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Growth Assessment
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Julia Driggers, Kanak Verma, Vi Goh
BMI can vary based on age, gender, and pubertal stage and is used as the clinical standard for diagnosing obesity in children 2 years of age and older. BMI is typically normal in children who have constitutional growth delay or familial short stature. A BMI less than the 5th percentile or greater than the 85th percentile may demonstrate that a child is underweight or overweight, respectively. Alternate height measurements should not be used to calculate BMI. Indices of body proportionality are valuable in the assessment of overall nutrition status, and the indices typically used are the ratio of weight to length (typically expressed as a percentile or a z-score) and BMI. Traditionally, weight-for-length z-score is used in children under the age of 2 years and BMI-for-age z-score beyond that age. However, BMI-for-age z-scores are available in children under 2 and can be used with the caveat that inaccuracy in length measurements (that are unfortunately common in infants) can change the BMI-for-age z-score more than it changes the weight-for-length z-score.
Nutrition and Growth
Published in Fima Lifshitz, Childhood Nutrition, 2020
Fima Lifshitz, Melanie M. Smith
In the differential diagnosis of short stature, the further analysis of body weight progression may be necessary to recognize ND11 (Figures 1a, 1b, and 1c). ND and FCC/CGD patients clinically appear similar, presenting with short stature, delayed puberty, bone age retardation, without overt malnutrition or biochemical abnormalities of short stature or malnutrition.10 Calculation of the theoretical weight based on the previous growth pattern may distinguish the poor weight gain of ND (Figure 1a). Theoretical weight is defined as the weight that the patient should have attained at the time of the examination if the patient continued to gain weight at his/her previous rate established during the pre-morbid growth period. A body weight deficit for theoretical weight is characteristic of ND (Figure 1b). On the other hand, adequately nourished short children, i.e., FSS/CGD, usually gain weight along established percentiles, and the theoretical body weight based on the previous growth pattern remains constant (Figure 1c). Thus, weight gain velocity is an important difference between patients with nutritional growth retardation and those with constitutional growth delay.
Endocrinology and diabetes
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
Constitutional growth delay is an important cause, however (this is normal growth until close to 12 months of age that slows afterward, puberty is delayed, adult height will eventually be in the expected range calculated from the parents’ height).
Impact of body mass index on growth hormone stimulation tests in children and adolescents: a systematic review and meta-analysis
Published in Critical Reviews in Clinical Laboratory Sciences, 2021
Ozair Abawi, Dieuwertje Augustijn, Sanne E. Hoeks, Yolanda B. de Rijke, Erica L. T. van den Akker
The search strategy identified 1988 articles in the selected databases after deduplication (Figure 2). In total, 58 articles describing 104 subcohorts of patients met inclusion criteria and were included in this study [24–81]. The main characteristics of included studies are summarized in Table 1 and Supplementary Material 1, Table 1. Forty-eight studies were published between 1967 and 2010; 10 studies were published in the past decade. In total, n = 5135 children were included (median per study 30; IQR 14–77), of which 633 children (12.3%) had obesity without GHD and 2006 children (39.1%) had GHD. The mean age of children at the subcohort level ranged from 7.4–15.9 years, with a weighted mean of 10.2 ± 3.6 years (available for 47 studies, n = 4318 children). The mean BMI SDS at the subcohort level ranged from −0.8 to +4.3, with a weighted mean of 0.13 ± 1.54 (available for 25 studies, n = 2081 children). Out of the 3713 children with information available on pubertal status, 2669 (71.9%) were pre-pubertal. Sex steroid priming was either not performed or not mentioned in all studies except for one in which a subgroup of 5 boys with constitutional growth delay received an intramuscular testosterone injection before GH stimulation testing [46].
Estimating peak height velocity in individuals: a comparison of statistical methods
Published in Annals of Human Biology, 2020
Melanie E. Boeyer, Kevin M. Middleton, Dana L. Duren, Emily V. Leary
The adolescent growth spurt is characterised by one of the most rapid periods of post-natal growth, which is followed closely by epiphyseal fusion and the attainment of final adult height (Bogin 1988; Bogin et al. 2018; Eveleth and Tanner 1990). Over the last several decades, significant progress has been made in the development of statistical methodologies for assessing individual and population average growth in height leading up to and throughout adolescence (Cole 2012; Cole et al. 2010; Preece and Baines 1978). These methods have allowed human biologists and paediatric practitioners to estimate the chronological age at which peak height velocity (aPHV) is attained as well as the rate of growth occurring during peak height velocity (PHV) (e.g. Sanders et al. 2017). Estimates of adolescent ontogenetic parameters are of critical importance, particularly for paediatric practitioners treating children with skeletal growth and/or developmental disorders, including constitutional growth delay (Poyrazoğlu et al. 2005), adolescent idiopathic scoliosis (Busscher et al. 2012; Chazono et al. 2015; Little et al. 2000), or leg length inequality (Green and Anderson 1960; Moseley 1977, 1987). However, the most commonly employed methodologies for predicting aPHV and/or PHV result in large differences in estimates, even when using identical data (Preece and Baines 1978; Simpkin et al. 2017).
Tanner’s tempo of growth in adolescence: recent SITAR insights with the Harpenden Growth Study and ALSPAC
Published in Annals of Human Biology, 2020
This ability of SITAR to identify groups of individuals with early or late APV could be exploited in cohort studies to construct specialist growth references for early and late developers. It could be done for example using all the data for the first and last groups, respectively, of Figures 9 and 10 (n > 4000, Table 5), and fitting growth reference centiles to them using the LMS method (Cole and Green 1992). This would be most useful for the clinical management of constitutional growth delay, where the chart would document the growth pattern of the 11% most delayed normal children. It might also be reassuring to parents to see just how late the growth spurt can be.