Post by kickingfrog on Mar 2, 2012 9:31:25 GMT
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J Pediatr Endocrinol Metab. 2005 Aug;18(8):769-75.
Growth and adult height in atypical coeliac patients, with or without growth hormone deficiency.
Salardi S, Cacciari E, Volta U, Santoni R, Ragni L, Elleri D, Cicognani A, Vaira D.
SourceDepartment of Pediatrics, University of Bologna, Bologna, Italy. salardi@med.unibo.it
Abstract
OBJECTIVE: To evaluate the effect of a gluten-free diet on growth and adult height, when available, in coeliac children without gastrointestinal symptoms.
PATIENTS AND METHODS: Sixty-one coeliac children without gastro-intestinal symptoms were included in the study.
The age at diagnosis was 9.50 +/- 3.3 years.
Thirty-eight had short stature at diagnosis (< 10th percentile) and 23 had normal stature.
Thirty-seven reached adult height.
RESULTS: After beginning the diet an increase in growth velocity was seen in 30 patients (responders) (20 with initial short stature), while in 31 patients (18 with short stature) there was no catch-up growth (non-responders).
Bone age at diagnosis was significantly more delayed in the responders than in the non-responders.
Target height was significantly higher in children with normal stature at diagnosis than those with short stature.
Growth hormone (GH) deficiency was found and confirmed after 6-12 months of diet in 12 of the 38 patients (32%) with short stature.
In the group of the 30 'short' patients who attained final height, target height was attained or improved in 12 patients (40%): in eight of the 16 (50%) responders and in four of the 14 (29%) non-responders; in eight (all responders) out of 22 (36%) without GH deficiency, and in four out of eight (50%) patients with GH deficiency treated with GH (all non-responders).
CONCLUSIONS: In children in whom coeliac disease is diagnosed because of short stature, a gluten-free diet will be successful if at diagnosis there is a delay of bone age and in the first year of diet there is an evident catch-up growth.
When this does not occur, i.e. in half of the patients (18 out of 38), it may be because of an associated and transient GH deficiency. In these patients a period of GH replacement therapy as well as a gluten-free diet may improve their final height
***********************
Catch-up growth in children with late-diagnosed coeliac disease
A. K. Patwari1*, Gaurav Kapur1, L. Satyanarayana2, V. K. Anand1, Amit Jain1, Ashutosh Gangil1
and Bharat Balani1
1Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Lady Hardinge Medical College & Associated Kalawati
Saran Children’s Hospital, New Delhi, India
2Division of Epidemiology and Biostatistics, Institute of Cytology and Preventive Oncology (ICMR), NOIDA (UP), India
(Received 4 May 2004 – Revised 25 February 2005 – Accepted 1 March 2005)
Anthropometric parameters and catch-up growth were prospectively evaluated in fifty late-diagnosed children with coeliac disease aged 2·25–10 years after 1–4
years of adhering to a strict gluten-free diet (GFD). The anthropometric parameters were expressed as Z scores relative to National Centre for Health Statistics
standards using Epi Info 2000 (weight-for-height Z score (WHZ) and height-for-age Z score (HAZ)). Catch-up growth was evaluated by repeated measures.
ANOVA,overall significance by anF test and pair-wise comparisons for estimated marginal means using the least significant difference. At the time of enrolment,
no significant difference was observed in WHZ and HAZ between children diagnosed before (group 1) or after (group 2) 4 years of age. On follow-up, HAZ was
significantly higher in group 1 after the first and third years of theGFD(P¼0·04 and 0·02, respectively), with a non-significant increase after completing 4 years of
the GFD (P¼0·22).
Feeding the GFD resulted in an overall significant (F¼3·99, P¼0·011) increase in HAZ up to 4 years of follow-up. However, the catch-up in
height was incomplete, with stunting in sixteen (55·4 %) of twenty-nine children after 3 years and in seven (46·6 %) of fifteen children after 4 years on the GFD.
Pair-wise comparisons demonstrated a linear catch-up growth during the initial follow-up on GFD. Treatment with the GFD did not result in an overall significant
increase in WHZ up to 4 years of follow-up (F¼1·01, P¼0·42). Our results suggest that, in children with late-diagnosed coeliac disease, treatment with a GFD
leads to a normalisation of body mass and a significant but incomplete recovery in HAZ during 4 years of follow-up.
******************************
Gluten-Free Diet on Growth and Small-Bowel Histology: Discussion
Dr Surender K Yachha, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. Email: skyachha@sgpgi.ac.in .
J Gastroenterol Hepatol. 2007;22(8):1300-1305. © 2007 Blackwell Publishing
...In a study of 60 children with CD complete catch-up growth was documented, and at a follow up of 5.2 years the HSDS had improved from -1.32 ± 1.14 to 0.14 ± 1.18 with only 2% continuing to have a HSDS of <-2;[14] but this study is different from the present study in several ways.
First, 85% of their subjects were diagnosed within 12 months of being symptomatic and their median age at diagnosis was 1.25 years.
This is in contrast to our patients who were diagnosed with CD at 8 years after having symptoms for nearly 6 years.
Second, only 30% of their patients had a HSDS of <-2 at diagnosis in contrast to 76% in our group. This shows that our subjects had suffered more prolonged damage both to the intestinal mucosa and in terms of growth retardation.
Incomplete catch up of height has been reported in 4/12 children with CD who were diagnosed after 5 years of age,[15] which supports our findings.
In another study of 26 children with CD followed up for 15.3 years the mean HSDS changed from -1.5 to -1 after 3 years of follow up, and in both sexes the growth pattern was below the 50th percentile.[16]
In our study at final follow up height for age ranged from 5th to 97th percentile in 76% (19/25) cases.
The remaining 24% (n = 6) of children were below the 5th percentile with WfH > 90% implying achievement of normal nutritional status without crossover to lowest normal frame of height curve. Subsequent to appropriate corrective measures children with growth retardation show more rapid gain in height velocity compared with the usual pattern.
As the children approach the normal growth-curve percentiles, the accelerated phase of height increase slows down.[14] A similar trend was observed in our study.
We have shown that height velocities during the first year of GFD were higher (mean 13.9, range 2.5-34 cm/year) compared with that of subsequent years of follow up (mean 5.6, range 1-20 cm/year).
In our patients with CD, a substantial improvement in nutritional status was observed following introduction of GFD; 60% of cases had undernutrition at diagnosis and by the end of follow up only 16% had undernutrition.
In the study of Damen et al. (n = 60), 19% of patients with CD at diagnosis were undernourished (WfH < 85%) and all achieved normal nutritional status at the end of follow up.[14] Again this study cannot be strictly compared to our group due to several differences as cited above for HSDS, in addition to the very low prevalence of undernutrition at diagnosis (16% in Damen et al.) compared with 60% in our cases....
************************
J Pediatr Endocrinol Metab. 2005 Aug;18(8):769-75.
Growth and adult height in atypical coeliac patients, with or without growth hormone deficiency.
Salardi S, Cacciari E, Volta U, Santoni R, Ragni L, Elleri D, Cicognani A, Vaira D.
SourceDepartment of Pediatrics, University of Bologna, Bologna, Italy. salardi@med.unibo.it
Abstract
OBJECTIVE: To evaluate the effect of a gluten-free diet on growth and adult height, when available, in coeliac children without gastrointestinal symptoms.
PATIENTS AND METHODS: Sixty-one coeliac children without gastro-intestinal symptoms were included in the study.
The age at diagnosis was 9.50 +/- 3.3 years.
Thirty-eight had short stature at diagnosis (< 10th percentile) and 23 had normal stature.
Thirty-seven reached adult height.
RESULTS: After beginning the diet an increase in growth velocity was seen in 30 patients (responders) (20 with initial short stature), while in 31 patients (18 with short stature) there was no catch-up growth (non-responders).
Bone age at diagnosis was significantly more delayed in the responders than in the non-responders.
Target height was significantly higher in children with normal stature at diagnosis than those with short stature.
Growth hormone (GH) deficiency was found and confirmed after 6-12 months of diet in 12 of the 38 patients (32%) with short stature.
In the group of the 30 'short' patients who attained final height, target height was attained or improved in 12 patients (40%): in eight of the 16 (50%) responders and in four of the 14 (29%) non-responders; in eight (all responders) out of 22 (36%) without GH deficiency, and in four out of eight (50%) patients with GH deficiency treated with GH (all non-responders).
CONCLUSIONS: In children in whom coeliac disease is diagnosed because of short stature, a gluten-free diet will be successful if at diagnosis there is a delay of bone age and in the first year of diet there is an evident catch-up growth.
When this does not occur, i.e. in half of the patients (18 out of 38), it may be because of an associated and transient GH deficiency. In these patients a period of GH replacement therapy as well as a gluten-free diet may improve their final height
***********************
Catch-up growth in children with late-diagnosed coeliac disease
A. K. Patwari1*, Gaurav Kapur1, L. Satyanarayana2, V. K. Anand1, Amit Jain1, Ashutosh Gangil1
and Bharat Balani1
1Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Lady Hardinge Medical College & Associated Kalawati
Saran Children’s Hospital, New Delhi, India
2Division of Epidemiology and Biostatistics, Institute of Cytology and Preventive Oncology (ICMR), NOIDA (UP), India
(Received 4 May 2004 – Revised 25 February 2005 – Accepted 1 March 2005)
Anthropometric parameters and catch-up growth were prospectively evaluated in fifty late-diagnosed children with coeliac disease aged 2·25–10 years after 1–4
years of adhering to a strict gluten-free diet (GFD). The anthropometric parameters were expressed as Z scores relative to National Centre for Health Statistics
standards using Epi Info 2000 (weight-for-height Z score (WHZ) and height-for-age Z score (HAZ)). Catch-up growth was evaluated by repeated measures.
ANOVA,overall significance by anF test and pair-wise comparisons for estimated marginal means using the least significant difference. At the time of enrolment,
no significant difference was observed in WHZ and HAZ between children diagnosed before (group 1) or after (group 2) 4 years of age. On follow-up, HAZ was
significantly higher in group 1 after the first and third years of theGFD(P¼0·04 and 0·02, respectively), with a non-significant increase after completing 4 years of
the GFD (P¼0·22).
Feeding the GFD resulted in an overall significant (F¼3·99, P¼0·011) increase in HAZ up to 4 years of follow-up. However, the catch-up in
height was incomplete, with stunting in sixteen (55·4 %) of twenty-nine children after 3 years and in seven (46·6 %) of fifteen children after 4 years on the GFD.
Pair-wise comparisons demonstrated a linear catch-up growth during the initial follow-up on GFD. Treatment with the GFD did not result in an overall significant
increase in WHZ up to 4 years of follow-up (F¼1·01, P¼0·42). Our results suggest that, in children with late-diagnosed coeliac disease, treatment with a GFD
leads to a normalisation of body mass and a significant but incomplete recovery in HAZ during 4 years of follow-up.
******************************
Gluten-Free Diet on Growth and Small-Bowel Histology: Discussion
Dr Surender K Yachha, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. Email: skyachha@sgpgi.ac.in .
J Gastroenterol Hepatol. 2007;22(8):1300-1305. © 2007 Blackwell Publishing
...In a study of 60 children with CD complete catch-up growth was documented, and at a follow up of 5.2 years the HSDS had improved from -1.32 ± 1.14 to 0.14 ± 1.18 with only 2% continuing to have a HSDS of <-2;[14] but this study is different from the present study in several ways.
First, 85% of their subjects were diagnosed within 12 months of being symptomatic and their median age at diagnosis was 1.25 years.
This is in contrast to our patients who were diagnosed with CD at 8 years after having symptoms for nearly 6 years.
Second, only 30% of their patients had a HSDS of <-2 at diagnosis in contrast to 76% in our group. This shows that our subjects had suffered more prolonged damage both to the intestinal mucosa and in terms of growth retardation.
Incomplete catch up of height has been reported in 4/12 children with CD who were diagnosed after 5 years of age,[15] which supports our findings.
In another study of 26 children with CD followed up for 15.3 years the mean HSDS changed from -1.5 to -1 after 3 years of follow up, and in both sexes the growth pattern was below the 50th percentile.[16]
In our study at final follow up height for age ranged from 5th to 97th percentile in 76% (19/25) cases.
The remaining 24% (n = 6) of children were below the 5th percentile with WfH > 90% implying achievement of normal nutritional status without crossover to lowest normal frame of height curve. Subsequent to appropriate corrective measures children with growth retardation show more rapid gain in height velocity compared with the usual pattern.
As the children approach the normal growth-curve percentiles, the accelerated phase of height increase slows down.[14] A similar trend was observed in our study.
We have shown that height velocities during the first year of GFD were higher (mean 13.9, range 2.5-34 cm/year) compared with that of subsequent years of follow up (mean 5.6, range 1-20 cm/year).
In our patients with CD, a substantial improvement in nutritional status was observed following introduction of GFD; 60% of cases had undernutrition at diagnosis and by the end of follow up only 16% had undernutrition.
In the study of Damen et al. (n = 60), 19% of patients with CD at diagnosis were undernourished (WfH < 85%) and all achieved normal nutritional status at the end of follow up.[14] Again this study cannot be strictly compared to our group due to several differences as cited above for HSDS, in addition to the very low prevalence of undernutrition at diagnosis (16% in Damen et al.) compared with 60% in our cases....
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