Desempenho cognitivo de pré-escolares com baixa estatura em tratamento de recuperação nutricional / Cognitive performance of stunted pre-school children undergoing nutritional recovery treatment

RESUMO Objetivo: Determinar se o tratamento de crianças com baixa estatura, ofertado em um centro especializado, influencia seu desempenho cognitivo. Métodos: Foram analisados dois grupos de crianças advindas de famílias vulneráveis, um com crianças com baixa estatura em tratamento no Centro de Recuperação e Educação Nutricional (CREN) e outro de crianças eutróficas de uma creche municipal localizada na mesma região do CREN. No CREN, as crianças são tratadas em semi-internato (9 horas/dia, 5 dias/semana), recebendo suporte médico, nutricional e psicopedagógico. Todas foram submetidas ao Teste de Triagem do Desenvolvimento de Denver-II e avaliadas quanto ao índice de estatura-para-idade em 3 momentos distintos: no início do acompanhamento e após 6 e 12 meses. A classificação socioeconômica das crianças, de acordo com os Critérios de Classificação Econômica Brasil, foi feita no início do acompanhamento. Calcularam-se razões de prevalência para a análise transversal da linha de base, por meio de uma regressão de Poisson, e razões de prevalência agrupadas para a análise longitudinal, por meio de um modelo de estimativas de equações generalizadas, ambas ajustadas por idade, sexo e classe socioeconômica. Resultados: Ao todo, 74 crianças foram analisadas, 37 em cada grupo. Não houve diferenças de idade, sexo e classe socioeconômica entre os grupos. Na análise longitudinal, o grupo CREN apresentou melhor desempenho no domínio pessoal-social (razão de prevalência agrupada: 0,89; intervalo de confiança de 95% - IC95%: 0,82-0,95), sem diferenças significativas para os demais domínios. Conclusão: O tratamento ofertado pelo CREN melhorou satisfatoriamente as habilidades sociais das crianças tratadas, sem alterar os demais domínios.

ABSTRACT Objective: To determine if the treatment of stunted children offered at a specialized center influences their cognitive performance. Methods: Two groups of children from vulnerable families were selected, one consisting of stunted children being treated at the Nutrition Education and Recovery Center (CREN), and the other group of eutrophic children from a local, public day care center. At CREN, children are treated in a day-hospital system (9 hours/day, 5 days/week), receiving medical, nutritional and psycho-pedagogical support. All children were submitted to the Denver-II Development Screening Test and had their development and the height-for-age index assessed at 3 moments: at the beginning of the follow-up, and after 6 and 12 months. The socioeconomic status, according to the Brazilian Economic Classification Criteria, was assessed at the beginning of the follow-up. Data were treated by prevalence ratios for cross-sectional baseline analysis, using the Poisson regression, and by pooled prevalence ratios for longitudinal analysis, using a generalized equation estimation model, both adjusted by age, sex and economic status. Results: Seventy-four children were included, 37 for each group. There were no differences in age, sex and socioeconomic status between groups. In the longitudinal analysis, the CREN group showed better performance in the personal-social domain (pooled prevalence ratio: 0.89; 95% confidence interval - 95%IC 0.82-0.95), with no differences in the other domains. Conclusions: The treatment offered at CREN satisfactorily improved the social skills of the treated children, without changing other domains.

Talla baja idiopática y uso de hormona de crecimiento: documento del consenso de la Sociedad Chilena de Endocrinología y Diabetes / Consensus recommendations of the Chilean Society of Endocrinology an Diabetes on growth hormone use in idiopathic short stature

The diagnosis of idiopathic short stature (ISS) is common among patients with short stature, especially those with a height lower than 2 standard deviations (SD) of the mean. The diagnosis of ISS is considered in children with short stature in whom no recognizable causes are found after a proper evaluation by pediatric endocrinologists. The professional must perform a complete personal and family history, appropriate anthropometry and physical examination and confirm that general and specific laboratory studies including supraphysiological stimuli to measure growth hormone, are normal. Growth hormone (GH) treatment is safe and effective in patients with ISS. Its effects are very similar to those observed in other conditions that affect growth as Turner Syndrome and Small for Gestational Age Short Children. However, treatment is still controversial because ethical, psychological, social, cultural and economic issues, wich are difficult to evaluate, must be taken into account. Individual patient differences and their family environment must also be considered. The hormone is more often indicated to fulfil parent or social environment needs rather than the wish of the patients. Although the treatment is safe, it is not free of complications and its results are often poorer than those expected by patients or their parents. The Chilean Society of Endocrinology and diabetes commissioned a panel of experts among its members, to generate a consensus document on ISS and the use of growth hormone, to provide information and recommendations to the Chilean community.

Growth status and academic performance in Brazilian school age children: growth retardation impairs mathematical, but not reading and spelling abilities / Crescimento e desempenho acadêmico em escolares brasileiros: retardo no crescimento interfere com a matemática mas não com a leitura e a escrita

AIM: To assess the effect of child growth status on academic achievement and the association between child growth and academic standing. METHOD: The heights of 722 middle-school children were measured using standard procedures and height-for-age z (HAZ) scores were calculated based on an international reference. Academic performance was assessed by an adaptation of the Wide Range Achievement Test (WRAT3) composed of Reading, Arithmetic and Spelling. RESULTS: Children in the group with higher HAZ scores performed better than children in the group with lower HAZ scores only on the Arithmetic subtest. This finding was confirmed by a multiple regression model analysis of the data. In addition, only performance on the Arithmetic subtest was positively associated with HAZ. CONCLUSION: These results indicate that growth retardation impacts specifically on the development of arithmetic (numeracy) skills and are consistent with a three-fold model of life course influences on health including latency, cumulative and pathway effects.

OBJETIVO: Examinar o efeito do crescimento no desempenho acadêmico e a associação entre crescimento e competência acadêmica. MÉTODO: A estatura de 722 escolares da rede pública de Niterói foi medida através de procedimentos padronizados e escores padronizados da estatura para a idade (HAZ) foram calculados com base em referência internacional. O desempenho acadêmico foi avaliado através de uma adaptação do Wide Range Achievement Test (WRAT3) composto de leitura, aritmética e ditado. RESULTADOS: Crianças com HAZs mais elevados apresentaram um desempenho melhor do que crianças com HAZs mais baixos somente na aritmética. Este achado foi confirmado por uma análise de modelo de regressão múltipla dos dados. Ademais, somente o rendimento em aritmética mostrou uma associação positiva com HAZ. CONCLUSÃO: Os resultados indicam que o retardo no crescimento impacta especificamente no desenvolvimento de competência em matemática e são consistentes com um modelo de influências durante o curso da vida que inclui efeitos de latência, cumulativos e de trajetória.