RESUMEN
BACKGROUND: In Qatar, the prevalence of metabolic syndrome (MetS) in children and adults is increasing in parallel with the markedly increasing trends in obesity rates. OBJECTIVE: The aim of our study was to assess the prevalence of different components of MetS, measure plasma atherogenic indexes (AIP), and to evaluate linear growth in young obese nondiabetic children (< 5 years) in comparison to older obese children (6-12 years). Methods: We analysed the anthropometric and biochemical profile of 135 random sample obese children who attended to the Paediatric Clinic of Hamad Medical Centre (HGH) in Doha (Qatar) from January 2018 to December 2019. RESULTS: A large proportion of children presented with obesity, around the age of 5 years, were obese at the end of their first year of life (63.8%) and more were obese at the 2 years of age (82.6%). Significantly rapid gain in weight and linear growth occurred during the first 6 months of postnatal life. Moreover, some metabolic risk factors and high AIP occurred more frequently in older obese children compared to young obese children. CONCLUSIONS: This study documented the early occurrence of different components of the MetS in young obese children and the progressive increase of their prevalence in older prepubertal children. Most of obese children who presented at or below 5 years of age had significant obesity and rapid linear growth during the first two years (infancy). These two findings pointed out to the necessity to impose early detection and preventive measures on a national scale.
Asunto(s)
Síndrome Metabólico , Obesidad Infantil , Adulto , Niño , Humanos , Anciano , Preescolar , Síndrome Metabólico/epidemiología , Prevalencia , Obesidad Infantil/epidemiología , Factores de Riesgo , Qatar/epidemiología , Índice de Masa CorporalRESUMEN
Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the rapid linear pubertal growth and development, change in body composition, and increased physical activity. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Severe primary or secondary malnutrition also can adversely delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries (LMIC), who require nutritional rehabilitation. This mini-review sums up some important findings in this important complex that links between nutrition, nutritional interventions, and pubertal development.
Asunto(s)
Desnutrición , Pubertad , Adolescente , Humanos , Desnutrición/epidemiología , Desnutrición/etiología , Micronutrientes , Necesidades NutricionalesRESUMEN
In Qatar, the prevalence of metabolic syndrome (MetS) in children and adolescents is increasing in parallel with the increasing trends in obesity rates. In Qatar, the prevalence of obesity is relatively high. AIM: To assess the prevalence of the different components of MetS and plasma atherogenic indexes (AIP) in obese children and adolescents and to compare their anthropometric data with their parents (genetic background). METHODOLOGY: We analysed the anthropometric and biochemical profile of 91 randomly selected obese children and young adolescents (age: 10.5 ± 2.7 years) who attended to the Paediatric Clinic of Hamad Medical Center (HGH) in Doha (Qatar) form January 2017 to December 2019. Data recorded included: age, gender, weight and height, body mass index (BMI), systolic and diastolic blood pressures. Biochemical data including lipid profile, glycated hemoglobin (A1C), and alanine transferase level (ALT) were recorded and compared with normal lab data for the same age group. RESULTS: Obese children had a high prevalence of dyslipidaemia, dysglycemia and non-alcoholic fatty liver disease (NAFLD). Using the modified adult MetS criteria, MetS was present in 30.2% of this obese cohort. AIP was high in 76.7% of the patients. Standing height standard deviation score (Ht-SDS) of obese children was significantly higher compared to Ht-SDS of their parents as well as to mid-parental height SDS (MPHt-SDS) (-0.37± 0.79). The BMI and BMI-SDS did not differ between obese children and their parents. CONCLUSION: The occurrence of MetS in 30% of our obese non-diabetic children and young adolescents pointed out to the necessity to impose early detection and preventive measures on a national scale.
Asunto(s)
Síndrome Metabólico , Obesidad Infantil , Adolescente , Adulto , Índice de Masa Corporal , Niño , Estudios Transversales , Humanos , Síndrome Metabólico/epidemiología , Padres , Obesidad Infantil/epidemiología , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND: Early detection of abnormal weight loss or gain in childhood may be important for preventive purposes. Variable growth response to nutrition rehabilitation have been reported in children with failure to thrive (FTT) who do not have any chronic disease or systematic illness due to different clinical and nutritional approach in their management. AIM OF THE STUDY: To analyze the association of different body mass index (BMI) and BMI- SDS, to linear growth (Ht-SDS) in different BMI categories of prepubertal children. In addition, we studied the effect of weight changes on linear growth in a randomly selected group of prepubertal underweight children who received nutritional rehabilitation (NR) for 9±2 months. SUBJECTS AND METHODS: 102 children, between 1 and 9 years, followed at the General Pediatric Clinic, between January 2017 to December 2017, because of abnormal weight gain (decreased or increased) which was not associated with any acute or chronic illness were included in the study. Anthropometric measurements included weigh, height, Ht-SDS, BMI, and BMI-SDS. Children BMI-SDS were categorized into 4 groups: Group 1: BMI-SDS <-2, group 2: BMI-SDS <-1 but >-2, group 3 BMI-SDS >-1 but <2, group 4 BMI-SDS >2. We also evaluated the effects of weight changes on linear growth in a randomly selected group of underweight children who received nutritional counselling and oral nutritional supplementation (n = 51) for 9±months. RESULTS: HT-SDS in children of groups 1 and 2 (underweight and at risk of underweight children) was significantly lower than Ht-SDS of groups 3 and 4 (normal and overweight children). Ht-SDS in children of group 4 was significantly higher than the Ht-SDS of children in group 3. A significant linear correlation was found between BMI-SDS and Ht-SDS in these prepubertal children. DISCUSSION: After nutritional rehabilitation for a year, 55% of underweight children increased their BMI-SDS and 43% increased their Ht-SDS. Children who had weight gain >7g/d, over the whole period of follow-up, (n =14) increased their BMI-SDS and Ht-SDS significantly after versus before NR. The BMI-SDS and Ht-SDS did not increase significantly in the group of children who had weight gain <7 g/day. 28 children out of 51 improved their BMI-SDS after nutritional rehabilitation (group A) and 23 did not have improvement in their BMI-SDS (Group B). Group A had higher weight gain per day versus group B. Height growth velocity was significantly higher in Group B (7.4±3.6 cm/yr) versus group A (5.7±2.8 cm/yr). Ht-SDS increased significantly in the group of patients who had lower Ht-SDS before NR. Children who had faster linear growth velocity, after nutritional rehabilitation, did not increase their BMI-SDS. Linear regression showed a significant correlation between BMI-SDS and Ht-SDS supporting the notion that proper nutrition and maintaining normal BMI-SDS is essential for adequate gain in height. CONCLUSION: It appears that calculating the weight gain per day, BMI-SDS and Ht-SDS are clinically useful parameters to detect the effect of weight gain on linear growth and to monitor the nutritional management. Daily weight gain was correlated significantly to height growth rate during nutritional rehabilitation. Based on our findings and literature reports, we suggest an algorithm for follow-up of underweight/ malnourished children based mainly on anthropometric assessment.
Asunto(s)
Índice de Masa Corporal , Peso Corporal/fisiología , Trastornos de la Nutrición del Niño/rehabilitación , Monitoreo Fisiológico/métodos , Aumento de Peso , Factores de Edad , Instituciones de Atención Ambulatoria , Antropometría/métodos , Niño , Desarrollo Infantil/fisiología , Trastornos de la Nutrición del Niño/diagnóstico , Preescolar , Estudios de Cohortes , Países en Desarrollo , Femenino , Humanos , Lactante , Modelos Lineales , Masculino , Estado Nutricional , Qatar , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Delgadez/rehabilitaciónRESUMEN
BACKGROUND: Celiac disease (CD) is a lifelong disorder with gluten-induced manifestations in different organs especially growth. Gluten free diet (GFD) is required to achieve remission and prevent abnormal growth. Study reports on growth of children with celiac disease on long-term GFD are not consistent. OBJECTIVE: We evaluated the effect of GFD on growth of children with the classical form of CD (diagnosed by serology and small intestine mucosal biopsy) on log-term GFD (>2 years). METHODS: We studied growth parameters (weight gain/day, BMI and BMI-SDS, height growth velocity, Ht-SDS) and lab data in 30 prepubertal children, aged 7.4±2.6 years, with CD, who were on GFD since the age of 3.2±1.6 years of age (>2 years on GFD) for duration of 1 year. The anthropometric data of 30 randomly selected normal, age and sex matched, children were used as control. Lab investigations of CD children included complete blood count (CBC), renal and liver functions (aspartate transaminase - AST, alanine aminotransferase - ALT, and alkaline phosphatase- ALP, serum albumin, fasting blood glucose, vitamin D, and thyroid function and antibodies. RESULTS: The weight gain per day was on average or above, for age and sex, in 27 children and below average in 3. Two out of those 3 children had slow linear growth (decreased Ht-SDS by -0.56 and -0.1, over one year). BMI-SDS was normal in 26/30 patients (>-1.5). BMI-SD changed from -0.36±1.1 to -0.33±1.1 during the year of treatment. BMI-SDS decreased in 9 children during the follow up period that was explained by their fast-linear growth (increased Ht-SDS) in seven of them. The Ht-SDS was <-2 in four out of 30 children at the beginning of the study (2 years after being on GFD) and in 2 children after a year of follow-up (catch-up growth). Ht-SDS remained normal or increased in 28/30 children during the year of treatment (-0.38 ±1.2 to -0.22±1.1), with a positive trend: 0.15±0.4 SDS. Only one patient crossed down 1 Ht-SDS during the year of follow up, with low weight gain/day and decreased BMI-SDS that can be explained by poor compliance with GFD. Ht-SDS and BMI-SDS increased significantly in the CD group versus controls during the year of follow-up. All patients had normal serum albumin, liver enzyme and hemoglobin levels. 33.3% of patients had low serum ferritin level and 33.3% had a vitamin D deficiency. CONCLUSIONS: Most of our children with CD grew normally both in height and weight during GFD. Significant catch-up growth occurred in some of them after 2 years of being on GFD. Those with low BMI-SDS and/or Ht-SDS needed further management, including reinforcement on the importance of GFD and investigations on factors affecting growth pattern. Measuring weight gain /day appears to be a sensitive indicator for monitoring growth in these children. Vitamin D and iron status should be monitored, and deficiencies corrected.