries. The objective of this review is to evaluate the nutritional status and dietary intakes of children (0-12 years) in selected EMR countries, namely, Jordan, Lebanon, Kingdom of Saudi Arabia (KSA), and the United Arab Emirates. MedLine, PubMed, Scopus, and Google Scholar were searched for relevant articles published between 1990 and 2016; international organizations and governmental websites were also searched. Stunting in the region was estimated at 7.3% to 9.3%, wasting at 1.1% to 11.8%, and underweight at 1.6% to 5.3%. In contrast, overweight and obesity affected 19% to 21% of school-aged children from Lebanon and KSA. Available biochemical data showed that pediatric anemia, vitamin A, and vitamin D deficiencies remain a challenge in the region. Dietary intake studies have identified inadequate intakes of iron, calcium, zinc, folic acid, vitamin A, and vitamin D, concurrently with high intakes of fat, saturated fat, and sugar. This review provides valuable insight into the nutrition situation of children in 2 major areas of the EMR, the Levant and the Gulf, and identified several gaps and challenges in existing nutritional assessment studies. Key issues include the triple burden of malnutrition in this age group (underweight, nutrient inadequacies, and overweight/obesity), while calling for integrated action to improve the nutritional status of children in countries of the region. Opportunities for future research include nationwide nutritional and dietary surveys in countries where the largest data gaps remain such as the United Arab Emirates and KSA.
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5.
Genetic causes of proportionate short stature.
Argente, J, Pérez-Jurado, LA
Best practice & research. Clinical endocrinology & metabolism. 2018;(4):499-522
Abstract
Human growth is a very complex phenomenon influenced by genetic, hormonal, nutritional and environmental factors, from fetal life to puberty. Although the GH-IGF axis has a central role with specific actions on growth, numerous genes are involved in the control of stature. Genome-wide association studies have identified >600 variants associated with human height, still explaining only a small fraction of phenotypic variation. Since short stature in childhood is a common reason for referral, pediatric endocrinologists must be aware of the multifactorial and polygenic contributions to height. Multiple disorders characterized by growth failure of prenatal and/or postnatal onset due to single gene defects have been described. Their early diagnosis, facilitated by advances in genomic technologies, is of upmost importance for their clinical management and to provide genetic counseling. Here we review the current clinical and genetic information regarding different syndromes and hormone abnormalities with proportionate short stature as the main feature, and provide an update of the approach for diagnosis and management.
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6.
Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review.
Hossain, M, Choudhury, N, Adib Binte Abdullah, K, Mondal, P, Jackson, AA, Walson, J, Ahmed, T
Archives of disease in childhood. 2017;(10):903-909
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Abstract
OBJECTIVE We systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs). METHODS Electronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings. FINDINGS Fourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed. INTERPRETATION For all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance. PROSPERO REGISTRATION NUMBER CRD42016043772.
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Vitamin D across growth hormone (GH) disorders: From GH deficiency to GH excess.
Ciresi, A, Giordano, C
Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society. 2017;:35-42
Abstract
The interplay between vitamin D and the growth hormone (GH)/insulin-like growth factor (IGF)-I system is very complex and to date it is not fully understood. GH directly regulates renal 1 alpha-hydroxylase activity, although the action of GH in modulating vitamin D metabolism may also be IGF-I mediated. On the other hand, vitamin D increases circulating IGF-I and the vitamin D deficiency should be normalized before measurement of IGF-I concentrations to obtain reliable and unbiased IGF-I values. Indeed, linear growth after treatment of nutritional vitamin D deficiency seems to be mediated through activation of the GH/IGF-I axis and it suggests an important role of vitamin D as a link between the proliferating cartilage cells of the growth plate and GH/IGF-I secretion. Vitamin D levels are commonly lower in patients with GH deficiency (GHD) than in controls, with a variable prevalence of insufficiency or deficiency, and this condition may worsen the already known cardiovascular and metabolic risk of GHD, although this finding is not common to all studies. In addition, data on the impact of GH treatment on vitamin D levels in GHD patients are quite conflicting. Conversely, in active acromegaly, a condition characterized by a chronic GH excess, both increased and decreased vitamin D levels have been highlighted, and the interplay between vitamin D and the GH/IGF-I axis becomes even more complicated when we consider the acromegaly treatment, both medical and surgical. The current review summarizes the available data on vitamin D in the main disorders of the GH/IGF-I axis, providing an overview of the current state of the art.
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Prevalence of stunting and overweight/obesity among Brazilian children according to different epidemiological scenarios: systematic review and meta-analysis.
Sousa, CP, Olinda, RA, Pedraza, DF
Sao Paulo medical journal = Revista paulista de medicina. 2016;(3):251-62
Abstract
CONTEXT AND OBJECTIVE Within the Brazilian nutritional panorama, coexistence of antagonistic nutritional disorders can be seen, especially the increasing prevalence of overweight and the persistence of significant rates of chronic malnutrition in vulnerable groups of the population. Because these are major public health problems, this study aimed to ascertain the prevalence of stunting and overweight/obesity among Brazilian children according to different epidemiological scenarios. DESIGN AND SETTING This was a systematic review of prevalence studies, developed at the State University of Paraíba. METHODS The SciELO, Lilacs and PubMed databases were searched for articles, using specific keywords. Articles published between 2006 and 2014 were selected. The review was conducted by two reviewers who worked independently. A systematic review with meta-analysis was conducted, for which the studies were grouped within different epidemiological settings. RESULTS Among the 33 articles recovered, 9 involved samples from daycare centers, 4 had samples from public healthcare services or social registers, 5 related to populations in situations of social inequity and 15 were population-based. Higher chances of stunting were found in populations in situations of social inequity and in those at public healthcare services or on social registers, in relation to reference populations. For overweight/obesity, none of the scenarios had a higher chance than the reference. CONCLUSION Among Brazilian children, stunting continues to be a socially determined public health problem that mainly affects marginalized populations. This problem coexists with significant rates of overweight/obesity affecting all social groups.
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Growth monitoring as an early detection tool: a systematic review.
Scherdel, P, Dunkel, L, van Dommelen, P, Goulet, O, Salaün, JF, Brauner, R, Heude, B, Chalumeau, M
The lancet. Diabetes & endocrinology. 2016;(5):447-56
Abstract
Growth monitoring of apparently healthy children aims at early detection of serious underlying disorders. However, existing growth-monitoring practices are mainly based on suboptimal methods, which can result in delayed diagnosis of severe diseases and inappropriate referrals. We did a systematic review to address two key and interconnected questions underlying growth monitoring: which conditions should be targeted, and how should abnormal growth be defined? We systematically searched for studies reporting algorithms for growth monitoring in children and studies comparing the performance of new WHO growth charts with that of other growth charts. Among 1556 identified citations, 69 met the inclusion criteria. Six target conditions have mainly been studied: Turner syndrome, coeliac disease, cystic fibrosis, growth hormone deficiency, renal tubular acidosis, and small for gestational age with no catch-up after 2 or 3 years. Seven algorithms to define abnormal growth have been proposed in the past 20 years, but their level of validation is low, and their overall sensitivities and specificities vary substantially; however, the Grote and Saari clinical decision rules seem the most promising. Two studies reported that WHO growth charts had poorer performance compared with other existing growth charts for early detection of target conditions. Available data suggest a large gap between the widespread implementation of growth monitoring and its level of evidence or the clinical implications of early detection of serious disorders in children. Further investigations are needed to standardise the practice of growth monitoring, with a consensus on a few priority target conditions and with internationally validated clinical decision rules to define abnormal growth, including the selection of appropriate growth charts.
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10.
Helicobacter pylori Infection and Children's Growth: An Overview.
Dror, G, Muhsen, K
Journal of pediatric gastroenterology and nutrition. 2016;(6):e48-59
Abstract
OBJECTIVES Helicobacter pylori infection is acquired in early childhood, yet its role in children's health is still not fully clear. In this narrative review, we focused on the association between H pylori infection and children's growth. METHODS A literature search of the Ovid MEDLINE (till June 2015) and EMBASE (till August 2015) databases was performed using the terms "Helicobacter pylori, growth, body height, growth disorders and child development." Original studies that addressed the association between H pylori infection or eradication and children's growth were reviewed and the risk of bias of each study was assessed. RESULTS The existing evidence is based on observational studies (N = 48) and suggests that H pylori infection may adversely influence children's growth; findings were more consistent across studies with low risk of bias. Regarding linear growth, observational studies have repeatedly linked between H pylori infection and slower or diminished linear growth; yet, it is not known whether this association is causal. The association between H pylori infection and ponderal growth has been less consistent. Scarce evidence exists on the effect of H pylori eradication on children's skeletal growth and weight gain, but there is an indication that H pylori eradication may benefit nutritional status. CONCLUSIONS H pylori infection may impair children's growth. Additional studies, especially clinical trials, are needed to elucidate the role of H pylori eradication in children's growth, and the mechanisms that may be involved in such.