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Swirsky JM, Rosie M, Xie H. Correlates of Early Adolescents' Social Media Engagement: The Role of Pubertal Status and Social Goals. J Youth Adolesc 2021; 51:74-85. [PMID: 34536196 DOI: 10.1007/s10964-021-01494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
Specific social media behaviors have been found to be differentially associated with adjustment outcomes; however, the extant research has yet to consider the motivations behind why adolescents engage in these specific behaviors. This study examined the role of two developmentally relevant motivational correlates (social goals and pubertal status) on four social media behaviors (self-disclosure, self-presentation, social monitoring, and lurking) and two time-based measures of social media use (daily number of hours on social media and frequency of social media use). Self-report data were collected from 426 middle-school students (54.2% female, 73.6% White, 11.5% Black, 4.8% Hispanic, 10.1% other ethnicity, and mean age = 12.91). Social goals and pubertal status were distinctly associated with different social media behaviors, with some relevant sex differences. Popularity goal was positively associated with all six measures of social media engagement, although the associations for self-presentation and social monitoring were stronger for girls. Sex differences in lurking followed the same pattern but did not reach significance. Acceptance goal was associated with fewer hours spent on social media for girls only. Early developers reported more self-disclosure and lurking behaviors, and marginally more social monitoring (girls only). These findings indicate the importance of identifying motivational factors, especially social goals, when considering early adolescents' social media behaviors.
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Affiliation(s)
- Jill M Swirsky
- Holy Family University, Philadelphia, USA.
- Temple University, Philadelphia, USA.
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Willoughby T, Heffer T, van Noordt S, Desjardins J, Segalowitz S, Schmidt L. An ERP investigation of children and adolescents' sensitivity to wins and losses during a peer observation manipulation. Dev Cogn Neurosci 2021; 51:100995. [PMID: 34364173 PMCID: PMC8353349 DOI: 10.1016/j.dcn.2021.100995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
The purpose of this ERP P3 study was to test a peer observation manipulation (being observed by a peer versus being alone) on neural markers of attention to reward (win-feedback) and punishment (loss-feedback) during the Balloon Analogue Risk Task. Participants (126 children, 53 % male, 8–10 years; 196 early adolescents, 50 % male, 11–13 years; and 121 mid-adolescents, 52 % male, 14–16 years) were assessed by age group and pubertal status. Individual differences in how participants felt about being observed by a peer, and self-report personality factors, also were examined. Findings indicated that early and mid-adolescents (and individuals in mid-puberty and late-puberty) were sensitive to peer observation as both groups showed larger neural responses to loss-feedback in the peer condition than in the alone condition. Conversely, children (and individuals in pre- and early-puberty) were unaffected by peer observation. In addition, there clearly were individual differences in how rewarding versus anxiety-provoking participants found the peer experience. Early adolescents and mid-adolescents (and individuals in mid- and late-puberty) who reported feeling more anxious about the peer observation elicited larger neural responses to loss-feedback, and individuals in mid- and late-puberty in particular reported higher worry and lower sensation-seeking scores than those who reported a positive experience.
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Affiliation(s)
| | | | | | - James Desjardins
- Montreal Neurological Institute, McGill University, Compute Ontario, Canada
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Choi YJ, Lee YJ, Lee NY, Lee SH, Kim SK, Ahn MB, Kim SH, Cho WK, Cho KS, Jung MH, Suh BK. Discriminatory performance of insulin-like growth factor 1 and insulin-like growth factor binding protein-3 by correlating values to chronological age, bone age, and pubertal status for diagnosis of isolated growth hormone deficiency. Ann Pediatr Endocrinol Metab 2020; 25:240-247. [PMID: 32871649 PMCID: PMC7788340 DOI: 10.6065/apem.2040018.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The discriminatory performance of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) was investigated by correlating their values with chronological age (CA), bone age (BA), and pubertal status (PS) for diagnosis of isolated growth hormone deficiency (IGHD). METHODS We evaluated IGF-1 and IGFBP-3 levels in 310 short-stature subjects subdivided into 2 groups: IGHD (n=31) and non-IGHD (n=279). IGF-1 and IGFBP-3 were assayed using immune-radiometric assay and transformed into standard deviation score (SDS) according to CA, BA, and PS. RESULTS The highest sensitivity was found in IGF-1-SDS for CA and IGFBP-3-SDS for CA (22.6% and 30.0%, respectively). The highest specificity was found in IGF-1-SDS for PS and IGFBP-3-SDS for PS (98.2% and 94.4%, respectively). Groups with the highest positive predictive values were IGF-1-SDS for BA and IGFBP-3-SDS for BA (10.9% and 5.1%, respectively). Highest negative predictive values were seen in IGF-1-SDS for CA and IGFBP-3-SDS for CA (98.4% and 98.4%, respectively). CONCLUSION IGF-1-SDS for CA, instead of IGF-1-SDS for BA or PS, could be used as a standard variable for IGHD screening. The sufficiently high specificity of IGF-1-SDS for PS suggests that this value is a useful tool for identification of IGHD.
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Affiliation(s)
- Yu jung Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ji Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na Yeong Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon-Hwa Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seul-Ki Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon-Bae Ahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin-Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Kyoung Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung-Soon Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea,Address for correspondence: Min Ho Jung, MD Department of Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1063(yuksam)-ro, Yeongdeungpogu, Seoul 07345, Korea Tel: +82-2-3779-1131 Fax: +82-2-783-2589 E-mail:
| | - Byung-Kyu Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Jacob SA, Williams DD, Boyd J, Dileepan K, Tsai SL. Variations in Morning Serum Cortisol Levels Based on Sex and Pubertal Status. Horm Res Paediatr 2020; 92:162-168. [PMID: 31851964 DOI: 10.1159/000504539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with suspected adrenal insufficiency undergo screening with a serum morning cortisol level and confirmatory testing with an adrenocorticotropic hormone (ACTH) stimulation test. However, much of the data collected to determine appropriate values for morning cortisol levels are derived from adult populations and may not accurately represent pediatric physiology. The purpose of this study was to evaluate the mean morning cortisol level in the pediatric population based on pubertal status and sex in order to better understand such influences on laboratory evaluation of adrenal insufficiency. METHODS A retrospective chart review was conducted using electronic medical records of patients seen at Children's Mercy Kansas City from 11/01/2007 to 11/01/2017. Patients between 2 and 18 years of age who had pubertal staging assessed by a pediatric endocrinologist and confirmed adrenal sufficiency by high-dose ACTH stimulation testing were included. Two-sample Wilcoxon rank sum (Mann-Whitney) tests or t tests were used to compare morning cortisol levels between females and males - both independent of Tanner stage and by Tanner stage. Multivariable regression models were used to evaluate associations among covariates on two outcomes: morning cortisol levels and peak cortisol values with ACTH stimulation. RESULTS Morning cortisol levels were greater in females than males independent of Tanner staging (p = 0.0054) and also in Tanner stage 1 (p = 0.0042). No differences in mean morning cortisol levels between Tanner stage 2-5 females and males were found (p = 0.4652). Morning cortisol levels were not significantly different between Tanner 1 patients and Tanner 2-5 patients independent of sex (p = 0.0575). Sex was predictive of serum morning cortisol levels (p = 0.015), and morning cortisol levels were predictive of peak cortisol levels during ACTH stimulation testing (p < 0.001). CONCLUSIONS These data suggest that different normative cortisol values may need to be established for pediatric females and males, and by pubertal status. Larger prospective studies are needed to evaluate the role of sex and pubertal status in identifying adrenal insufficiency in the -pediatric population.
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Affiliation(s)
- Sarah A Jacob
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - David D Williams
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Jennifer Boyd
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Pediatric Endocrinology and Diabetes, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Kavitha Dileepan
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Pediatric Endocrinology and Diabetes, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Sarah L Tsai
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA, .,Division of Pediatric Endocrinology and Diabetes, Children's Mercy Kansas City, Kansas City, Missouri, USA,
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Béghin L, Vanhelst J, Drumez E, Migueles JH, Androutsos O, Widhalm K, Julian C, Moreno LA, De Henauw S, Gottrand F. Gender influences physical activity changes during adolescence: The HELENA study. Clin Nutr 2019; 38:2900-2905. [PMID: 30718097 DOI: 10.1016/j.clnu.2018.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND We compared differences in physical activity (PA) between pre/mid-pubertal and post-pubertal participants according to gender. METHODS The study included a total of 1842 healthy participants aged 12.5-17.4 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Participants wore a uniaxial accelerometer (ActiGraph© GT1M, Pensacola, FL, USA) attached to their lower back for seven consecutive days to measure PA. Pubertal status was assessed by physical examination and the population was classified as pre/mid-pubertal (Tanner stages 1-3) or post-pubertal (Tanner stages 4-5). PA was compared between these groups according to gender during the whole week, on school-free days and on school days, before and after school, and during lessons and recesses. RESULTS When comparing the pre/mid-pubertal group with the post-pubertal group, girls' total PA did not differ between groups. However, a slight difference was observed in boys, among whom PA on school-free days showed a difference of 17.6% between the pre/mid-pubertal group and the post-pubertal group (679 kcounts vs 564 kcounts, respectively; P = 0.0007) and 20% (162 kcount vs 135 kcounts; P = 0.006) for school recess. There was no difference among girls. CONCLUSIONS A reduced level of PA in the post-pubertal groups was only observed in boys during non-organized times such as on school-free days and during school recesses, with a moderate impact on total PA.
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Affiliation(s)
- L Béghin
- Univ. Lille, CHU Lille, LIRIC UMR 995 Inserm, Clinical Investigation Center, CIC-1403-Inserm-CHU, F-59000 Lille, France.
| | - J Vanhelst
- Univ. Lille, CHU Lille, LIRIC UMR 995 Inserm, Clinical Investigation Center, CIC-1403-Inserm-CHU, F-59000 Lille, France
| | - E Drumez
- Univ. Lille, CHU Lille, Department of Biostatistics, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France
| | - J H Migueles
- PROFITH ''PROmoting FITness and Health through physical Activity'' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Ctra. Alfacar s/n, 18011 Granada, Spain
| | - O Androutsos
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | - K Widhalm
- Department of Pediatrics, School of Medicine, Vienna University, Vienna, Austria
| | - C Julian
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Zaragoza University, Zaragoza, Spain
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Zaragoza University, Zaragoza, Spain
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - F Gottrand
- Univ. Lille, CHU Lille, LIRIC UMR 995 Inserm, Clinical Investigation Center, CIC-1403-Inserm-CHU, F-59000 Lille, France
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de Moraes AM, Carvalho HM, Gonçalves EM, Guerra-Júnior G. Quantitative Ultrasonography Measurements of the Phalanges in Adolescents: A Mixed Longitudinal Study. Ultrasound Med Biol 2017; 43:2934-2938. [PMID: 28964616 DOI: 10.1016/j.ultrasmedbio.2017.08.931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
This study examined the effect of pubertal development on Amplitude Dependent Speed of Sound (AD-SoS), accounting for the growth in stature among adolescents. A mixed-longitudinal design with 3 assessments across a 15-mo period in 439 adolescents (girls: 215; boys: 224) aged 9-16 y was used. Bayesian multilevel models were used to describe gender-specific AD-SoS variations among participants during pubertal years. Substantial increments in AD-SoS during pubertal years were observed in both genders. AD-SoS changes were positively related to stature, and the rate of stature growth per year. Quantitative ultrasonography was sensible to describe age-related changes of bone mass during pubertal development. It seemed clinically reliable to use AD-SoS in the study of bone growth and development.
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Affiliation(s)
- Anderson M de Moraes
- Department of Physical Education, Pontifical Catholic University of Campinas, Campinas, Brazil; Laboratory of Growth and Development, Center for Investigation in Pediatrics (CIPED), Faculty of Medical Sciences (FMS), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Humberto M Carvalho
- Department of Physical Education, Sports Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Ezequiel M Gonçalves
- Laboratory of Growth and Development, Center for Investigation in Pediatrics (CIPED), Faculty of Medical Sciences (FMS), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Gil Guerra-Júnior
- Laboratory of Growth and Development, Center for Investigation in Pediatrics (CIPED), Faculty of Medical Sciences (FMS), University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Baams L, Dubas JS, Overbeek G, van Aken MA. Transitions in body and behavior: a meta-analytic study on the relationship between pubertal development and adolescent sexual behavior. J Adolesc Health 2015; 56:586-98. [PMID: 25636818 DOI: 10.1016/j.jadohealth.2014.11.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 11/20/2022]
Abstract
The present meta-analysis studies the relations of pubertal timing and status with sexual behavior and sexual risk behavior among youth aged 10.5-22.4 years. We included biological sex, age, and ethnicity as potential moderators. Four databases were searched for studies (published between 1980 and 2012) on the relation between pubertal timing or status and sexual behavior. The outcomes were (1) sexual intercourse; (2) combined sexual behavior; and (3) risky sexual behavior. Earlier pubertal timing or more advanced pubertal status was related to earlier and more sexual behavior, and earlier pubertal timing was related to more risky sexual behavior. Further, the links between (1) pubertal status and combined sexual behavior and (2) pubertal timing and sexual intercourse status, combined sexual behavior, and risky sexual behavior were stronger for girls than boys. Most links between pubertal status, timing, and sexual behavior and sexual risk behavior were stronger for younger adolescents. Moderation by ethnicity did not yield consistent results. There was significant variation in results among studies that was not fully explained by differences in biological sex, age, and ethnicity. Future research is needed to identify moderators that explain the variation in effects and to design sexual health interventions for young adolescents.
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Abstract
How and why are teenagers different from children and adults? A key question concerns the ways in which pubertal development shapes psychological changes in adolescence directly through changes to the brain and indirectly through the social environment. Empirical work linking pubertal development to adolescent psychological function draws from several different perspectives, often with varying approaches and a focus on different outcomes and mechanisms. The main themes concern effects of atypical pubertal timing on behavior problems during adolescence, effects of pubertal status (and associated hormones) on normative changes in behaviors that can facilitate or hinder development (especially risk-taking, social reorientation, and stress responsivity), and the role of puberty in triggering psychopathology in vulnerable individuals. There is also interest in understanding the ways in which changes in the brain reflect pubertal processes and underlie psychological development in adolescence. In this chapter, we consider the ways that puberty might affect adolescent psychological development, and why this is of importance to developmentalists. We describe the processes of pubertal development; summarize what is known about pubertal influences on adolescent development; consider the assumptions that underlie most work and the methodological issues that affect the interpretation of results; and propose research directions to help understand paths from puberty to behavior. Throughout, we emphasize the importance of pubertal change in all aspects of psychological development, and the ways in which puberty represents an opportunity to study the interplay of biological and social influences.
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Affiliation(s)
- Sheri A Berenbaum
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA; Department of Pediatrics, The Pennsylvania State University, University Park, Pennsylvania, USA.
| | - Adriene M Beltz
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA; Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robin Corley
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, USA
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Bennett DS, Birnkrant JM, Carmody DP, Lewis M. Effects of prenatal cocaine exposure on pubertal development. Neurotoxicol Teratol 2014; 47:146-53. [PMID: 25446013 DOI: 10.1016/j.ntt.2014.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 01/19/2023]
Abstract
The purpose of the current study was to examine the relationship between prenatal cocaine exposure (PCE) and pubertal development. Children (n=192; 41% with PCE) completed the Pubertal Development Scale (Petersen et al. 1988) and provided salivary dehydroepiandrosterone (DHEA) samples at 6month intervals from 11 to 13years. PCE was examined as a predictor of pubertal status, pubertal tempo, and DHEA levels in mixed models analyses controlling for age, sex, environmental risk, neonatal medical problems, other prenatal exposures, and BMI. PCE interacted with age such that PCE predicted slower pubertal tempo during early adolescence. PCE also interacted with age to predict slower increases in DHEA levels during early adolescence. These findings suggest that PCE may affect pubertal development and, if slower pubertal tempo continues, could lead to delayed pubertal status in mid-adolescence.
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Affiliation(s)
- David S Bennett
- Drexel University College of Medicine, GLAD Program, 4700 Wissahickon Avenue, Philadelphia, PA, 19144, United States.
| | - Jennifer M Birnkrant
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, 89 French Street, New Brunswick, NJ 08901, United States.
| | - Dennis P Carmody
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, 89 French Street, New Brunswick, NJ 08901, United States.
| | - Michael Lewis
- Rutgers Robert Wood Johnson Medical School, Institute for the Study of Child Development, 89 French Street, New Brunswick, NJ 08901, United States.
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Hill RJ. Update on nutritional status, body composition and growth in paediatric inflammatory bowel disease. World J Gastroenterol 2014; 20:3191-3197. [PMID: 24696604 PMCID: PMC3964391 DOI: 10.3748/wjg.v20.i12.3191] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/02/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Growth and nutritional status are important issues in paediatric inflammatory bowel disease (IBD). While linear growth is easy to assess, nutritional status is more complicated, with reports often compromised by the use of simple measures, such as weight and the body mass index, to assess nutritional status rather than more appropriate and sophisticated techniques to measure body composition. This review is an update on what is currently known about nutritional status as determined by body composition in paediatric IBD. Further, this review will focus on the impact of biologics on growth in paediatric IBD. Significant lean mass deficits have been reported in children with IBD compared with controls, and there is evidence these deficits persist over time. Furthermore, data imply that gender differences exist in body composition, both at diagnosis and in response to treatment. With respect to growth improvements following treatment with biologics, there are conflicting data. While some studies report enhancement of growth, others do not. The relationship between disease severity, impaired growth and the requirement for biologics needs to be considered when interpreting these data. However, key features associated with improvements in growth appear to be successful clinical response to treatment, patients in early stages of puberty, and the presence of growth failure at the onset of treatment.
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