Growth differences between North American and European children at risk for type 1 diabetes.

AIM: To evaluate the relationships between early growth and regional variations in type 1 diabetes (T1D) incidence in an international cohort of children with familial and genetic risk for T1D. METHODS: Anthropometric indices between birth to 5 yr of age were compared among regions and T1D proband in 2160 children participating in the Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk study. RESULTS: Children in Northern Europe had the highest weight z-score between birth to 12 months of age, while those in Southern Europe and U.S.A. had the lowest weight and length/height z-scores at most time points (p < 0.005 to p < 0.001). Few differences in z-score values for weight, height, and body mass index were found by maternal T1D status. Using International Obesity Task Force criteria, the obesity rates generally increased with age and at 5 yr were highest in males in Northern Europe (6.0%) and in females in Canada (12.8%). However, no statistically significance difference was found by geographic region. In Canada, the obesity rate for female children of mothers with and without T1D differed significantly at 4 and 5 yr (6.0 vs. 0.0% and 21.3 vs. 1.9%, respectively; p < 0.0125) but no differences by maternal T1D status were found in other regions. CONCLUSIONS: There are regional differences in early childhood growth that are consistent with the higher incidence of T1D in Northern Europe and Canada as compared to Southern Europe. Our prospective study from birth will allow evaluation of relationships between growth and the emerging development of autoimmunity and progression to T1D by region in this at-risk population of children.

Accelerated tooth eruption in children with diabetes mellitus.

OBJECTIVE: The objective of this study was to evaluate tooth eruption in 6- to 14-year-old children with diabetes mellitus. METHODS: Tooth eruption status was assessed for 270 children with diabetes and 320 control children without diabetes. Data on important diabetes-related variables were collected. Analyses were performed using logistic regression models. RESULTS: Children with diabetes exhibited accelerated tooth eruption in the late mixed dentition period (10-14 years of age) compared to healthy children. For both case patients and control subjects the odds of a tooth being in an advanced eruptive stage were significantly higher among girls than boys. There was also a trend associating gingival inflammation with expedited tooth eruption in both groups. No association was found between the odds of a tooth being in an advanced stage of eruption and hemoglobin A(1c) or duration of diabetes. Patients with higher body mass index percentile demonstrated statistically higher odds for accelerated tooth eruption, but the association was not clinically significant. CONCLUSIONS: Children with diabetes exhibit accelerated tooth eruption. Future studies need to ascertain the role of such aberrations in dental development and complications such as malocclusion, impaired oral hygiene, and periodontal disease. The standards of care for children with diabetes should include screening and referral programs aimed at oral health promotion and disease prevention.

Gingival bleeding in 6- to 13-year-old children with diabetes mellitus.

PURPOSE: This study assessed gingival bleeding in diabetic children during the mixed dentition period. METHODS: Three hundred fifty-five 6- to 13-year-old diabetic (99% type 1) and nondiabetic control children in the mixed dentition stage were evaluated from a total cohort of 700 6- to 18-year-old children. Gingival status was assessed, and data on important diabetes-related variables were collected. Analyses were performed using Poisson's regression. RESULTS: Diabetic children had significantly more gingival bleeding than controls for both primary and permanent teeth. The risk of gingival bleeding around the primary teeth in cases was 35% more than in the control group (P=.001); and the risk of gingival bleeding around the permanent teeth in cases was 57% more than in the controls (P<.001). The number of teeth with bleeding had a very modest, but statistically significant, association with: (1) mean HbA1c; (2) body mass index (BMI)-for-age percentile; and (3) duration of diabetes. CONCLUSIONS: These findings demonstrate that diabetic children are at a significantly higher risk for gingival bleeding. Diabetes-related oral complications affect the primary periodontium as early as age 6 and possibly earlier. The emphasis on oral hygiene may be valuable in preventing future periodontal complications in diabetic patients.

Diabetes mellitus promotes periodontal destruction in children.

AIM: The association between diabetes mellitus and periodontal attachment and bone loss is well established. Most of the prior literature has focused on adults, and studies in children have mostly reported gingival changes. Our aim was to assess the periodontal status of a large cohort of children and adolescents with diabetes. MATERIAL AND METHODS: We examined 350 children with diabetes (cases) and 350 non-diabetic controls (6-18 years of age). Using three different case definitions for periodontal disease, which incorporated gingival bleeding and/or attachment loss findings, multiple logistic regression analyses adjusting for age, gender, ethnicity, frequency of prior dental visits, dental plaque, and examiner were performed. RESULTS: Subjects with diabetes had increased gingival inflammation and attachment loss compared with controls. Regression analyses revealed statistically significant differences in periodontal destruction between cases and controls across all disease definitions tested (odds ratios ranging from 1.84 to 3.72). The effect of diabetes on periodontal destruction remained significant when we separately analysed 6-11 and 12-18 year old subgroups. CONCLUSIONS: These findings demonstrate an association between diabetes and an increased risk for periodontal destruction even very early in life, and suggest that programmes to address periodontal needs should be the standard of care for diabetic youth.

Effects of growth hormone therapy in children after cardiac transplantation.

BACKGROUND: Growth hormone (GH) is used to treat growth failure in children with GH deficiency. The safety and efficacy of GH after pediatric cardiac transplantation is not known. The objective of this study was to evaluate growth and cardiovascular effects of GH in children with growth failure after cardiac transplantation. METHODS: Pediatric cardiac transplant recipients who received GH from 1994 to 2004 were evaluated. Growth, cardiac function, hemodynamics and rejection frequency were serially monitored for 2 years before, during and after GH. Eight age-matched heart transplant recipients undergoing a natural growth spurt were evaluated as controls. RESULTS: The mean age of subjects at initiation of GH was 13 +/- 3 years (mean duration 2.5 +/- 1 years, n = 10), of whom 3 were GH-deficient. Growth velocity (GV) increased from 2.5 +/- 2 to 8.6 +/- 3 cm/year with GH. There was an increase in left ventricular (LV) shortening fraction (SF; 37 +/- 1% to 41 +/- 1%), LV mass (93 +/- 11 to 118 +/- 15 g/m2), LV volume (138 +/- 14 to 188 +/- 21 ml/m2) and cardiac index (3.1 +/- 0.7 to 4.1 +/- 0.5 liters/min/m2) during GH therapy (p < 0.05). After discontinuation of GH, SF, cardiac index and LV mass returned to normal, but LV volume did not. In control patients, LV volume increased without an increase in SF or mass. Rejection frequency did not change in either group. There were no adverse events related to GH. CONCLUSIONS: GH is safe and effective in treating growth failure in children after cardiac transplantation. GH therapy is associated with an increase in LV mass, volume and cardiac output. These changes are partially reversible after discontinuation of GH. The mechanisms and long-term consequences of these changes require further investigation.

Growth and skeletal maturation after pediatric cardiac transplantation.

To examine the effects of cardiac transplantation on skeletal maturation and linear growth, we retrospectively evaluated annual bone age determinations and growth parameters of pediatric cardiac transplant recipients followed at our center. Included in the analysis were records of 86 patients (32 females) who had received a cardiac transplant at our institution between 1984 and 1998. Bone age delay of > or =12 months was apparent in 38.5% at the time of transplantation. At some point in their post-transplant course, 23 patients (29%) had one or more bone age measurements that were > or =36 months delayed with respect to chronological age. Children transplanted before age seven and those with a pretransplantation diagnosis of cardiomyopathy experienced the most significant decrement in skeletal maturation after transplantation. High cyclosporin A levels and low body mass index were the only parameters found to be associated with delayed bone age. Although the majority of children grew at a normal rate after transplantation, height Z scores and height age were adversely affected regardless of the type of heart disease or the age at transplantation. The pathogenesis of both delayed skeletal maturation and growth retardation in this population warrant further investigation.

Case report of an anaphylactoid reaction to arginine.

BACKGROUND: Arginine is an agent commonly used to evaluate adequacy of growth hormone (GH) secretion. Because arginine is a simple amino acid, it is considered safe and rarely causes adverse reactions. OBJECTIVE: To report the second anaphylactoid reaction to arginine in a child undergoing stimulation testing with arginine for assessing GH secretion. METHODS: Allergy skin testing to arginine was performed with a protocol similar to penicillin testing 4 weeks after the anaphylactoid reaction. RESULTS: Testing revealed a positive response to the arginine. CONCLUSIONS: The use of intravenous arginine as a test of GH reserve remains safe and effective, but it is prudent to have the equipment and medication available to treat an allergic reaction.