Anemia and iron deficiency among schoolchildren in the Aral Sea region,Kazakhstan

The objectives of this study were to estimate the prevalence of anemia and iron deficiency among schoolchildren in the Aral Sea region of Kazakhstan and to determine the various factors associated with anemia in this population. We conducted a cross-sectional study of randomly selected schoolchildren. Blood samples were collected for measuring hemoglobin (Hb), serum ferritin (SF), total iron binding capacity (TIBC), and other hematological indices, and subjects were screened for anemia and iron deficiency. Associations between Hb concentration and SF, TIBC, anthropometric, and socioeconomic data were evaluated using regression analysis. The prevalence of anemia was 49.8 per cent although levels were mostly mild. Twenty-two per cent of the children were iron depleted (SF < 12 microg/l). Of the anemic children, 32.4 per cent were found to have iron deficiency anemia (anemia with SF < 12 microg/l). There were significant positive correlations between the levels of Hb and SF, but a negative correlation with serum TIBC. Age, mean corpuscular volume (MCV) and SF were found to be significantly related to Hb by stepwise multiple regression analysis. Multiple logistic regression analysis revealed that anemia was independently related to living district, education of father, and child's age. The results suggest that iron deficiency is an important determinant of anemia in this population; however, whole anemia cannot be solely explained by iron deficiency. Further studies are needed for consideration of micronutrients status, parasite infestation, hereditary disorders, and exposure to environmental pollutants.     

A cross-sectional study of growth, puberty and endocrine function in patients with thalassaemia major in Hong Kong

Methodology: A cross-sectional study of growth, puberty and endocrine function was performed on 35 girls and 33 boys with thalassaemia major.
Results Despite regular transfusion and chelation therapy, 75% of the girls and 62% of the boys over the age of 12 years were below the third percentile for height. Hypogonadotropic hypogonadism was found in a similar percentage of patients. Moderate to marked zinc deficiency secondary to chelation therapy was considered unlikely because normal serum zinc levels were found in all but three of our patients, but we could not exclude the possibility of a marginal status of zinc nutrition causing growth failure. Growth hormone deficiency and diabetes mellitus were sometimes encountered but hypothyroidism, hypoparathyroidism and adrenal insufficiency were rare among our patients. Most of the patients with growth failure had normal growth hormone (GH) response to insulin induced hypoglycaemia. The serum insulin-like growth factor-1 (IGF-1) levels were low in our patients and no significant difference in the serum IGF-1 levels was found between prepubertal children with or without growth failure (0.4±0.1 mU/mL vs 0.37±0.11 mU/mL, P = 0.39). Similarly, no difference in the serum IGF-1 levels was found between pubertal children with or without growth failure (0.48 ± 0.2 U/mL vs 0.56 ±0.14 U/mL, P= 0.26).
Conclusions Delayed sexual maturation and a possible defect in growth unrelated to the GH-IGF-1 axis may be responsible for the growth failure in adolescent children with thalassaemia major.     

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目的探讨血清生长激素(GH)、胰岛素样生长因子-1(IGF-1)及尿GH检测对矮小儿童诊断的意义。方法华中科技大学同济医院儿科于2004-11—2005-06对106例矮小儿童进行垂体功能复合刺激试验,试验前收集所有受试者夜间12h(2000~800)尿。另选取19例正常青春发育期前儿童为对照组。对垂体功能复合刺激试验GH分泌异常的56例矮小儿童,用ELISA方法检测相应的血清GH、IGF-1及尿中GH水平,并进行相关分析。结果根据垂体功能复合刺激试验的GH检测结果将矮小儿分类,包括完全性GH缺乏症(cGHD)25例、部分性GH缺乏症(pGHD)9例和GH神经分泌功能障碍(GHND)22例。GHD组患儿血清IGF-1、尿GH水平与正常儿相比明显降低(P<0·01)。pGHD和GHND组患儿血IGF-1水平波动较大,无统计学差异。GHND组患儿尿GH水平按ng/g肌酐(Cr)计量显著低于正常对照相(P<0·05),而按ng/12h尿量计算值虽低于正常组,但无统计学意义(P>0·05)。pGHD组患儿尿GH水平按两种方法计量值均介于正常和GHD患者之间,与正常及GHD患者比较均有显著性差异(P均<0·05)。cGHD和pGHD组患儿尿GH的ng/gCr计量值与其血GH峰值呈显著性正相关(rcGHD=0·556,P<0·05;rpGHD=0·423,P<0·05),GHND组患儿尿GH的ng/gCr计量值与其血中GH峰值无相关性(P>0·05)。结论尿GH水平测定无创、简便,配合IGF-1等指标的检测,对于矮小儿童的诊断和鉴别诊断具有重要意义。     

宫内发育迟缓儿脐血胰岛素样生长因子-1、胰岛素和生长激素水平测定及意义

目的：研究宫内发育迟缓(IUGR)的发生与脐血中胰岛素样生长因子-1（IGF-1）、胰岛素（INS）和生长激素（GH）的关系,以探讨内分泌环境对胎儿IUGR的影响。方法：选择新生儿63例（男37例,女26例）,根据出生体重分为IUGR组(n=33)和正常出生体重组(对照组,n=30)。测定并比较两组脐血中IGF-1、INS和GH的含量。结果：①IUGR组脐血中IGF-1和INS的水平均明显低于对照组, GH的水平明显高于对照组(P<0.05)。②相关分析显示出生体重与脐血中IGF-1水平呈正相关(r=0.625,P<0.01),与GH水平呈负相关(r=-0.257,P<0.05);胎龄与脐血中IGF-1水平呈正相关(r=0.271,P<0.05)。③多元线性逐步回归分析显示脐血IGF-1和INS水平是影响出生体重的重要因素。结论：内分泌环境调控胎儿的生长发育,脐血中的IGF-1和INS水平对胎儿体重有影响,IGF-1水平低下可能是导致IUGR 的原因之一。［中国当代儿科杂志,2010,12（10）：771-773］     

Non-nutritive sucking does not increase blood levels of gastrin, motilin, insulin and insulin-like growth factor 1 in premature infants receiving enteral feedings

Non-nutritive sucking in premature infants accelerates weight gain for unclear reasons. The effects of non-nutritive sucking on enteral hormone secretion may augment digestion and/or absorption of nutrients. Blood concentrations of gastrin, motilin, insulin and insulin-like growth factor-1 were measured before and 72 h after the initiation of nasogastric feedings in 21 premature infants randomly assigned to either a non-nutritive suckling or control group. Gastrin and motilin concentrations increased significantly after feedings in all infants (mean +/- SEM) (gastrin, 41 +/- 4 to 73 +/- 9 pg/ml, p < 0.01; motilin, 141 +/- 5 to 181 +/- 3 pg/ml, p < 0.01) Pre- and post-feed insulin concentrations were greater in the non-nutritive sucking group receiving bolus feeds than in control infants who were bolus-fed (P < 0.01). Non-nutritive sucking in premature infants does not appear to alter blood concentrations of motilin, gastrin, insulin or insulin-like growth factor-1 three days after initiation of feedings. If changes in the secretion of these hormones are induced by non-nutritive sucking, they may be at a local paracrine level.     

胰岛素样生长因子-1(IGF-1)对缺氧缺血脑损伤新生鼠内源性IGF-1和IGF-1受体基因表达的影响

目的　胰岛素样生长因子 1(IGF 1)对损伤的神经组织有修复作用 ,但外源性IGF 1是否会抑制内源性IGF 1、IGF 1受体的生成 ,从而减弱IGF 1的神经保护作用尚不明确。本文通过观察IGF 1治疗新生大鼠缺血缺氧脑损伤 (HIBD)后脑IGF 1和IGF 1受体mRNA水平的变化 ,研究IGF 1对HIBD新生大鼠内源性IGF 1、IGF 1受体的影响。方法　制作新生大鼠HIBD模型 ,用原位杂交方法观察HIBD后各时间点海马和大脑皮层IGF 1和IGF 1受体基因表达的动态变化 ,并比较IGF 1治疗组与未治疗组HIBD后 12h、72hIGF 1、IGF 1受体mRNA的表达水平。结果　HIBD后 4 8h海马IGF 1和IGF 1受体mRNA开始升高 ,72h达高峰。损伤后 12 0h ,IGF 1mRNA降至正常水平 ,而IGF 1受体mRNA仍处于较高水平。在皮层 ,IGF 1和IGF 1受体mRNA开始升高时间稍早于海马 ,2 4h上升 ,96h降至正常 ,但是上升幅度相对较小。与未治疗组比较 ,IGF 1治疗后内源性IGF 1表达无明显变化。IGF 1受体的表达在治疗后 12h无明显差别 ,但在 72h时显著增加。结论　HIBD后皮层、海马等脑损伤区的IGF 1和IGF 1受体表达均升高。给予外源性IGF 1后并不降低内源性IGF 1的表达 ,还能刺激IGF 1受体表达增加。     

Effects of in utero exposure to 2,2',4,4',5,5'-hexachlorobiphenyl (PCB 153) on somatic growth and endocrine status in rat offspring

Exposure to polychlorobiphenyl (PCB) mixtures at an early stage of development has been reported to affect endocrine glands; however, little is known about the precise toxicological properties of individual PCB. The present study was undertaken to determine whether prenatal exposure to 2,2',4,4',5,5'-hexachlorobiphenyl (PCB 153), a di-ortho-substituted non-coplanar congener, affects postnatal development in rat offspring. Pregnant Sprague-Dawley rats (Crj: CD (SD) IGS) were given PCB 153 (0, 16, or 64 mg/kg/day) orally from gestational day (GD) 10 through GD 16, and developmental parameters in the male and female offspring were examined. We found no dose-dependent changes in body weight, body length (nose-anus length), tail length, or the weights of kidneys, testes, ovaries and uterus in offspring at 1 or 3 weeks of age. Liver weights were increased in the PCB 153-treated groups, although we observed a significant difference only in males. Anogenital distance was unaffected in the PCB 153-treated groups. We observed a significant dose-dependent decrease in the plasma concentrations of thyroxine and tri-iodothyronine, whereas those of thyroid-stimulating hormone were not significantly changed. In addition, there were no dose-dependent changes in plasma concentrations of growth hormone and insulin-like growth factor-I in any dose group. These findings suggest that prenatal exposure to PCB 153 (GD 10-16, 16-64 mg/kg/day) may alter the thyroid status in rat offspring to some extent without affecting somatic growth or its related hormonal parameters.     

早产儿胃食管反流与表皮生长因子和胰岛素样生长因子-I关系的探讨

目的观察早产儿胃食管反流(GER)血清中胰岛素样生长因子I(IGF-I)以及血清和胃液中表皮生长因子(EGF)的水平变化,探讨IGF-I及EGF对新生儿胃肠运动功能的影响。方法用24h食管pH监测仪测定46例早产儿,15例无GER早产儿作为对照组,放免法测定血清IGF-I、EGF及胃液EGF的含量。结果不同程度GER患儿IGF-I水平与正常对照组比较均无明显差异(P>0.05),中重度胃食管反流早产儿血清、胃液EGF水平较正常对照组显著下降(P<0.01)。结论早产儿GER发生的程度与EGF含量有关,IGF-I水平与GER发生无关。EGF作为一种胃肠激素,对早产儿胃肠运动功能有明显影响。     

Demography, auxology and response to recombinant human growth hormone treatment in girls with Turner's syndrome in the Kabi Pharmacia International Growth Study

Demographic and auxological data were analysed from 818 girls with Turner's syndrome treated with recombinant human growth hormone (GH) and entered into the Kabi Pharmacia International Growth Study. Size at birth was low and correlated with the heights of both parents. The median age at start of GH treatment was 11.4 years and the parents had a median height SDS of -2.9. Height SDS at the start of treatment correlated with parental heights. Height velocities conformed to Turner-specific standards. The weight-for-height index increased sharply above 9 years of age. The frequency of spontaneous appearance of Tanner breast stage 2 was high (34.1% of girls > 10 years of age). Bone age (Greulich and Pyle) data were described by the equation: bone age = 1.61 (chronological age) -0.04(chronological age)² - 3.61. This equation was used to correct adult height predictions. The median initial dose of GH was 0.8 IUkglweek and was maintained during the first 3 years of treatment. The median frequency of injections was six/week. Height velocity increased from 4.1 to 6.8 cm/year in the first year, and height velocity SDS for chronological age remained positive for 4 years. The height prediction corrected for bone age increased over the first 2 years only. Differences in demography and auxology were described according to karyotype and country of origin. A greater height velocity SDS was observed at higher GH doses and when oxandrolone was used concomitantly.     

Arm span, serum IGF-1 and IGFBP-3 levels as screening parameters for the diagnosis of growth hormone deficiency in patients with myelomeningocele – preliminary data

Short stature is a common problem in patients with myelomeningocele (MMC) and hydrocephalus. We evaluated auxological and laboratory parameters to differentiate short stature due to neurological defect from short stature additionally caused by growth hormone deficiency (GHD). In a group of 38 prepubertal patients with MMC and hydrocephalus aged 3.8–11.0 years, auxological parameters, including arm span and bone age, and serum insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels were measured. Patients with normal supine length (n = 15) had normal arm span. Serum IGF-1 and IGFBP-3 levels were normal (≥ 10th percentile) in 14/15 patients. Twenty-three MMC patients had short stature (height SDS < −2), 11/23 patients had reduced arm span (SDS < −2), and 12/23 had normal arm span. Serum IGF-1 and IGFBP-3 levels were normal in 10/12 of short statured patients with normal arm span, but low (<10th percentile) in those patients with reduced arm span (IGF-1: 8/11 patients, P<0.05; IGFBP-3: 9/11 patients, P<0.005). In 7/11 short statured MMC patients with reduced arm span and low serum IGF-1 and IGFBP-3 levels, growth hormone secretion was investigated. All had a disturbed growth hormone secretion (GHD: n = 4; neurosecretory dysfunction: n = 3). Conclusion Arm span, serum IGF-1 and IGFBP-3 levels are estimated to be appropriate screening parameters for GHD in patients with MMC. Initiating growth hormone therapy should be considered not only according to endocrine findings but also with respect to neurological and orthopaedic anomalies. Received: 27 March 1997 / Accepted: revised form 18 September 1997     

Ghrelin levels in obesity and anorexia nervosa: effect of weight reduction or recuperation

OBJECTIVE: To study the influence of dietary intervention on plasma ghrelin levels in obese children and adolescents with anorexia nervosa (AN).Study design Prepubertal obese children (n=16) and 16 anorexic adolescents were studied at three different points: clinical diagnosis and after a reduction or recuperation of 25% and 50% of the initial BMI SD score. Controls included 21 Tanner growth stage 1 and 36 Tanner growth stage 5 subjects. We analyzed plasma ghrelin levels and their correlation with plasma levels of leptin, insulin, insulin-like growth factor I (IGF-I), insulin-like growth factor binding protein 1 (IGFBP-1), insulin-like growth factor binding protein 2 (IGFBP-2), insulin-like growth factor binding protein 3 (IGFBP-3), and integrated concentration of growth hormone (ICGH) before and after dietary intervention. RESULTS: At diagnosis, ghrelin levels were significantly decreased in obese children (52% of control levels) and significantly increased in adolescents with AN (164% of control levels). After dietary intervention, ghrelin increased in obese patients but without reaching control levels even after a 50% reduction in body mass index (BMI). In adolescents with AN, ghrelin levels normalized after a 25% increase in BMI. Ghrelin correlated negatively with the BMI and positively with IGFBP-1 levels in controls but not in obese patients or in patients with AN at diagnosis. The positive correlation between ghrelin and IGFBP-1 was recovered after dietary intervention. CONCLUSIONS: Plasma ghrelin levels present opposite changes in obesity and AN after dietary intervention, suggesting that ghrelin is a good marker of nutritional status.     

Growth hormone in T-lymphocyte thymic and postthymic development: a study in HIV-infected children

OBJECTIVES: Growth hormone (GH) plays a role in thymic function, and recombinant GH may stimulate thymopoiesis in HIV-infected individuals. We performed immunologic analyses in 26 antiretroviral-treated children matched for age, pubertal status, clinical parameters, and antiretroviral exposure who did or did not show an impaired response to GH-release stimulation tests with arginine + GH-releasing hormone. RESULTS: The following abnormalities were found in GH-deficient compared with GH-nondeficient children after >4 years of therapy: CD4 count ( P = .02) and percentage ( P = .03), CD4 as percentage of normal cells for age ( P = .003), serum interleukin-7 concentration ( P = .02), and thymic volume ( P = .01). Naive CD4 (4+62+RA+ and 4+CCR7+RA+) and CD8 (8+CCR7+RA+) lymphocytes were lower in GH-deficient children ( P = .003; P = .007; and P = .02, respectively). Postthymic pathways were also impaired in GH-deficient children. Thus, central memory (4+CCR7+RA-) CD4+ cells were reduced ( P = .006), whereas effector memory (4+CCR7-RA-) CD4+ cells ( P = .002) and late effector CD8+ lymphocytes (8+CCR7-RA+ and 8+27-28-) ( P = .009 and P = .002, respectively) were increased in these children. CONCLUSIONS: Growth hormone plays a role in thymic and postthymic pathways, and defective GH production may be associated with incomplete immunoreconstitution. Immunomodulant agents (including GH) could be useful in patients with defective GH production.     

Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise

OBJECTIVES: To assess subclinical inflammation, fasting insulin, and endothelial function before and after exercise in overweight children and adolescents. STUDY DESIGN: Twenty-five children (body mass index [BMI] >85th percentile) were assessed for brachial artery flow-mediated dilation (FMD), nitroglycerin-induced dilation, C-reactive protein (CRP), lipids, glucose, insulin, oral glucose tolerance, body composition, aerobic fitness (peak oxygen uptake [VO 2 peak]), and blood pressure. Twenty of these persons were equally and randomly assigned to either 8 weeks of stationary cycling or to a non-exercising control group. RESULTS: A baseline correlation was found between CRP and fasting insulin (r = 0.62; P < .001), which remained significant after adjusting for baseline variables (r = 0.53; P < .05). After 8 weeks, significant improvements were observed in the exercise group compared with the control group for VO 2 peak (exercise group = 21.8 +/- 2.1 to 23.2 +/- 1.5 mL/kg/minute vs control group = 23.4 +/- 1.6 to 20.9 +/- 2.2 mL/kg/minute; P < .05), high-density lipoprotein (HDL) cholesterol (exercise group = 1.02 +/- 0.03 to 1.10 +/- 0.04 mmol/L vs control group = 1.08 +/- 0.07 to 0.99 +/- 0.09 mmol/L; P < .05), and FMD area under the curve (AUC) (exercise group = 746 +/- 66 to 919 +/- 94 %*sec vs control group = 731 +/- 102 to 515 +/- 73 %*sec; P < .05). CONCLUSIONS: In overweight children and adolescents, CRP is independently associated with fasting insulin. Eight weeks of aerobic exercise improves fitness, HDL cholesterol, and endothelial function in this group.