ASSESSING NORMAL AND ABNORMAL PATTERNS OF GROWTH

A longitudinal study of resting energy expenditure relative to body composition during puberty in African American and white children

BACKGROUND

Body composition and resting energy expenditure (REE) have not been examined longitudinally during puberty.

OBJECTIVE

The purpose of this longitudinal study was to examine the influence of pubertal maturation on REE relative to body composition in African American and white children.

DESIGN

The study included 92 white and 64 African American children (mean age at baseline: 8.3 and 7.9 y, respectively) from Birmingham, AL. The children had 2-5 annual measurements of fat mass (FM), lean mass (LM), and REE. The Tanner stages of the children ranged from 1 to 5. Mixed-model repeated-measures analyses were used to test the change in REE relative to body composition with increasing Tanner stage among ethnic and sex groups.

RESULTS

LM increased from Tanner stage 1 to subsequent stages. FM relative to LM decreased from Tanner stage 1 to stages 3, 4, and 5 but not from stage 1 to stage 2. The African American children had relatively higher limb LM and lower trunk LM than did the white children. REE declined with Tanner stage after adjustment for ethnicity, sex, FM, and LM. This decline was significant from Tanner stage 1 to stages 3, 4, and 5 but not to Tanner stage 2. After adjustment for age, Tanner stage, FM, and LM or LM distribution, REE was significantly higher in white than in African American children (by approximately 250 kJ/d).

CONCLUSION

In a large sample of children at various Tanner stages, we found an ethnic difference in REE after adjustment for age, Tanner stage, FM, and LM that was not explained by the difference in LM distribution.

Assessing growth patterns--routine but sometimes overlooked

We performed a retrospective chart review for 149 randomly selected well-child encounters to evaluate the frequency with which clinicians plot growth measurements and document growth abnormalities during health maintenance visits. Providers failed to plot at least one measurement of height, weight, and/or head circumference in 31 of 149 encounters (21%, 95% CI = 14.5% to 27.5%). Growth abnormalities in size, velocity, and/or disproportion were not documented in 22 of 40 relevant encounters (55%, 95% CI = 40% to 70%). Overall, 52 of 149 encounters (35%) were associated with an unplotted measurement and/or an undocumented growth abnormality. We feel that both documentation and assessment of growth represent potential areas for quality improvement.

Growth and development: physical, mental, and social aspects

This article details normal adolescent growth and development, including Tanner staging. Problems of abnormal adolescent growth and development are also discussed, along with treatment of short stature. Tables and graphs outlining these topics are included.