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1.
The Clinical Spectrum of Resistance to Thyroid Hormone Alpha in Children and Adults.
Erbaş, İM, Demir, K
Journal of clinical research in pediatric endocrinology. 2021;(1):1-14
Abstract
Resistance to thyroid hormone alpha occurs due to pathogenic, heterozygous variants in THRA. The entity was first described in 2012 and to date only a small number of patients with varying severity have been reported. In this review, we summarize and interpret the heterogeneous clinical and laboratory features of all published cases, including ours. Many symptoms and findings are similar to those seen in primary hypothyroidism. However, thyroid-stimulating hormone levels are normal. Free triiodothyronine (T3) levels are in the upper half of normal range or frankly high and free thyroxine (T4) levels are low or in the lower half of normal range. Alterations in free T3 and free T4 may not be remarkable, particularly in adults, possibly contributing to underdiagnosis. In such patients, low reverse T3 levels, normo- or macrocytic anemia or, particularly in children, mildly elevated creatine kinase levels would warrant THRA sequencing. Treatment with L-thyroxine results in improvement of some clinical findings.
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2.
Oesophageal atresia: The growth gap.
Traini, I, Menzies, J, Hughes, J, Leach, ST, Krishnan, U
World journal of gastroenterology. 2020;(12):1262-1272
Abstract
Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia (OA) repair. Few studies have specifically explored the reasons for growth impairment in this complex cohort. The association between poor growth with younger age and fundoplication appears to have the strongest supportive evidence, highlighting the need for early involvement of a dietitian and speech pathologist, and consideration of optimal medical reflux management prior to referring for anti-reflux surgery. However, it remains difficult to reach conclusions regarding other factors which may negatively influence growth, due to conflicting findings, inconsistent definitions and lack of validated tool utilisation. While swallowing and feeding difficulties are particularly frequent in younger children, their relationship with growth remains unclear. It is possible that these morbidities impact on the diet of children with OA, but detailed analysis of dietary composition and quality, and its relationship with these complications and growth, has not yet been conducted. Another potential area of research in OA is the role of the microbiota in growth and nutrition. While the microbiota has been linked to growth impairment in other paediatric conditions, it is yet to be investigated in OA. Further research is needed to identify the most important contributory factors to poor growth, the role of the intestinal microbiota, and effective interventions to maximise growth and nutritional outcomes in this cohort.
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3.
Auxological and endocrinological features in internationally adopted children.
Stagi, S, Papacciuoli, V, Boiro, D, Maggioli, C, Ndambao, NN, Losi, S, Chiappini, E, Toni, S, Ndiaye, O
Italian journal of pediatrics. 2020;(1):82
Abstract
In internationally adopted children disorders of linear growth, puberty development, thyroid function, and bone metabolism are frequently reported. It is important that these children receive careful auxological and endocrinological evaluations and follow-up.Pediatricians and other healthcare providers should be aware that auxological and endocrinological problems are common in newly arrived international adoptees.
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4.
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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5.
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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6.
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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7.
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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8.
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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9.
[Growth retardation in children with chronic renal disease].
Srpski arhiv za celokupno lekarstvo. 2014;(9-10):614-20
Abstract
Despite recent advances in the management of children with chronic renal disease (CRD), growth retardation remains its most visible comorbid condition. Growth retardation has adverse impact on morbidity and mortality rates, quality of life and education, and in adult patients on job family life, and independent leaving accomodation. Pathophysiology of impaired growth in CRD is complex and still not fully understood. The following complications are: anorexia, malnutrition, inflammation, decreased residual renal function, dialysis frequency and adequacy, renal anemia, metabolic acidosis, fluid/electrolyte imbalance, renal osteodistrophy, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) resistance. Malnutrition is most frequent and most important factor contributing to the degree of growth retardation in infancy. The degree of renal dysfunction is the major determinant of variability in growth from third year of age until puberty onset, while in puberty hypergonadotropic hypogonadism has negative effect. The main factors that influence growth after renal transplantation are the age of the recipient and glucocorticoid drugs dosage with negative effect and allograft function with positive effect. In order to improve growth in children with CRD it is necessary to include: diet with optimal caloric intake, correction of fluid/ electrolyte imbalance, correction of acidosis, renal osteodistrophy and anemia. If growth velocity is insufficient to normalize growth, it is necessary to start recombinant human GH (rhGH) therapy at 0.05 mg/kg per day (0.35 mg/kg per week or 28 IU/m2 per week) administered by subcutaneous injection.
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10.
Africa in transition: growth trends in children and implications for nutrition.
Norris, SA, Wrottesley, S, Mohamed, RS, Micklesfield, LK
Annals of nutrition & metabolism. 2014;:8-13
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Abstract
The aims of this paper were to: (1) review the literature and examine contemporary child growth in terms of stunting prevalence across Africa; (2) discuss child stunting within the context of economic growth and adult obesity, and (3) elucidate the implications for child nutrition. It is evident that stunting in under-5-year-old children still plagues Africa and has not decreased as expected in line with the concomitant improvement in economic development over the past decade. Persisting and possibly widening inequality ensures that not all segments of the population, in particular the most vulnerable, benefit equally from economic growth. Of concern is the association between the increasing economic progress across Africa and the rising adult obesity, especially amongst females. More and more African countries are now afflicted with a double burden of malnutrition. The implication for child nutrition is that African countries need not only apply a multisectoral approach to accelerate the reduction in stunting levels, but also to arrest and prevent obesity.