Growth hormone use in pediatric inflammatory bowel disease.

OBJECTIVES: Impaired linear growth is a known complication of pediatric inflammatory bowel disease (IBD), but the use of growth hormone (GH) in this population is not well-described. The primary aim of this study is to determine whether growth hormone use in pediatric IBD leads to improved height outcomes. METHODS: This was a retrospective chart review of patients with IBD aged 0-21 years followed at a single center between 2018 and 2021 treated with at least 1 year of GH. Records collected included demographics, IBD phenotype, IBD disease activity scores, medications, weight z-score, height z-score, bone age, and details of GH therapy including testing for GH deficiency. The primary outcome measure was change in height z-score after 1 year of GH treatment. RESULTS: Forty-six patients were identified and 18 were excluded. Of the 28 patients included (7 female; 25.0 %), 26 (92.9 %) had a diagnosis of Crohn's disease (CD) and 2 (7.1 %) had ulcerative colitis (UC). The mean (SD) age at GH initiation was 9.6 (3.4) years. Among all participants, there was a significant mean difference in height z-score from baseline to 1 year on therapy (-2.25 vs. -1.50, respectively; difference, 0.75; 95 % CI, 0.56 to 0.94; p<0.001). Among the 19 subjects that completed GH therapy there was a significant mean difference between baseline and final height z-scores (-2.41 vs. -0.77, respectively; difference, 1.64; 95 % CI, 1.30 to 1.98; p<0.001). CONCLUSIONS: GH use was associated with improved height outcomes. The pediatric IBD patients in this cohort had significant improvements in height z-scores both after one year on therapy and at completion of GH therapy.

Poor Glycemic Control Is Associated With Impaired Bone Accrual in the Year Following a Diagnosis of Type 1 Diabetes.

CONTEXT: Type 1 diabetes (T1D) is associated with an increased fracture risk across the life course. The effects on bone accrual early in the disease are unknown. OBJECTIVE: To characterize changes in bone density and structure over the year following diagnosis of T1D and to identify contributors to impaired bone accrual. DESIGN: Prospective cohort study. SETTING: Academic children's hospital. PARTICIPANTS: Thirty-six children, ages 7 to 17 years, enrolled at diagnosis of T1D. OUTCOMES: Whole body and regional dual-energy X-ray absorptiometry and tibia peripheral quantitative computed tomography obtained at baseline and 12 months. The primary outcome was bone accrual assessed by bone mineral content (BMC) and areal bone mineral density (aBMD) velocity z score. RESULTS: Participants had low total body less head (TBLH) BMC (z = -0.46 ± 0.76), femoral neck aBMD (z = -0.57 ± 0.99), and tibia cortical volumetric BMD (z = -0.44 ± 1.11) at diagnosis, compared with reference data, P < 0.05. TBLH BMC velocity in the year following diagnosis was lower in participants with poor (hemoglobin A1c ≥7.5%) vs good (hemoglobin A1c <7.5%) glycemic control at 12 months, z = -0.36 ± 0.84 vs 0.58 ± 0.71, P = 0.003. TBLH BMC velocity was correlated with gains in tibia cortical area (R = 0.71, P = 0.003) and periosteal circumference (R = 0.67, P = 0.007) z scores in participants with good, but not poor control. CONCLUSIONS: Our results suggest that the adverse effects of T1D on BMD develop early in the disease. Bone accrual following diagnosis was impaired in participants with poor glycemic control and appeared to be mediated by diminished bone formation on the periosteal surface.

Body Composition and BMI Growth Charts in Children With Down Syndrome.

BACKGROUND AND OBJECTIVES: New US Down syndrome (DS) BMI growth charts were recently published, but their utility in identifying children with excess adiposity or increased cardiometabolic risk (CMR) remains unknown. We sought to compare the ability of the Centers for Disease Control and Prevention (CDC) BMI 85th percentile and DS-specific BMI 85th percentile to identify excess adiposity in children with DS. METHODS: Participants with DS aged 10 to 20 years were enrolled in a cross-sectional CMR study. Data from typically developing children enrolled in the Bone Mineral Density in Childhood Study (BMDCS) were used for comparison. Sensitivity and specificity were calculated to assess the CDC BMI 85th percentile in the BMDCS and DS groups, and the DS-specific BMI 85th percentile in the DS group, relative to fat mass index (FMI) ≥80th percentile, a threshold associated with increased CMR. RESULTS: Included were 121 DS participants (age 14.8 ± 3.3 years, 57% girls) and 7978 BMDCS reference data points (age 15.0 ± 3.0 years, 51.3% girls). The CDC BMI 85th percentile identified FMI ≥80th percentile with 96.9% sensitivity and 87.4% specificity in typically developing children. Similarly, the CDC BMI 85th percentile identified FMI ≥80th percentile with 100% sensitivity and 78.3% specificity in children with DS. In contrast, the sensitivity of the DS-specific BMI 85th percentile was only 62.3% (P < .0001), but was 100% specific. CONCLUSIONS: For children with DS ≥10 years, the CDC BMI growth chart 85th percentile is a better indicator of excess adiposity, than the new DS-specific BMI charts. Additional studies are needed to clarify the relationships of BMI and FMI with CMR in DS.

Sex differences in the associations of visceral adiposity, homeostatic model assessment of insulin resistance, and body mass index with lipoprotein subclass analysis in obese adolescents.

BACKGROUND: The relationship of lipoprotein particle subclasses to visceral adipose tissue area (VAT-area) in obese children has not been examined previously. OBJECTIVES: The study aims were to compare the relationships of VAT-area, homeostatic model assessment of insulin resistance (HOMA-IR), and body mass index (BMI) with lipids and lipoprotein subclasses in obese adolescents and to determine whether these relationships vary by sex. METHODS: This cross-sectional study of obese adolescents (BMI ≥ 95th percentile), aged 12 to 18 years, measured VAT-area by dual-energy X-ray absorptiometry, BMI, fasting lipids, lipoprotein subclasses, and HOMA-IR. Linear regression models evaluated the associations of VAT-area, HOMA-IR, and BMI with lipid cardiometabolic risk factors. Sex-stratified analyses further explored these associations. RESULTS: Included were 127 adolescents (age = 14.4 ± 1.5 years; 53.5% female; 88.2% African-American), mean BMI = 34.0 ± 5.1 kg/m(2). VAT-area was negatively associated with low-density lipoprotein particle (LDL-P) size (ß = -0.28, P = .0001), high-density lipoprotein particle (HDL-P) size (ß = -0.33, P < .0001), and large HDL-P concentration (ß = -0.29, P < .0001) and positively associated with small LDL-P concentration (ß = 0.23, P = .0005) and small HDL-P concentration (ß = 0.25, P = .05). When VAT-area, HOMA-IR, and BMI associations were compared, VAT-area had the strongest associations with most of the lipoprotein subclasses. After sex stratification, the associations of VAT-area with HDL cholesterol, LDL-P size, and large LDL-P concentration were significant only for females (all P < .05). CONCLUSIONS: In a cohort of largely African-American obese adolescents, VAT-area was associated with a more atherogenic lipoprotein subclass profile. When compared with HOMA-IR and BMI, VAT-area had the strongest associations with most lipoprotein subclasses. The relationships between VAT-area and certain lipoprotein subclasses are significantly different in males vs females.