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Acerini CL, Patton CM, Savage MO, Kernell A, Westphal O, Dunger DB. Randomised placebo-controlled trial of human recombinant insulin-like growth factor I plus intensive insulin therapy in adolescents with insulin-dependent diabetes mellitus. Lancet 1997; 350:1199-204. [PMID: 9652560 DOI: 10.1016/s0140-6736(97)06467-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Good glycaemic control in insulin-dependent diabetes mellitus (IDDM) to prevent complications may be difficult to achieve during adolescence, because abnormalities in production of growth hormone or insulin-like growth-factor-I (IGF-I) can lead to lower insulin sensitivity. Recombinant human IGF-I (rhIGF-I) given as an adjunct to insulin therapy in IDDM, might improve glycaemic control in adolescents; we investigated the effects of the addition of IGF-I in a randomised, double-blind, placebo-controlled trial. METHODS 53 patients with IDDM (26 male, 27 female) with a median age of 16.1 years (range 10.8-20.6) and diabetes of more than 2 years' duration were randomly assigned subcutaneous rhIGF-I (20 or 40 microg/kg daily [n=18, n=18, respectively]) or placebo (n=17), both in addition to multiple-injection insulin therapy for 24 weeks. The primary endpoint, glycated haemoglobin (HbA1c) and routine biochemistry were measured every 4 weeks. Retinal photographs and glomerular-filtration rates were assessed at base line and at the end of the study. Data were analysed by intention to treat. FINDINGS With a dose of 40 microg/kg rhIGF-I daily, we found significant reductions in HbA1c compared with placebo (p=0.03), without changes in body-mass index, rate of hypoglycaemia, insulin dose, or circulating concentrations of IGF-binding proteins 1 and 3. The greatest median change in HbA1c of -0.6% (range -2.8 to -1.5%) was seen with rhIGF-I 40 microg/kg at week 12, but was not sustained at week 24. The greatest reductions in HbA1c at week 24 were seen among patients with the greatest changes in IGF-I concentrations (r=-0442, p=0.002). Retinal photographs, renal function (glomerular filtration rate and urinary albumin excretion), and routine biochemistry showed no adverse events. INTERPRETATION Our data confirm that rhIGF-I as an adjunct to insulin therapy can improve HbA1c values in adolescents with IDDM without overt toxic effects, but they raise questions about whether these effects can be sustained in cases of poor compliance or reduced bioefficacy.
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Affiliation(s)
- C L Acerini
- University Department of Paediatrics, John Radcliffe Hospital, Oxford, UK
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Chapman IM, Hartman ML, Pezzoli SS, Harrell FE, Hintz RL, Alberti KG, Thorner MO. Effect of aging on the sensitivity of growth hormone secretion to insulin-like growth factor-I negative feedback. J Clin Endocrinol Metab 1997; 82:2996-3004. [PMID: 9284733 DOI: 10.1210/jcem.82.9.4223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To determine the effect of aging on the suppression of GH secretion by insulin-like growth factor (IGF)-I, we studied 11 healthy young adults (6 men, 5 women, mean +/- SD: 25.2 +/- 4.6 yr old; body mass index 23.7 +/- 1.8 kg/m2) and 11 older adults (6 men, 5 women, 69.5 +/- 5.8 yr old; body mass index 24.2 +/- 2.5 kg/m2). Saline (control) or recombinant human IGF-I (rhIGF-I) (2 h baseline then, in sequence, 2.5 h each of 1, 3, and 10 micrograms/kg.h) was infused iv during the last 9.5 h of a 40.5-h fast; serum glucose was clamped within 15% of baseline. Baseline serum GH concentrations (mean +/- SE: 3.3 +/- 0.7 vs. 1.9 +/- 0.5 micrograms/L, P = 0.02) and total IGF-I concentrations (219 +/- 15 vs. 103 +/- 19 micrograms/L, P < 0.01) were higher in the younger subjects. In both age groups, GH concentrations were significantly decreased by 3 and 10 micrograms/kg.h, but not by 1 microgram/kg.h rhIGF-I. The absolute decrease in GH concentrations was greater in young than in older subjects during the 3 and 10 micrograms/kg.h rhIGF-I infusion periods, but both young and older subjects suppressed to a similar GH level during the last hour of the rhIGF-I infusion (0.78 +/- 0.24 microgram/L and 0.61 +/- 0.16 microgram/L, respectively). The older subjects had a greater increase above baseline in serum concentrations of both total (306 +/- 24 vs. 244 +/- 14 micrograms/L, P = 0.04) and free IGF-I (8.5 +/- 1.4 vs. 4.2 +/- 0.6 micrograms/L, P = 0.01) than the young subjects during rhIGF-I infusion, and their GH suppression expressed in relation to increases in both total and free serum IGF-I concentrations was significantly less than in the young subjects. We conclude that the ability of exogenous rhIGF-I to suppress serum GH concentrations declines with increasing age. This suggests that increased sensitivity to endogenous IGF-I negative feedback is not a cause of the decline in GH secretion that occurs with aging.
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Affiliation(s)
- I M Chapman
- Department of Medicine, University of Virginia Health Sciences Center, USA.
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Abstract
Insulin has an important role in the GH:IGF-I axis, and its absence leads to major endocrine disturbances, particularly during puberty. Rapid growth in the prediabetic phase occurs and may be a risk factor. Final height reflects gender and the age of onset more than specific growth factors. The influence of hepatic insulin on IGF-I bioactivity has important implications in diabetic adolescents.
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Affiliation(s)
- M H Connors
- Department of Pediatrics, University of California, Davis Medical Center, Sacramento, USA
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Olsen BS, Nir M, Kjaer I, Vølund A, Mortensen HB. Elevated vibration perception threshold in young patients with type 1 diabetes in comparison to non-diabetic children and adolescents. Diabet Med 1994; 11:888-92. [PMID: 7705028 DOI: 10.1111/j.1464-5491.1994.tb00374.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The vibration perception threshold (VPT) was investigated by biothesiometry in 61 children (28 boys) with Type 1 diabetes, mean age 15.5 (range 10-21) years, duration of diabetes 6.9 (range 1-19) years, and in 76 healthy children (39 males), mean age 13.8 (range 10-19) years. The measurements were performed in triplicate on the right second finger and on the right first toe. The vibration perception threshold was significantly increased (p < 0.0001) in the young diabetic patients (mean +/- SD, finger 4.1 +/- 1.1 V, toe: 5.7 +/- 1.3 V) compared to healthy children (finger 3.4 +/- 0.9 V, toe: 3.6 +/- 1.3 V). Twenty percent of adolescents with Type 1 diabetes had a VPT above the 95th percentiles (finger: 5 V, toe 6.5 V) for normal control children. In healthy controls a significant correlation (r = 0.27, p < 0.01) was found for VPT in finger versus toe. This relationship was not significant in the diabetic group and may be due to reduced sensitivity of the fingertips caused by frequent blood glucose testing. Age, Tanner stage and height were significantly correlated to VPT (toe) in both diabetic and normal boys, while duration of diabetes, HbA1c, arterial blood-pressure and body mass index were not significantly associated with VPT in any of the groups. The results indicate that changes in VPT appears early in childhood and emphasize a need for further studies of subclinical neuropathy in young patients with Type 1 diabetes.
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Clayton KL, Holly JM, Carlsson LM, Jones J, Cheetham TD, Taylor AM, Dunger DB. Loss of the normal relationships between growth hormone, growth hormone-binding protein and insulin-like growth factor-I in adolescents with insulin-dependent diabetes mellitus. Clin Endocrinol (Oxf) 1994; 41:517-24. [PMID: 7955462 DOI: 10.1111/j.1365-2265.1994.tb02584.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE It has been proposed that the dissociation between growth hormone secretion and insulin-like growth factor-I (IGF-I) concentrations in insulin-dependent diabetes mellitus arises because of partial resistance at the GH receptor. In order to explore this hypothesis further we have examined the relations between IGF-I, GH-binding protein (GHBP), and GH secretion in normal subjects and patients with diabetes during puberty. DESIGN AND SUBJECTS Blood samples for the estimation of IGF-I and GHBP levels were obtained from 104 patients with diabetes and 89 puberty matched controls. Thirty-four of the controls and 42 of the patients with diabetes also underwent an overnight GH secretory profile with measurements of GH every 15-20 minutes between 2000 and 0800 h. RESULTS In multivariate analysis using sex, puberty stage, and presence or absence of diabetes as dependent variables, diabetes was associated with increased GH levels (F = 23.04, P < 0.001), reduced IGF-I (F = 10.89, P < 0.001), and reduced GHBP levels (F = 31.36, P < 0.001). A negative relation between GH and GHBP levels (r = -0.44, P < 0.01) was found in normal subjects but this was absent in those with diabetes. Both GHBP and IGF-I levels in the diabetic subjects were correlated with total insulin dose (r = 0.4, P < 0.001, and r = 0.46, P < 0.001, respectively). Yet there was no direct correlation between GHBP and IGF-I concentrations. The variation in IGF-I levels was also related to glycosylated haemoglobin levels in the diabetics (r = -0.27, P = 0.01). In a stepwise multiple regression analysis insulin dose contributed 23%, HbA1 4.4% and C-peptide levels 3.7% to the variation in IGF-I levels. CONCLUSIONS In adolescents with insulin dependent diabetes mellitus, the elevated GH concentrations are associated with low circulating IGF-I and GHBP concentrations and the normal reciprocal relation between GHBP and GH is no longer evident. Although IGF-I and GHBP are both related to insulin dose, there is no direct correlation between these variables. This may indicate that GHBP reflects GH receptor numbers but not necessarily post receptor events, and the weak positive correlation between GH and IGF-I indicates that increased growth hormone secretion may compensate for reduced receptor numbers.
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Affiliation(s)
- K L Clayton
- Department of Paediatrics, University of Oxford, UK
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Adcock CJ, Perry LA, Lindsell DR, Taylor AM, Holly JM, Jones J, Dunger DB. Menstrual irregularities are more common in adolescents with type 1 diabetes: association with poor glycaemic control and weight gain. Diabet Med 1994; 11:465-70. [PMID: 8088124 DOI: 10.1111/j.1464-5491.1994.tb00307.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Ovarian function in post-menarchal girls with Type 1 diabetes was evaluated. Menstrual histories from 24 adolescents with Type 1 diabetes were compared with those from 24 age and sex matched controls. A fasting blood sample was obtained from subjects with Type 1 diabetes for the measurement of ovarian and adrenal sex hormones, LH and FSH, glucose and insulin, insulin-like growth factor-I (IGF-I), and insulin-like growth factor binding protein-1 (IGFBP-1); and an ovarian ultrasound scan was performed. Menstrual irregularity was more prevalent in patients with Type 1 diabetes than controls (54% vs 21%, p < 0.01) and their mean body mass index (BMI) was greater (22.3 +/- 0.5 (+/- SEM) vs 20.7 +/- 0.6 kg m-2, p < 0.05). Subjects with Type 1 diabetes with irregular menses (when compared with diabetic subjects with a regular cycle) had a significantly higher HbA1 (12.8 +/- 0.4 vs 10.5 +/- 0.5%, p < 0.01) and BMI (23.2 +/- 0.6 vs 21.4 +/- 0.6 kg m-2, p < 0.05) associated with a lower sex hormone binding globulin (SHBG) (37.2 +/- 4.0 vs 52.6 +/- 4.0 nmol l-1, p < 0.025) and IGF-I (1.4 +/- 0.2 vs 2.2 +/- 0.2 mUI-1, p < 0.025) and a higher LH:FSH ratio (2.6 +/- 0.5 vs 1.4 +/- 0.2, p < 0.05). Polycystic ovarian changes were identified in 10/13 (77%) of these patients with an irregular cycle. Menstrual irregularity is common in post-menarchal girls with Type 1 diabetes and is associated with poor glycaemic control and weight gain. The apparent high incidence of polycystic ovarian change requires further investigation.
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Affiliation(s)
- C J Adcock
- Department of Paediatrics, John Radcliffe Hospital, Oxford, UK
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Cheetham TD, Clayton KL, Taylor AM, Holly J, Matthews DR, Dunger DB. The effects of recombinant human insulin-like growth factor I on growth hormone secretion in adolescents with insulin dependent diabetes mellitus. Clin Endocrinol (Oxf) 1994; 40:515-22. [PMID: 8187319 DOI: 10.1111/j.1365-2265.1994.tb02492.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE It has been proposed that low IGF-I levels and reduced IGF-I bioactivity may lead to elevated GH levels in adolescents with insulin dependent diabetes (IDDM). We have therefore studied the effects of human recombinant insulin-like growth factor I (rhIGF-I) administration on GH levels and GH secretion in adolescents with IDDM. PATIENTS Nine late pubertal adolescents (four male and five female) with IDDM. DESIGN A double-blind placebo controlled study of rhIGF-I administered subcutaneously in a dose of 40 micrograms/kg body weight at 1800 h. MEASUREMENTS IGF-I and GH concentrations were measured at regular intervals throughout the study. Twenty-two hour GH secretory rates were calculated by deconvolution analysis. Overnight GH profiles were analysed by distribution analysis, and Fourier transformations were performed on both overnight GH concentrations and GH secretory rates. RESULTS Mean IGF-I levels over the 22-hour study period were significantly elevated following rhIGF-I administration (350 +/- 26 vs 205 +/- 21 micrograms/l (mean +/- SEM), P < 0.01). Mean 22-hour GH levels were reduced following rhIGF-I administration (19.4 +/- 4.0 compared with 33.6 +/- 5.8 mU/l; P = 0.01). Distribution analysis demonstrated that the reduction in GH levels was due to changes in the proportion of values at both high and low concentrations. Deconvolution analysis also revealed a significant overall reduction in GH secretory rate following IGF-I administration (1.81 +/- 0.30 vs 2.98 +/- 0.47 mU/min, P = 0.01) which was still apparent during the final 5.5 hours of the study period (1.51 +/- 0.30 vs 2.76 +/- 0.61 mU/min, P = 0.02). The dominant periodicity of GH secretory episodes as determined by Fourier transformation was between 120 and 180 minutes after both IGF-I and placebo. CONCLUSIONS In late pubertal adolescents with IDDM the rise in IGF-I levels following rhIGF-I administration in a subcutaneous dose of 40 micrograms/kg body weight leads to a significant reduction in GH levels and GH secretory rate. The reduction in GH secretion is due to changes in pulse amplitude rather than frequency. A reduction in GH secretion was apparent at the beginning and also towards the end of the 22-hour study period.
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Affiliation(s)
- T D Cheetham
- Department of Paediatrics John Radcliffe Hospital, Headington, Oxford, UK
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Cheetham TD, Jones J, Taylor AM, Holly J, Matthews DR, Dunger DB. The effects of recombinant insulin-like growth factor I administration on growth hormone levels and insulin requirements in adolescents with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1993; 36:678-81. [PMID: 8359587 DOI: 10.1007/bf00404081] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Type 1 (insulin-dependent) diabetes mellitus in adolescence is associated with reduced levels of insulin-like growth factor I, elevated growth hormone concentrations and insulin resistance. In order to determine whether restoring insulin-like growth factor I levels to normal might lead to a reduction in growth hormone levels and insulin requirements, we undertook a double-blind placebo controlled study of a single s.c. dose of recombinant insulin-like growth factor I (40 micrograms/kg body weight) in nine late pubertal subjects with Type 1 diabetes. After administration of placebo or insulin-like growth factor I at 18.00 hours, a variable rate insulin infusion was used to maintain euglycaemia overnight. Plasma insulin-like growth factor I, growth hormone, free insulin, and intermediate metabolite concentrations were monitored throughout the study. Recombinant insulin-like growth factor I led to a rise in plasma concentrations which reached a peak at 5.5 h (413.1 +/- 28.2 ng/ml, mean +/- SEM). Mean growth hormone levels between 20.00 and 08.00 hours were significantly reduced after recombinant insulin-like growth factor I (19.4 +/- 4.0 compared with 33.6 +/- 5.8 mU/l; p = 0.01), as were the insulin requirements for euglycaemia (0.25 +/- 0.02 compared with 0.31 +/- 0.04 mU.kg-1.min-1; p = 0.03). Plasma free insulin levels were lower after recombinant insulin-like growth factor I administration (31.9 +/- 2.7 compared with 67.9 +/- 16.0 mU/l; p = 0.001) but no significant differences in ketone or lactate levels were detected.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T D Cheetham
- Department of Paediatrics, John Radcliffe Hospital, Oxford, UK
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Krassowski J, Szulc P, Makowska A, Godziejewska M, Jeske W, Zgliczynski S. Short term pirenzepine treatment is ineffective in suppressing 24-h growth hormone secretion in type 1 diabetes mellitus. Diabetes Res Clin Pract 1993; 19:211-6. [PMID: 8319519 DOI: 10.1016/0168-8227(93)90116-m] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Large doses of pirenzepine given at bedtime suppress nocturnal GH secretion and abolish dawn phenomenon. As GH suppression may be beneficial in diabetic subjects we have investigated the effect of routine doses of pirenzepine on GH secretion in 9 type 1 diabetics. In the acute study pirenzepine 20 mg i.v. administered 15 min before GHRH 80 micrograms i.v. completely inhibited GHRH-induced GH response and the peak GH values were reduced from 66.3 to 9.2 ng/ml, P < 0.005. In the chronic study pirenzepine was given in a daily dose of 75 or 150 mg for 4 days and GH was measured hourly during 24-h study before and on the fourth day of pirenzepine administration. GH secretion calculated as area under curve (AUC) was not affected by pirenzepine and the values of AUC were: 139 ng/ml per h (the control 24-h study) and 123 ng/ml per h (pirenzepine 75 mg) and 303 ng/ml per h (pirenzepine 150 mg). Mean plasma glucose was not changed by pirenzepine. GH secretion calculated as AUC and mean 24-h GH level did not correlate with metabolic control of diabetes assessed by HbA1. It is concluded that routine doses of pirenzepine do not suppress GH hypersecretion in type 1 diabetic subjects and therefore this agent does not seem suitable for the purpose of 24-h GH suppression in type 1 diabetes mellitus.
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Affiliation(s)
- J Krassowski
- Department of Endocrinology, Medical Centre of Postgraduate Education, Warsaw, Poland
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Dunger DB, Cheetham TD, Holly JM, Matthews DR. Does recombinant insulin-like growth factor I have a role in the treatment of insulin-dependent diabetes mellitus during adolescence? ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1993; 388:49-52; discussion 53. [PMID: 8329831 DOI: 10.1111/j.1651-2227.1993.tb12841.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D B Dunger
- Department of Paediatrics, University of Oxford, UK
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Mortensen HB, Villumsen J, Vølund A, Petersen KE, Nerup J. Relationship between insulin injection regimen and metabolic control in young Danish type 1 diabetic patients. The Danish Study Group of Diabetes in Childhood. Diabet Med 1992; 9:834-9. [PMID: 1473324 DOI: 10.1111/j.1464-5491.1992.tb01902.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 1987 and 1989 nationwide screening for HbA1c was carried out in Denmark. Twenty-one paediatric departments treating children with diabetes participated in the first study and twenty-two in the second. During this 2-year period metabolic control deteriorated despite the fact that the use of multiple injection regimens increased from 39% to 54%. The possible reasons for the deterioration in metabolic control were examined in the 429 children (> or = 9 years, 1987) and adolescents (< 18.8 years, 1989) who participated in both studies. All had diabetes duration of greater than one year (1987) and all were treated by the same departments during the study period. The children were divided into three subgroups according to injection regimen. Group A (n = 128) received twice-daily insulin injections; group B (n = 171) were on multiple injections (three or more) while group C (n = 130) shifted from twice-daily insulin to multiple injections during the 2-year period. A deterioration of blood glucose control as assessed by HbA1c was observed in all three treatment groups. For group C the 2-year increase in daily insulin dose was more pronounced for males (19%) than for females (6%). Body mass index increased significantly in all treatment groups during the study period. The 1989 mean levels were higher in group B (males 20.6 kg m-2, females 22.0 kg m-2) than group A (males 19.3 kg m-2, p = 0.002; females 20.7 kg m-2, p = 0.000003) and group C (males 19.4 kg m-2, p = 0.0005; females 20.7 kg m-2, p = 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H B Mortensen
- Department of Paediatrics, Glostrup Hospital, Bagsvaerd, Denmark
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