Growth curves in Down syndrome: implications for clinical practice.

Growth curves have been developed for individuals with Down syndrome (DS) in several countries. However, in order to facilitate the preparation of clinical guidelines it is necessary to verify the eligibility of these curves. The search was conducted according to the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). It was conducted between July 2012 and June 2013 in MEDLINE/PubMed and BIREME. The inclusion and exclusion criteria were applied to identify the studies and a total of 16 relevant articles were selected. The aspects analyzed in the articles consisted of sample size, number of observations, age group, anthropometric variables, standard deviation scores (SDS), type of study, collection and analysis of data, participants, inclusion/exclusion criteria and outcomes. The mean, standard deviations (SDs) and percentiles for sex and age were used to develop the curve of weight, height, and head circumference. The individuals with DS presented growth between -0.4 and -4.0 SDS in comparison to healthy controls. The variation in these observations can be explained by genetic differences, secular trends in growth and disease status. Regarding the limitations identified, it was observed that most of the studies did not provide data concerning the number of individuals and observations, mean values and respective SDs by sex and age. In addition, most studies did not use LMS methods to evaluate asymmetry, the median and data variability. In conclusion, the results of this review demonstrated that in order to avoid false diagnoses in children and adolescents with DS new growth curves must be developed.

Peso, estatura e comprimento em crianças e adolescentes com síndrome de Down: análise comparativa de indicadores antropométricos de obesidade / Weight, height and length in children and adolescents with Down syndrome: a comparative analysis of anthropometric indicators of obesity

A obesidade é considerada uma epidemia, que acomete também crianças e adolescentes com síndrome de Down. Contudo, como não há um parâmetro consensual para diagnosticar obesidade nessa população, o objetivo deste trabalho foi realizar uma revisão crítica de artigos que estudam índices antropométricos, para avaliação do estado nutricional de crianças e adolescentes com essa síndrome. O levantamento dos artigos foi realizado nas bases de dados PubMed, MedlLine, Lilacs e SciELO, dando-se importância aos parâmetros antropométricos e sua relação com a obesidade. De 83 artigos iniciais, foram selecionados 11 para análise crítica. Nos Estados Unidos, estabeleceram uma curva de normalidade para peso e estatura de crianças e adolescentes com síndrome de Down e, quando compararam os seus valores com as curvas do National Center for Health Statistics, observaram que houve um padrão menor de crescimento em estatura. Em estudos europeus, observou-se o mesmo fato. No Brasil, Mustacchi desenvolveu índices de peso/idade e estatura/idade e observou deficit importante de estatura, quando comparou estatura/idade com as curvas do National Center for Health Statistics e com as curvas de Cronk et al. Em CONCLUSÃO:, os dados antropométricos disponíveis em curvas pôndero-estaturais são considerados relativos a uma determinada população e revelam suas características específicas, porque expressam a influência dos fatores ambientais e determinantes genéticos. Portanto, há necessidade de se definir curvas de padrão de referência para crianças e adolescentes com síndrome de Down em diferentes faixas etárias, regiões e etnias, para se diagnosticar corretamente seu estado nutricional.

Obesity is considered an epidemic and also affects children and adolescents with Down syndrome. However, since a consensual parameter for diagnosing obesity in this population does not exist, the objetive of this study was to perform a critical review of the literature on anthropometric indices to assess the nutritional status of children and adolescents with this syndrome. The databases PubMed, MedLine, Lilacs and SciELO were searched focusing on the importance of anthropometric parameters and their relationship with obesity. Of the 83 articles found, 11 were selected for critical analysis. In the United States of America, weight and height curves were established specifically for children and adolescents with Down syndrome. When these curves were compared with those of the National Center for Health Statistics, they found that children and adolescents with Down syndrome grow less. The same fact was reported by European studies. In Brazil, Mustacchi developed weight-for-age and height-for-age indices for these children and compared his height-for-age curve with those of the National Center for Health Statistics and Cronk et al.'s, and found that Brazilian children with Down syndrome are significantly shorter. In conclusion, the anthropometric data in weight-for-height curves refer to a particular population and reveal their specific characteristics since they reflect the influence of environmental factors and genetic determinants. Therefore, it is necessary to define standard reference curves for children and adolescents with Down syndrome of different ages, regions and ethnicities, so that their nutritional status can be diagnosed properly.