[Effect of Psychosocial Factors on Growth]. / Einfluss von psychosozialen Belastungsfaktoren auf das Längenwachstum.

BACKGROUND: Genes, hormones and factors such as nutrition and psychosocial environment affect growth. OBJECTIVE: What is the significance of various psychosocial factors on growth? METHODS: Evaluation of results of a working meeting of paediatric endocrinologist with current literature research. RESULTS: Psychosocial deprivation in children can be associated with growth hormone deficiency (GHD) and short stature. GHD can be reversed by a change of environment and psychosocial support. War and migration are often associated with underweight, growth disturbances and poor health care. These factors can improve after the end of conflicts, but children often remain too short. Consumption of alcohol or opiates during pregnancy are associated with lower birth weight and increased risk of early and small for gestational age (SGA) childbirth. Children with attention deficit hyperactivity disorder show a slight slowdown in growth after they started stimulant therapy. However, they reach normal adult height. CONCLUSIONS: In children with idiopathic short stature, psychosocial causes should be taken into account in the differential diagnosis. Notably there is an increased risk of growth disturbances in children from conflict regions or after prenatal drug exposure.

Bone maturation in extremely low birth weight infants in relation to birth weight and endocrine parameters.

Modern intensive care techniques have led to higher survival rates of extremely low birth weight infants (ELBW, birth weight <1,000 g). Previous studies have suggested a link between abnormal birth parameters and subsequent endocrine disturbances, but a possible impact on bone maturation during childhood has not been studied. ELBW children were studied (mean chronological age (CA), 6.01 years; range, 4.5-8.2). Skeletal maturation was assessed according to Greulich and Pyle (8). Bone age (BA) was defined as retarded when DeltaBA-CA was < -1 SD and accelerated when DeltaBA-CA was >+1 SD. BA was either retarded or accelerated in 15 patients (24.6%). Twenty-one of 61 radiograms (34.4%) showed a discordant BA with a marked gender difference (14/24 boys; 7/37 girls). DeltaBA-CA correlated significantly with BMI (r = 0.36; p = 0.005) and height SDS (r = 0.35; p = 0.006). We found significant correlations between BA and androgens. Insulin-like growth factor binding protein-1 (IGFBP-1), which decreases in insulin-resistant individuals, correlated negatively with BA. In conclusion, bone maturation in ELBW children is correlative with height and weight. It is modulated by a variety of metabolic factors, including IGFBP-1 and androgens. Bone age, together with height and weight catch-up, can thus possibly serve as early indicators of insulin resistance later in life.

Does gender-specific BMI development modulate insulin sensitivity in extremely low birth weight infants?

BACKGROUND: Increasing numbers of extremely low birth weight infants (ELBW, birth weight < 1,000 g) survive. We studied the impact of birth weight, gender, and catch-up growth on metabolic parameters in ELBW infants. CHILDREN: Sixty-three ELBW children were investigated at a mean age of 5.8 years. Forty-eight showed catch-up growth. RESULTS: ELBW children who were small for gestational age were significantly shorter than those whose size was appropriate for their gestational age (height SDS: -1.1 [SD 0.8] vs -0.4 [0.9]; p < 0.001). This corresponded with significantly lower standard deviation scores for IGF-I (-1.1 [1.3] vs 0.1 [0.8]; p < 0.05) and IGFBP-3 (-0.7 [1.7] vs 0.4 [1.1]; p < 0.05). No differences were found regarding fasting insulin, glucose, HOMA and IGFBP-1. The catch-up group showed lower IGFBP-1 concentrations than the non-catch-up group. IGFBP-1 decreased in individuals who became more insulin resistant. No differences were found regarding mean IGF-1 and IGFBP-3 SDS. A gender-related pattern was found for weight development: girls demonstrated a normalization of BMI from the age of 2 years whereas boys remained at a mean BMI of -1.96 SDS. Corresponding to this, girls showed lower IGFBP-1 levels than boys. CONCLUSION: Metabolic parameters in ELBW children are modulated by subsequent catch-up growth and sex-dependent weight development, resulting in measurable differences even in early childhood.

Fetal adiponectin and resistin in correlation with birth weight difference in monozygotic twins with discordant growth.

BACKGROUND: Various studies have demonstrated an increased risk for adult diseases in newborns born small-for-gestational-age (SGA). Adiponectin and resistin can be detected in cord blood and are suggested to affect insulin resistance (IR). This might represent a link between metabolic syndrome and SGA birth. STUDY DESIGN: We investigated the relationship between the adipocytokines and inter-twin birth weight (BW) difference of 31 monozygotic twins with twin-twin transfusion syndrome; in 14 twin pairs BW difference was >15% (1 SGA twin, 1 appropriate-for-gestational-age, AGA, twin). RESULTS: BW and length of all patients were positively related to adiponectin (r = 0.57; p < 0.0001; r = 0.47; p < 0.0001) and to resistin (r = 0.31; p < 0.01; r = 0.35; p < 0.01). In 71% (10/14), the SGA twins showed lower adiponectin concentrations than their AGA co-twins (only 6/14 for resistin). To correct for gestational age we calculated the relationship between the intrapair differences (Delta) of BW and Delta of the hormones. We found Delta BW positively correlated with adiponectin (r = 0.55; p < 0.001) but not with resistin (r = 0.22; p = 0.2). Delta adiponectin was positively correlated with Delta resistin (r = 0.45; p < 0.01). CONCLUSION: These data demonstrate that adiponectin and resistin levels are associated with BW with only adiponectin levels being reduced in SGA children independently of gestational age. Prenatally different metabolic status between the twins might predispose the SGA twin to develop IR later in life.

Cord blood leptin and IGF-I in relation to birth weight differences and head circumference in monozygotic twins.

OBJECTIVES: To investigate a potential role of leptin and insulin-like growth factor (IGF)-I on fetal growth and metabolic function we determined plasma leptin and IGF-I concentrations in twins in relation to discordant fetal growth. STUDY DESIGN: In studying monochorionic twins with inter-twin birth weight difference, we investigated the relative contribution of genetic (fetus) versus environmental (maternal/placental) factors on growth. Thirty-six sets of twins (14 with discordant growth, birth weight difference >15%) who had been treated for severe twin-to-twin transfusion syndrome (TTTS) by laser coagulation were studied. Cord blood samples were collected at birth and analyzed for IGF-I and leptin. Inter-twin differences (delta) of birth weight and head circumference were correlated to delta hormone levels. RESULTS: An inter-twin correlation for leptin (r = 0.69; p <0.0001) and delta IGF-I (r = 0.49; p <0.0001) was found. delta birth weight correlated significantly with delta IGF-I (r = 0.67; p <0.0001) but not with delta leptin (r = 0.23; p = 0.19). delta IGF-I concentrations did not correlate with delta leptin (r = 0.18). delta head circumference correlated significantly with delta leptin (r = 0.47; p <0.01) and with delta IGF-I (r = 0.46; p <0.01). Using a multiple regression model with head circumference as dependent variable, adjusted for gestational age, head circumference remained significantly associated with higher leptin concentrations in all patients (p = 0.03). CONCLUSION: IGF-I is a good indicator for fetal growth and brain development. Leptin seems to be mainly genetically determined but may play a role in fetal brain development and is not only an index for fetal fat mass.

Fetal insulin-like growth factor (IGF)-I, IGF-II, and ghrelin in association with birth weight and postnatal growth in monozygotic twins with discordant growth.

OBJECTIVE: To investigate the relative contribution of genetic (fetal) vs. environmental (maternal/placental) factors on growth, we studied monozygotic twins with intertwin birth weight difference. PATIENTS AND METHODS: Twenty-seven twins (15 with discordant growth) who have been treated for severe twin-to-twin transfusion syndrome by laser coagulation were studied. Cord blood samples were analyzed for IGF-I, IGF-II, IGF-binding protein-2, and ghrelin. Intertwin difference (Delta) of birth weight was correlated to Delta of the parameters analyzed. The Delta weight after 1 yr was correlated with Delta birth weight and all hormones. RESULTS: The Delta birth weight was positively correlated with Delta IGF-I (r = 0.66; P < 0.0002) and negatively correlated with Delta IGF-binding protein-2 levels (r = -0.68; P < 0.001) but with neither Delta IGF-II nor Delta ghrelin. There was a strong intertwin correlation for all hormones. By comparing the growth in the first year, we found an overall reduction of the relative weight difference between the twins of 57%. ANOVA was used to calculate factors for prediction of postnatal catch-up growth. Besides the birth weight difference (R2= 0.84; P < 0.0001), only ghrelin was of prognostic value for postnatal catch-up growth (R2= 0.94; P = 0.0035). CONCLUSION: These data confirm the importance of IGF-I in contrast to IGF-II for fetal weight. Additionally, ghrelin seems to be involved in fetal and probably postnatal growth.

Insulin-like growth factor-I in cord blood is predictive of catch-up growth in monozygotic twins with discordant growth.

OBJECTIVE: The aim was to investigate the growth of monozygotic twins with discordant birth weights and the predictive value of birth-weight, birth-length, and cord-blood concentration of growth factors on their catch-up growth up to the age of 4 yr. PATIENTS AND METHODS: Twenty-five monozygotic twin-pairs [14 with an intertwin birth-weight sd score (SDS) difference>1] were studied at birth and at 4 yr of age. In all pairs, several parameters including IGF-I were analyzed in cord blood, and in 20 pairs parameters were analyzed again at 4 yr of age. Intertwin differences (Δ) in birth weight, birth length, and growth at 3, 6, 12, 24, and 48 months were correlated with Δ of the parameters analyzed. RESULTS: We found a reduction of Δ height SDS from birth to 4 yr, with the main catch-up occurring during the first year, but only a slight, statistically insignificant reduction of Δ body mass index SDS during the observation period. Correlation coefficients were used to identify factors predicting postnatal catch-up growth. Both birth-weight difference (r=0.653; P=0.001) and Δ IGF-I in cord blood (r=0.613; P=0.007) were of similar predictive value. Variance analysis showed no significant difference in individual impact between these two parameters, although both correlated strongly with actual height. CONCLUSION: We observed a gradual convergence in height but not body mass index up to the age of 4 yr between genetically identical twins with discordant birth weights. Both birth-weight and cord-blood IGF-I are predictive of subsequent catch-up growth.

Body mass index and segmental proportion in children with different subtypes of psychosocial short stature.

UNLABELLED: We describe change in height, segmental proportion and weight in 46 children (19 girls, 27 boys, all but four prepubertal) diagnosed by a multidisciplinary team as having psychosocial short stature (PSS) who had a change in their environment (31 were separated from their family). The classification of PSS has recently been modified to include appetite disturbance at presentation: hyperphagic (IIA), non-hyperphagic (IIB) and anorexic type (III). The 46 patients were subdivided into these three classifications and analysed separately concerning their auxology and change in body mass index before and after intervention. Although in all groups a significant improvement in height velocity SDS was seen after intervention, subtle differences in body proportions could be demonstrated. Proportional short stature was seen in both non-anorexic types of PSS (type IIA and type IIB) and did not change with intervention, whereas a significant change in body proportion was found in the anorexic type (type III). Body mass index at presentation was within normal limits and did not increase significantly in any of the three subgroups after intervention. CONCLUSION: the main diagnostic feature of psychosocial short stature is catch-up growth after change of environment which occurs in almost all patients. The classification on the basis of appetite disturbance was supported by our auxological data with specific differences in body proportions.