Niveles plasmáticos de vitamina D en población autóctona y en poblaciones inmigrantes de diferentes etnias menores de 6 años de edad / Plasma vitamin D levels in native and immigrant children under the age of 6 years of different ethnic origins

INTRODUCCIÓN: El raquitismo carencial es una enfermedad emergente en nuestro medio y se describe especialmente en lactantes y niños inmigrantes de raza negra o piel oscura procedentes de países en vías de desarrollo. El objetivo de este trabajo está dirigido a conocer el estado nutricional de vitamina D en lactantes y niños inmigrantes de diferentes etnias de edad inferior a 6 años y compararlo con una población infantil autóctona. Población y métodos: Estudio prospectivo efectuado en un Centro de Asistencia Primaria de la localidad de Salt (Girona). Población: 307 niños con la siguiente distribución por origen y etnia: caucásicos (n=85; 28%), subsaharianos (n=101; 32,5%); magrebíes (n=87, 28,0%); centroamericanos (n=20; 6,4%) e indopakistaníes (n=14; 4,5%). Parámetros bioquímicos evaluados: calcemia, fosforemia, fosfatasa alcalina, 25-hidroxivitamina D y parathormona. Encuesta nutricional para estimar la ingesta de calcio, el aporte de vitamina D y el grado de exposición solar. RESULTADOS: Presentan déficit de vitamina D (< 20 ng/ml) el 8% de los niños de origen caucásico, el 18% de los subsaharianos, el 20% de los centroamericanos, el 34,5% de los magrebíes y el 64% de los niños de origen indopakistaní. El 2,9% de los niños estudiados (n = 9) presentan déficit grave de vitamina D (< 10 ng/ml), de los que tan solo un niño de origen subsahariano reúne criterios bioquímicos de raquitismo clásico. La prevalencia de la deficiencia de vitamina D es significativamente más elevada en los niños sin suplementación con vitamina D durante el primer año de vida. CONCLUSIONES: El 22,5% de los niños menores de 6 años de edad presenta concentraciones plasmáticas en rango deficitario de vitamina D, siendo más prevalente en los niños de origen indopakistaní y magrebí

INTRODUCTION: Nutritional rickets is an emergent disease in Spain, and occurs particularly in black and dark-skinned infants and children from immigrant populations. The aim of this work was to ascertain the vitamin D reserve in a population of native and immigrant children under the age of 6 years. Population and methods: A prospective study was conducted at a Primary Healthcare Centre in Salt (Girona). PATIENTS: 307 children with the following origin and race distribution: Caucasian (n = 85; 28%), Sub-Saharan (n = 101; 32.5%); Maghrebí (n = 87, 28.0%); Central-American (n = 20; 6.4%) and Indo-Pakistani (n = 14; 4.5%). The biochemistry blood parameters studied were: calcium, phosphorus, alkaline phosphatase, 25-hydroxivitamin D, and parathormone. A nutritional survey was used to estimate calcium and vitamin D intake and degree of sun exposure. RESULTS: Vitamin D deficiency (< 20 ng/ml) was detected in Caucasians (8%), Sub-Saharans (18%), Central-Americans (20%), Maghrebís (34.5%), and Indo-Pakistanis (64%). Of the children studied (n = 9), 2.9% had serious vitamin D deficiency (< 10 ng/ml); only one child of Sub-Saharan origin met the biochemical criteria for classical rickets. The prevalence of vitamin D deficiency was significantly higher in children not receiving vitamin D supplements in the first year of life. CONCLUSIONS: Plasma vitamin D concentrations were deficient in 22.5% of children under the age of six, being more prevalent in children of Indo-Pakistani and Maghrebí origin

Evaluación de la anemia ferropénica en niños menores de 6 años de edad de diferentes etnias / Evaluation of iron deficiency anemia in a population of different ethnic groups under 6 years

Introducción: La alta prevalencia de ferropenia en nuestro medio, así como el número elevado de población inmigrante con hábitos y culturas alimentarias diferentes, fundamentan un estudio para evaluar el estado nutricional y documentar la presencia de ferropenias secundarias a las diversas pautas de alimentación. Objetivos: Evaluar los parámetros antropométricos y las concentraciones plasmáticas de hemoglobina, ferritina y sideremia de cada etnia. Población y métodos: Estudio prospectivo realizado durante los años 2008-2010 en una consulta de pediatría de atención primaria, en una población de 307 niños de Salt (Girona), con una edad inferior a 6 años, de diferentes etnias: caucásicos (n= 85; 27,4%), magrebíes (n= 87; 28%), subsaharianos (n= 101; 32,5%), centroamericanos (n= 20; 6,4%) e indopakistaníes (n= 14; 4,5%). Los parámetros bioquímicos estudiados fueron la hematimetría, la sideremia y la ferritina. Resultados: El análisis de los parámetros antropométricos no demuestra diferencias significativas entre la población autóctona y la inmigrante. En el análisis bioquímico se pone de manifiesto un déficit de hierro (sideremia <50 µg/dL) (caucásicos 38,5%, magrebíes 51%, subsaharianos 43%, centroamericanos 35%, indopakistaníes 79%), un déficit de ferritina (<20 ng/mL) (caucásicos 10,5%, magrebíes 49%, subsaharianos 29%, centroamericanos 15% e indopakistaníes 85%) y un déficit de hemoglobina (<10,5 mg/mL) (caucásicos 3,7%, magrebíes 7%, subsaharianos 15%, centroamericanos 5% e indopakistaníes 21%). Conclusiones: No se ha detectado desnutrición con repercusión auxológica en las poblaciones evaluadas. Pero se aprecia un déficit de hierro, ferritina y hemoglobina en las poblaciones infantiles magrebí, subsahariana y, de forma más acusada, indopakistaní (AU)

Introduction: Due to the high prevalence of ferropenic diseases and the increase of different immigrant populations with their own eating habits, a population-based study was considered necessary in order to evaluate the nutritional status and document possible iron deficiencies secondary to each food culture. Study purpose: To evaluate the anthropometric parameters, the hemoglobin and ferritin plasmatic concentrations and the sideremy values in each ethnic group. Population and methods: Prospective study carried out from 2008 to 2010, in a paediatrician consultation working area. Population: 307 children from Salt (Girona) under the age of 6, Caucasian (n= 85; 27.4%), Moroccan (n= 87; 28%), Sub-Saharan African (n= 101; 32.5%), Central American (n= 20; 6.4%) and Indian-Paquistan (n= 14; 4.5%). Biochemical parameters: blood count, sideremy and ferritin values. Results: Analysis of anthropometric parameters did not show any relevant difference between the native and the immigrant population. The biochemical data showed a sideremy deficiency (<50 µg/dL) (Caucasian population 38.5%, Moroccan 51%, Sub-Saharan African 43%, Central American 35%, Indian-Paquistan 79%), a ferritin deficiency (<20 ng/mL) (Caucasian population 10.5%, Moroccan 49%, Sub-Saharan African 29%, Central American 15%, Indian-Paquistan 85%) and an hemoglobin deficiency (<10.5 mg/mL) (Caucasian population 3.7%, Moroccan 7%, Sub-Saharan African 15%, Central American 5%, Indian-Paquistan 21%). Conclusions: No auxologic malnutrition was detected in the studied population; however, there was a clear deficiency in sideremy, ferritin and hemoglobin in the child populations from Morocco and Sub-Saharan Africa, this being even more evident among the Indian-Paquistan population (AU)

[Plasma vitamin D levels in native and immigrant children under the age of 6 years of different ethnic origins]. / Niveles plasmáticos de vitamina D en población autóctona y en poblaciones inmigrantes de diferentes etnias menores de 6 años de edad.

INTRODUCTION: Nutritional rickets is an emergent disease in Spain, and occurs particularly in black and dark-skinned infants and children from immigrant populations. The aim of this work was to ascertain the vitamin D reserve in a population of native and immigrant children under the age of 6 years. POPULATION AND METHODS: A prospective study was conducted at a Primary Healthcare Centre in Salt (Girona). PATIENTS: 307 children with the following origin and race distribution: Caucasian (n=85; 28%), Sub-Saharan (n=101; 32.5%); Maghrebí (n=87, 28.0%); Central-American (n=20; 6.4%) and Indo-Pakistani (n=14; 4.5%). The biochemistry blood parameters studied were: calcium, phosphorus, alkaline phosphatase, 25-hydroxivitamin D, and parathormone. A nutritional survey was used to estimate calcium and vitamin D intake and degree of sun exposure. RESULTS: Vitamin D deficiency (<20 ng/ml) was detected in Caucasians (8%), Sub-Saharans (18%), Central-Americans (20%), Maghrebís (34.5%), and Indo-Pakistanis (64%). Of the children studied (n=9), 2.9% had serious vitamin D deficiency (< 10 ng/ml); only one child of Sub-Saharan origin met the biochemical criteria for classical rickets. The prevalence of vitamin D deficiency was significantly higher in children not receiving vitamin D supplements in the first year of life. CONCLUSIONS: Plasma vitamin D concentrations were deficient in 22.5% of children under the age of six, being more prevalent in children of Indo-Pakistani and Maghrebí origin.

Niveles plasmáticos de vitamina D en población autóctona y en poblaciones inmigrantes de diferentes etnias / Vitamin D plasma levels in the indigeous populaton and immigrant populations of different ethinicities

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Estudios españoles de crecimiento: situación actual, utilidad y recomendaciones de uso / Growth spanish studies: the current situation, their effectiveness and recommendations for their use

La monitorización del crecimiento infantil tiene, además de su utilidad clínica para el seguimiento de la salud infantil, una utilidad social, como indicador de los avances de equidad en el mundo. En España ha habido una larga tradición en la realización de estudios de crecimiento. Recientemente, 5 grupos que han efectuado estudios de crecimiento en la última década en las poblaciones de Andalucía, Barcelona, Bilbao, Madrid y Zaragoza han fusionado sus datos, lo que ha dado lugar a los estudios transversales españoles 2008 y 2010, y al estudio longitudinal español 1978/2000. Estos estudios han demostrado que las diferencias regionales de crecimiento en España han desaparecido y que han tenido lugar cambios seculares en las últimas décadas, de modo que la talla adulta se ha acercado a la de otros países europeos y americanos, manteniéndose por debajo de algunos países del centro y norte de Europa. Se han observado también diferencias entre los estudios españoles y el estudio multicéntrico de la Organización Mundial de la Salud (OMS), debido, entre otras razones, a los diferentes criterios para la selección de la muestra, «poblacional» en los estudios españoles, y «socioeconómico» y «nutricional» en el estudio de la OMS. En el momento actual, para la población española, es adecuado utilizar como estándares de referencia los estudios españoles integrados, tanto el transversal como el longitudinal. Dada la existencia de tendencias seculares, sería deseable continuar realizando en el futuro estudios transversales prospectivos, homogéneos metodológicamente, representativos de las distintas regiones, con una periodicidad de 10-15 años (AU)

The child growth assessment is useful not only for the follow up of children health but also for social purposes, as an indicator of the equity advances in the world. In Spain there has been a long tradition in carrying out growth studies. During the last decade five Spanish research groups have conducted studies among the population of Andalucía, Barcelona, Bilbao, Madrid and Zaragoza. They have combined their data and have produced the «Transversal Spanish Studies 2008 and 2010» and the «Longitudinal Spanish Study 1978/2000». These studies have showed that in Spain the regional differences on growth have disappeared, and that this has had a secular trend in the last decades. The Spanish adult height has approached to other European and American countries, still below some Centre and North European countries. There are some differences between the Spanish growth studies and the multicentric World Health Organization (WHO) growth study. This is due, among other reasons, to the different criteria that are used for the sample selection. In Spain the studies are based on the «population» criteria, whereas the WHO study is based on the «socioeconomic» and «nutritional» criteria. Currently for the Spanish population is appropriate to use, as standard reference, the Spanish multicentric studies, which are the transversal as well as the longitudinal studies. Due to the recent secular trend, it would be convenient to carry out, in the future, prospective transversal growth studies, methodologically homogeneous, representatives of the different Spanish regions, and preferably made every ten to fifteen years (AU)

[Spanish growth studies: the current situation, their effectiveness and recommendations for their use]. / Estudios españoles de crecimiento: situación actual, utilidad y recomendaciones de uso.

The child growth assessment is useful not only for the follow up of children's health but also for social purposes, as an indicator of the equity advances in the world. In Spain there has been a long tradition in carrying out growth studies. During the last decade five Spanish research groups have conducted studies among the population of Andalucía, Barcelona, Bilbao, Madrid and Zaragoza. They have combined their data and have produced the "Transversal Spanish Studies 2008 and 2010" and the "Longitudinal Spanish Study 1978/2000". These studies have showed that in Spain the regional differences on growth have disappeared, and that this has had a secular trend in the last decades. The Spanish adult height has approached to other European and American countries, still below some Centre and North European countries. There are some differences between the Spanish growth studies and the multicentric World Health Organization (WHO) growth study. This is due, among other reasons, to the different criteria that are used for the sample selection. In Spain the studies are based on the "population" criteria, whereas the WHO study is based on the "socioeconomic" and "nutritional" criteria. Currently for the Spanish population is appropriate to use, as standard reference, the Spanish multicentric studies, which are the transversal as well as the longitudinal studies. Due to the recent secular trend, it would be convenient to carry out, in the future, prospective transversal growth studies, methodologically homogeneous, representatives of the different Spanish regions, and preferably made every ten to fifteen years.

Valoración del peso, talla e IMC en niños, adolescentes y adultos jóvenes de la Comunidad Autónoma de Madrid / Evaluation of weight, height and BMI in children, adolescents and young adults from the Community of Madrid

Introducción: Recientemente se han fusionado los datos de 4 estudios de crecimiento realizados en poblaciones de Andalucía, Barcelona, Bilbao y Zaragoza, configurándose el estudio transversal español de crecimiento 2008.Con el objetivo de comprobar si existían o no diferencias entre la población de Madrid y las incluidas en el estudio español y de esta forma evaluar la aplicabilidad de este estándar de referencia también en nuestra comunidad autónoma, hemos realizado un estudio transversal en la Comunidad de Madrid valorando peso, talla e IMC en una muestra de sujetos. Pacientes y métodos: Hemos analizado una muestra de 6.463 sujetos (3.055 mujeres y 3.408 varones) con edades comprendidas entre 3 y 24 años. Todos estaban sanos, eran de raza caucásica y tenían origen español. Las diferencias entre los datos de Madrid y las poblaciones incluidas en el estudio transversal español 2008 se evaluaron mediante regresión lineal múltiple del logaritmo de la talla, el peso y el IMC ajustado por grupo de edad y por área geográfica de procedencia. Se ha utilizado el procedimiento de comparaciones múltiples de Tukey para los contrastes de los diferentes rangos de edad. El análisis estadístico se realizó mediante el paquete estadístico SAS versión 8.2. Resultados: Se exponen los valores de la media aritmética y desviación estándar de peso, talla e IMC por grupos de edades para varones y mujeres, así como su distribución percentilada. No encontramos diferencias de relevancia clínica para los valores de peso, talla e IMC de nuestra población y los correspondientes del estudio transversal español 2008. Respecto a otros estudios realizados hace más de 20 años observamos un incremento en los valores de todos los percentiles de peso y talla. Conclusiones: En resumen, los datos de referencia que ofrece el estudio español de crecimiento 2008 son aplicables en la Comunidad Autónoma de Madrid. Además teniendo en cuenta que la comparación de los estudios transversales recientes realizados en 5 comunidades autónomas (Andalucía, Aragón, Cataluña, Madrid y País Vasco) no mostraron diferencias significativas en las medias de los parámetros antropométricos de peso, talla, IMC, ni en la talla final, podría considerarse a la población española actual como una población homogénea desde el punto de vista antropométrico y extender por tanto la aplicabilidad del estudio español de crecimiento 2008 al resto del país (AU)

Introduction: The data of four growth studies involving populations from Andalusia, Barcelona, Bilbao and Zaragoza have recently been reported as part of the Spanish Cross-sectional Growth Study 2008 (SCGS).With the aim of detecting possible differences between the population of the Madrid region and those of the SCGS, and by so-doing assess the applicability of the conclusions of this reference work to the Madrid region, a cross-sectional study of the latter was undertaken, recording the weight, height and body mass index (BMI). Subjects and methods: We have analyzed 6463 subjects (3055 females and 3408 males) aged 3–24 years. All subjects were healthy, Caucasian, and of Spanish origin. Differences between the results of the Madrid and SCGS studies were sought by multiple linear regression analysis of the log of the height, weight and BMI data adjusted for age and geographical area. The Tukey multiple comparisons test was used to analyse differences in age ranges. All calculations were performed using SAS v. 8.2 software. Results: Means and standard deviations are provided for the weight, height and BMI of women and men; distributions by percentiles are also provided.No differences of clinical importance were seen in the weight, height or BMI between the subjects of the Madrid region and those of the SCGS. However, comparisons with the results of other studies performed more than 20 years ago revealed an increase in the weight and height values in all percentiles. Conclusions: In summary, the official Spanish SCGS reference data for 2008 are similar to those recorded for the Madrid region. Bearing in mind that recent cross-sectional studies undertaken in Andalusia, Aragon, Catalonia, the Basque Country and the present work show no significant differences in mean weights, heights or BMIs in any age group, nor in the final height attained by adults, the Spanish population would appear to be anthropometrically homogeneous. The conclusions of the SCGS may therefore be applicable to the entire country (AU)

[Evaluation of weight, height and BMI in children, adolescents and young adults from the Community of Madrid]. / Valoración del peso, talla e IMC en niños, adolescentes y adultos jóvenes de la Comunidad Autónoma de Madrid.

INTRODUCTION: The data of four growth studies involving populations from Andalusia, Barcelona, Bilbao and Zaragoza have recently been reported as part of the Spanish Cross-sectional Growth Study 2008 (SCGS). With the aim of detecting possible differences between the population of the Madrid region and those of the SCGS, and by so-doing assess the applicability of the conclusions of this reference work to the Madrid region, a cross-sectional study of the latter was undertaken, recording the weight, height and body mass index (BMI). SUBJECTS AND METHODS: We have analyzed 6463 subjects (3055 females and 3408 males) aged 3-24 years. All subjects were healthy, Caucasian, and of Spanish origin. Differences between the results of the Madrid and SCGS studies were sought by multiple linear regression analysis of the log of the height, weight and BMI data adjusted for age and geographical area. The Tukey multiple comparisons test was used to analyse differences in age ranges. All calculations were performed using SAS v. 8.2 software. RESULTS: Means and standard deviations are provided for the weight, height and BMI of women and men; distributions by percentiles are also provided. No differences of clinical importance were seen in the weight, height or BMI between the subjects of the Madrid region and those of the SCGS. However, comparisons with the results of other studies performed more than 20 years ago revealed an increase in the weight and height values in all percentiles. CONCLUSIONS: In summary, the official Spanish SCGS reference data for 2008 are similar to those recorded for the Madrid region. Bearing in mind that recent cross-sectional studies undertaken in Andalusia, Aragon, Catalonia, the Basque Country and the present work show no significant differences in mean weights, heights or BMIs in any age group, nor in the final height attained by adults, the Spanish population would appear to be anthropometrically homogeneous. The conclusions of the SCGS may therefore be applicable to the entire country.

[Spanish cross-sectional growth study 2008. Part I: weight and height values in newborns of 26-42 weeks of gestational age]. / Estudio transversal español de crecimiento 2008. Parte I: valores de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional.

INTRODUCTION: Gestational age and neonatal anthropometric parameters are related to neonatal and postnatal morbidity and mortality. SUBJECTS AND METHODS: Weight and vertex-heel length were evaluated in 9.362 caucasian newborns (4.884 males and 4.478 females) products of single pregnancies, 26-42 weeks of gestational age, born between 1999 and 2002 in Vall d'Hebron (Barcelona, Spain) and Miguel Servet (Zaragoza, Spain) Children's Hospitals. RESULTS: Mean and standard deviation and percentile distribution values of weight, and length according to sex and gestational age are presented. A progressive increase in these parameters with gestational age and a sexual dimorphism was observed from the 30 week of gestational age onwards, with statistically-significant differences (p<0.01) from 35 weeks of gestational age. At 38 and 42 weeks of gestational ages these differences were 170 g, 160 g, 0.8 cm and 0.9 cm respectively. An increase in weight and length values in relation to previous Spanish studies (1987-1992) was also documented. CONCLUSIONS: A sexual dimorphism in intrauterine anthropometric growth parameters was observed. These parameters change with time and may be updated.

[Spanish cross-sectional growth study 2008. Part II. Height, weight and body mass index values from birth to adulthood]. / Estudio transversal español de crecimiento 2008. Parte II: valores de talla, peso e índice de masa corporal desde el nacimiento a la talla adulta.

INTRODUCTION: In developed countries a secular trend in growth has been reported. Our aim was to evaluate weight, height and body mass index (BMI) values in a Spanish population coming from Andalusia, Barcelona, Bilbao and Zaragoza, and to compare these values with those obtained before 1988 (BIB 88 and CAT 87 studies). SUBJECTS AND METHODS: Cross-sectional evaluation of height, weight and BMI in 32,064 subjects (16,607 males and 15,457 females) from birth to adulthood between the years 2000 and 2004. Three subpopulations were evaluated: a) 5,796 (2,974 males, 2,822 females) newborns at term from normal gestations; b) 23,701 (12,358 males; 11,343 females) children and adolescents 0.25-18 years old, and c) 2,567 (1,275 males, 1,292 females) young adults 18.1-24 years of age. All were healthy caucasians, and their parents from Spanish origin. The LSM method was used. RESULTS: Mean, standard deviation, Skewness index and percentiles values with a 0.25-0.5 year-period intervals from birth to adulthood are reported. As regards the data obtained previously in Spanish populations, an increase of 1.8 cm, 1.4 cm and 3.3 cm were observed in adult height for percentiles 3, 50 and 97 in males respect to BIB 88 and 2.5 cm, 3.3 cm and 3.8 respect to CAT 87. In females these values were 3.5 cm, 2.5 cm and 4.2 cm respect to BIB 88 and 3.5 cm, 3.1 cm and 3.9 cm respect to CAT 87. The corresponding values for weight, in males, were increased in 5.4 kg, 6.2 kg and 11.7 kg respect to BIB 88 and 6.7 kg, 6.3 kg and 10.1 kg respect to CAT 87; in females these increased were 1.7 kg, 2,2 kg and 8.3 kg respect to BIB 88 and 1.8 kg, 2.4 kg and 3.6 kg respect to CAT 87. The corresponding increased for BMI values, in males, were 2.0, 1.4 and 3.9 respect to BIB 88 and 0.1, 0.2 and 5.3 respect to CAT 87; in females these values were 0.9, 0.4 and 3.7 respect to BIB 88 and 1.8, 0.1 and 4 respect to CAT 87. In young adults, 25 and 30 BMI values correspond to percentiles 80 and 97 in males, and 85 and 97 in females. Mean values of adult height were similar to those observed in other longitudinal and cross-sectional Spanish, European, and American studies, but lower than those reported for German, Swedish and Netherlands populations. CONCLUSIONS: A secular trend of growth was observed in our population with a non-proportional increased of weight to height ratio (BMI) values, particularly for those corresponding to the 97 percentile. The need of periodical updates of growth data used in the evaluation of children and adolescents is required.

Estudio transversal español de crecimiento 2008. Parte I: valores de peso y longitud en recién nacidos de 26-42 semanas de edad gestacional / Spanish cross-sectional growth study 2008. Part I: weight and height values in newborns of 26-42 weeks of gestational age

Introducción: La edad gestacional, el peso y la longitud al nacer son factores relacionados con la morbilidad y mortalidad en el período neonatal y en la vida adulta. Sujetos y métodos: Valoración del peso y la longitud vértice-talón al nacer, en 9.362 recién nacidos vivos de raza caucásica (4.884 varones y 4.478 niñas) y de gestaciones únicas (26-42 semanas de edad gestacional), nacidos entre 1999 y 2002 en el Hospital Materno-Infantil Vall d’Hebron de Barcelona y en el Hospital Materno-Infantil Miguel Servet de Zaragoza. Resultados: Valores de la media y desviación estándar, y distribución percentilada del peso y de la longitud en los recién nacidos de ambos sexos según su edad gestacional. Existe un incremento progresivo con la edad gestacional y un dimorfismo sexual a partir de la semana 30 de gestación con diferencias estadísticamente significativas entre ambos sexos para ambos parámetros (p < 0,01) a partir de la semana 35 de edad gestacional. A las 38 y 42 semanas de edad gestacional los valores de la media para el peso y para la longitud son, respectivamente, 170 y 160 g, y 0,8 y 0,9 cm superiores en los varones que en las niñas. También se observó un incremento en los valores de la media de peso y longitud respecto a estudios previos (1987-1992). Conclusiones: Existe un dimorfismo sexual en el peso y la longitud de los recién nacidos pretérmino y a término. Estos parámetros cambian con el tiempo y deben ser revisados periódicamente (AU)

Introduction: Gestational age and neonatal anthropometric parameters are related to neonatal and postnatal morbidity and mortality. Subjects and methods: Weight and vertex-heel length were evaluated in 9.362 caucasian newborns (4.884 males and 4.478 females) products of single pregnancies, 26-42 weeks of gestational age, born between 1999 and 2002 in Vall d’Hebron (Barcelona, Spain) and Miguel Servet (Zaragoza, Spain) Children’s Hospitals. Results: Mean and standard deviation and percentile distribution values of weight, and length according to sex and gestational age are presented. A progressive increase in these parameters with gestational age and a sexual dimorphism was observed from the 30 week of gestational age onwards, with statistically-significant differences (p < 0.01) from 35 weeks of gestational age. At 38 and 42 weeks of gestational ages these differences were 170 g, 160 g, 0,8 cm and 0,9 cm respectively. An increase in weight and length values in relation to previous Spanish studies (1987-1992) was also documented. Conclusions: A sexual dimorphism in intrauterine anthropometric growth parameters was observed. These parameters change with time and may be updated (AU)

Estudio transversal español de crecimiento 2008. Parte II: valores de talla, peso e índice de masa corporal desde el nacimiento a la talla adulta / Spanish cross-sectional growth study 2008. Part II. Height, weight and body mass index values from birth to adulthood

Introducción: En las sociedades desarrolladas existe una aceleración secular del crecimiento. Entre los años 2000 y 2004 hemos valorado el crecimiento en una población caucásica española procedente de Andalucía, Barcelona, Bilbao y Zaragoza y hemos comparado los resultados con estudios españoles realizados antes de 1988 en poblaciones caucásicas de Bilbao (BIB 88) y Cataluña (CAT 87). Sujetos y métodos: Estudio transversal que valora el peso, la longitud y el índice de masa corporal (IMC) en 32.064 sujetos (16.607 varones y 15.457 mujeres) desde el nacimiento a la talla adulta: a) 5.796 son recién nacidos a término (2.974 varones y 2.822 mujeres) hijos de madres sanas, de gestaciones únicas; b) 23.701 son niños y adolescentes (12.358 varones y 11.343 mujeres) de 0,25 a 18 años de edad ambos inclusive, y c) 2.567 son adultos jóvenes (1.275 varones y 1.292 mujeres) de 18,1 a 24 años de edad. Todos estaban sanos, eran de raza caucásica y sus padres, de origen español. La distribución percentilada, el valor z-score y el diseño de las gráficas se ha realizado según el método LMS. Resultados: Se expresan los valores de la media, desviación estándar, coeficiente de Skewness y percentiles desde el nacimiento a la edad adulta, en intervalos de 0,25-0,50 años. Existe un dimorfismo sexual y un incremento en los valores de peso y talla de todos los percentiles respecto a los estudios BIB 88 y CAT 87. Los valores de los percentiles 3, 50 y 97 de la talla adulta son superiores en 1,8, 1,4 y 3,3 cm respecto a BIB 88, y en 2,5, 3,3 y 3,8 cm respecto a CAT 87 en los varones, y 3,5, 2,5 y 4,2 cm respecto a BIB 88 y 3,5, 3,1 y 3,9 cm respecto a CAT 87 en las mujeres. Los correspondientes valores de peso son 5,4, 6,2 y 11,7 kg superiores a los de BIB 88 y 6,7, 6,3 y 10,1 kg superiores a los de CAT 87 en los varones y 1,7, 2,2 y 8,3 kg superiores a los de BIB 88, y 1,8, 2,4 y 3,6 kg superiores CAT 87 en las mujeres. Los respectivos incrementos en el IMC son 2,0, 1,4 y 3,9 respecto a BIB 88 y –0,1, –0,2 y 5,3 respecto a CAT 87 en los varones y 0,9, 0,4 y 3,7 respecto a BIB 88 y –1,8, –0,1 y 4,0 respecto a CAT 87, en las mujeres. Los valores del IMC de 25 y 30 “en la edad adulta” corresponden a los percentiles 80 y 97 en los varones y 85 y 97 en las mujeres. En ambos sexos los valores de la talla media adulta son similares a los observados en otros estudios longitudinales y transversales españoles recientes y a los observados en estudios europeos y americanos, aunque inferiores a los de la población alemana, sueca y holandesa. Conclusiones: Con relación a estudios españoles previos, existe una aceleración secular de peso y talla, con un incremento desproporcionado en los valores del IMC correspondientes al percentil 75 o superiores, y de forma marcada en los del percentil 97. Este estudio muestra la necesidad de actualizar periódicamente los datos de referencia utilizados en la valoración del crecimiento durante la infancia y adolescencia (AU)

Introduction: In developed countries a secular trend in growth has been reported. Our aim was to evaluate weight, height and body mass index (BMI) values in a Spanish population coming from Andalusia, Barcelona, Bilbao and Zaragoza, and to compare these values with those obtained before 1988 (BIB 88 and CAT 87 studies). Subjects and methods: Cross-sectional evaluation of height, weight and BMI in 32,064 subjects (16,607 males and 15,457 females) from birth to adulthood between the years 2000 and 2004. Three subpopulations were evaluated: a) 5,796 (2,974 males, 2,822 females) newborns at term from normal gestations; b) 23,701 (12,358 males; 11,343 females) children and adolescents 0.25-18 years old, and c) 2,567 (1,275 males, 1,292 females) young adults 18.1-24 years of age. All were healthy caucasians, and their parents from Spanish origin. The LSM method was used. Results: Mean, standard deviation, Skewness index and percentiles values with a 0.25-0.5 year-period intervals from birth to adulthood are reported. As regards the data obtained previously in Spanish populations, an increase of 1.8 cm, 1.4 cm and 3.3 cm were observed in adult height for percetiles 3, 50 and 97 in males respect to BIB 88 and 2.5 cm, 3.3 cm and 3.8 respect to CAT 87. In females these values were 3.5 cm, 2.5 cm and 4.2 cm respect to BIB 88 and 3.5 cm, 3.1 cm and 3.9 cm respect to CAT 87. The corresponding values for weight, in males, were increased in 5.4 kg, 6.2 kg and 11.7 kg respect to BIB 88 and 6.7 kg, 6.3 kg and 10.1 kg respect to CAT 87; in females these increased were 1.7 kg, 2,2 kg and 8.3 kg respect to BIB 88 and 1.8 kg, 2.4 kg and 3.6 kg respect to CAT 87. The corresponding increased for BMI values, in males, were 2.0, 1.4 and 3.9 respect to BIB 88 and –0.1, –0.2 and 5.3 respect to CAT 87; in females these values were 0.9, 0.4 and 3.7 respect to BIB 88 and –1.8, –0.1 and 4 respect to CAT 87. In young adults, 25 and 30 BMI values correspond to percentiles 80 and 97 in males, and 85 and 97 in females. Mean values of adult height were similar to those observed in other longitudinal and cross-sectional Spanish, European, and American studies, but lower than those reported for German, Swedish and Netherlands populations. Conclusions: A secular trend of growth was observed in our population with a non-proportional increased of weight to height ratio (BMI) values, particularly for those corresponding to the 97 percentile. The need of periodical updates of growth data used in the evaluation of children and adolescents is required (AU)

[Hepatomegaly due to glycogen storage disease and type 1 diabetes mellitus]. / Hepatomegalia por depósito de glucógeno hepático y diabetes mellitus tipo 1.

Patients with type 1 diabetes and poor metabolic control can develop hepatomegaly due to intrahepatic glycogen deposition. If these patients also have elevated liver enzymes, dyslipidemia, cushingoid features and delayed growth or sexual maturation, Mauriac syndrome can be diagnosed. This disorder is common and reversible with optimization of insulin therapy. We report three adolescents with type 1 diabetes and a long-standing history of poor glycemic control, who developed hepatomegaly, elevated liver enzymes and dyslipidemia with preserved liver function. One of these patients also had delayed growth and another had hypogonadotropic hypogonadism. Liver ultrasound showed changes suggestive of glycogenosis. In all three patients, optimization of insulin therapy achieved good glycemic control and reversed the manifestations within 2 weeks. The etiology of Mauriac syndrome is controversial since both prolonged hyperglycemia and hyperinsulinization produce glycogen accumulation in the liver. Hypercortisolism (due to ketosis or hypoglycemia) contributes to glycogen storage and also causes growth and sexual maturation delay.

Hepatomegalia por depósito de glucógeno hepático y diabetes mellitus tipo 1 / Hepatomegaly due to glycogen storage disease and type 1 diabetes mellitus

Los pacientes diabéticos tipo 1 con mal control metabólico pueden desarrollar hepatomegalia secundaria al depósito de glucógeno intrahepático. Si además presentan hipertransaminasemia, dislipemia, rasgos cushingoides, y retraso del crecimiento y del desarrollo puberal podemos hablar de síndrome de Mauriac. Este síndrome es frecuente y reversible con la optimización del tratamiento insulínico. Presentamos 3 adolescentes diabéticos tipo 1 de larga evolución con mal control metabólico que manifestaron hepatomegalia, hipertransaminasemia y dislipemia con funcionalismo hepático normal. Uno de ellos presentó retraso de crecimiento y otro hipogonadismo hipogonadotropo. Las ecografías hepáticas mostraron glucogenosis. El cuadro revirtió en todos ellos con la optimización de la insulinoterapia manteniendo controles glucémicos normales en el plazo de 2 semanas. La etiología del síndrome Mauriac es controvertida pues tanto la hiperglucemia mantenida como la hiperinsulinización producen glucogenosis. La hipercortisolemia también (fruto de la cetosis o hipoglucemia) y además produce retraso de crecimiento y del desarrollo puberal

Patients with type 1 diabetes and poor metabolic control can develop hepatomegaly due to intrahepatic glycogen deposition. If these patients also have elevated liver enzymes, dyslipidemia, cushingoid features and delayed growth or sexual maturation, Mauriac syndrome can be diagnosed. This disorder is common and reversible with optimization of insulin therapy. We report three adolescents with type 1 diabetes and a long-standing history of poor glycemic control, who developed hepatomegaly, elevated liver enzymes and dyslipidemia with preserved liver function. One of these patients also had delayed growth and another had hypogonadotropic hypogonadism. Liver ultrasound showed changes suggestive of glycogenosis. In all three patients, optimization of insulin therapy achieved good glycemic control and reversed the manifestations within 2 weeks. The etiology of Mauriac syndrome is controversial since both prolonged hyperglycemia and hyperinsulinization produce glycogen accumulation in the liver. Hypercortisolism (due to ketosis or hypoglycemia) contributes to glycogen storage and also causes growth and sexual maturation delay

[Idiopathic short stature: definition and treatment]. / Talla baja idiopática: definición y tratamiento.

Short stature is the leading cause of consultation in Pediatric Endocrinology. Decreased growth velocity and abnormally short height are characteristic of several different nosologic entities. Some are well characterized, while others correspond to what is known as idiopathic short stature (ISS). ISS includes children who grow less than 2 SD of the mean height values corresponding to their peers of similar age and the same sex, in whom the known causes of short stature have been ruled out. The diagnosis of ISS does not include children who only present a constitutional delay in growth and development. Several clinical trials have demonstrated the efficacy of growth hormone (rhGH) treatment in achieving catch-up growth in these children. Therefore, ISS should be kept in mind in the diagnosis of patients with short stature and abnormal growth patterns, who may benefit from rhGH treatment.

Talla baja idiopática: definición y tratamiento / Idiopathic short stature: definition and treatment

La talla baja es el motivo de consulta más frecuente en las consultas de endocrinología pediátrica. Diferentes entidades nosológicas se caracterizan por una disminución de la velocidad de crecimiento y una talla anormalmente baja. Unas están bien caracterizadas; otras corresponden a la denominada talla baja idiopática (TBI). Ésta abarca a los niños que presentan un crecimiento por debajo de ­2 DE de los valores de la talla media correspondiente a los niños de su población de similar edad y sexo, en los que se han descartado las causas conocidas de talla baja. No incluye a aquellos niños que presentan únicamente un retraso constitucional del crecimiento y el desarrollo. Diferentes ensayos clínicos demuestran la eficacia del tratamiento con hormona de crecimiento (rhGH) para que estos niños consigan un crecimiento recuperador. Por ello, la TBI debe considerarse como una entidad que se debe tener en cuenta en el diagnóstico de un paciente con talla baja y patrón de crecimiento anómalo que puede beneficiarse del tratamiento con rhGH

Short stature is the leading cause of consultation in Pediatric Endocrinology. Decreased growth velocity and abnormally short height are characteristic of several different nosologic entities. Some are well characterized, while others correspond to what is known as idiopathic short stature (ISS). ISS includes children who grow less than 2 SD of the mean height values corresponding to their peers of similar age and the same sex, in whom the known causes of short stature have been ruled out. The diagnosis of ISS does not include children who only present a constitutional delay in growth and development. Several clinical trials have demonstrated the efficacy of growth hormone (rhGH) treatment in achieving catch-up growth in these children. Therefore, ISS should be kept in mind in the diagnosis of patients with short stature and abnormal growth patterns, who may benefit from rhGH treatment

Hemiagenesia tiroidea diagnosticada a los cinco meses de edad / Thyroid hemiagenesia diagnosed in a 5-month-old infant

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[Glycogen storage disease type IX presenting as abdominal distention, hepatomegaly and hypoglycemia during infancy]. / Hepatomegalia, distensión abdominal e hipoglucemia en un lactante: expresión clínica de la glucogenosis tipo IX.

Glycogen storage diseases are a rare group of disorders in daily pediatric practice but must be taken into account when a patient presents with poor physical growth, hepatomegaly, hypoglycemia, hypotonia and/or other metabolic disturbances. Early diagnosis allows treatment that might improve the patient's outcome to be started or, at the very least, genetic counseling to be given to the parents. We present a 10-month-old boy who presented with growth retardation, abdominal distention and hepatomegaly and who was finally diagnosed with glycogenosis type IX. Definitive diagnosis was obtained by demonstrating the enzyme defect (phosphorylase beta-kinase) in affected tissues. Enteral nutrition was started using a diurnal high-carbohydrate diet with frequent feedings and nocturnal nasogastric continuous feeding, achieving optimal growth parameters and clinical response.

Hepatomegalia, distensión abdominal e hipoglucemia en un lactante: expresión clínica de la glucogenosis tipo IX / Glycogen storage disease type IX presenting as abdominal distention, hepatomegaly and hypoglycemia during infancy

Las glucogenosis son entidades poco frecuentes en la práctica diaria de un pediatra, pero deben tenerse en cuenta ante todo paciente que se presente con retraso del crecimiento, hepatomegalia, hipoglucemia, alteración del tono muscular y/o alteraciones en el estudio metabólico. La importancia de su diagnóstico precoz puede permitir iniciar un tratamiento con el cual poder mejorar el pronóstico del paciente o, en el peor de los casos, ofrecer a la familia un consejo genético adecuado. Se comenta el caso de un lactante de sexo masculino de 10 meses de edad que presentaba un cuadro de estancamiento ponderal, distensión abdominal y hepatomegalia. El diagnóstico de glucogenosis tipo IX se confirmó mediante la demostración de la ausencia de actividad enzimática de la fosforilasa -cinasa, enzima alterada en esta entidad. Se inició alimentación enteral mediante gastroclisis continua nocturna y dieta diurna rica en hidratos de carbono con buena respuesta clínica y recuperación de los parámetros somatométricos (AU)