Plasma somatomedin activity in protein calorie malnutrition

Evaluation of some facial anthropometric parameters in an Iranian population: infancy through adolescence

OBJECTIVES

By finding the mean value of anthropometric parameters in normal samples of a population, it is possible to create a template for facial analysis. The aim of our study was to measure the anthropometric parameters in 0- to 12-year-old girls of Fars ethnic origin in the Northeast of Iran.

STUDY DESIGN

Six hundred sixty-two newborn to 12-year-old girls of Fars ethnic origin participated in the study. A digital camera was used to take frontal full-face photographs of each child. Thirteen measurements were taken with the Smile Analyzer software: al-al, ch-ch, en-en, ex-ex, ft'-ft', go'-go', t-t, zy'-zy', n'-gn', n'-sn, t-g', t-gn', t-sn. Data were analyzed using the SPSS software at the significance level of 0.05.

RESULTS

In almost all parameters, we found significant growth acceleration between 2 and 4 years as well as 5 and 6 years of age. Another growth spurt was seen between 9 and 11 years, although it was less noticeable. Comparing the linear regression equations suggests that different craniofacial dimensions do not grow similarly.

CONCLUSIONS

By age, craniofacial dimensions change at different rates. Different craniofacial dimensions do not grow at consistent rates. Some parts grow slower compared with others. The intercanthal width has the slowest growth. Facial height shows the fastest growth.

Assessment of facial and cranial development and comparison of anthropometric ratios

BACKGROUND

Anthropometry is the biologic science of human body measurement. Craniofacial anthropometry discusses the characteristics on the measures of different soft and hard tissues of the head and face, and it is considered an important paraclinical record for the growth and development of the index and also for the diagnosis and curing orthodontic matters. Studying the craniofacial anthropometrics ratios is very useful in sciences such as dentistry, medicine, maxillofacial surgery, growth and development studies, plastic surgery, bioengineering, and nonmedical branches such as respiratory equipment and eye-glasses industries.

OBJECTIVES

The aims of this study were to determine Iranian cranial and facial anthropometric ratios and compare anthropometric ratios between Iranian and Canadian populations.

METHODS

This cross-sectional analytical study was done randomly on 564 four-to-eleven-year-old boys from Shirvan (North Khorasan, Iran) with normal face patterns. Facial and cranial ratios were estimated and compared. Data were analyzed by SPSS software. The mean values of these parameters were calculated .Finally, the regression line and the growth coefficient were determined for each parameter. Furthermore, the mean anthropometric measurement of Iranians was compared with Canadians. Student t test was used for comparing the measured values.

RESULTS

Iranian population when born has hypereuryprosopic face and hypercephalic cranium form. While getting older, the midface height increases, face becomes more prominent, chin becomes shorter, and the face and cranium change to eurycephalic and hyperleptoprosopic form, respectively. Comparison of results related to the face and cranium size between Iranian and Canadian boys (4-11 years old) showed that many craniofacial ratios have significant differences (P < 0.05).

CONCLUSIONS

Approximately, all of the anthropometric measurements in Iranian population and Canadians were significantly different. Considering the significant difference in the facial and cranial anthropologic ratios and size among Iranians and Canadians, the results obtained from Canadians should not be applied as criteria for treatment plans. Because of the wide population affinity combinations in Iran, more studies, with wider variations, should be conducted among different Iranian population affinity.

Insulin-like growth factor-I and the liver

Insulin-like growth factors (IGFs) play an essential role in growth and development, as well as in the overall cellular regulation and metabolism in the human body. In chronic liver disease, IGF levels are decreased, and the circulating levels correlate to the extent of hepatocellular dysfunction. Patients with cirrhosis are characterised by a variety of metabolic disturbances, including nutritional and metabolic complications such as insulin resistance, malnutrition, osteopenia and hypogonadism, all related to IGF-I deficiency. The complex process of hepatic fibrogenesis and the systemic consequences in cirrhosis are only partly understood. Disruption of the growth hormone (GH)-IGF-I axis seems to be closely associated with the development of liver disease, and treatment with recombinant human IGF (rhIGF)-I has been shown to halt, and even reverse, the fibrotic degeneration. IGF-I in itself has a strong antifibrotic effect that acts directly through the GH/IGF system and indirectly by the regulation of hepatoprotective and profibrogenic factors. It is most likely that IGF-I deficiency contributes to the diverse metabolic complications of cirrhosis. At present, liver transplantation remains the only efficient treatment of cirrhosis, and thus new methods of managing the disease are called for. RhIGF-I supplementation and IGF-I gene therapy may represent future perspectives of treatment.

The circulating insulin-like growth factor system in children with coeliac disease: an additional marker for disease activity

BACKGROUND

Chronic undernutrition resulting from coeliac disease (CD) could be associated with changes in the circulating insulin-like growth factor (IGF) system, which may participate in the pathogenesis of growth retardation occurring in these patients.

METHODS

We performed a cross-sectional study in CD subjects attempting to (1) document the pattern of serum IGF-I and IGF binding protein (IGFBP) 1 and 3 at diagnosis and (2) assess the response of circulating IGF system to dietary treatments, in comparison with the response of clinical and laboratory findings utilized for the diagnosis of CD. Thirty-two prepubertal CD children were divided into three groups based on the dietetic treatment: at diagnosis (D, n=18); on gluten-free diet for at least 6 months (GFD, n=7); and on gluten challenge for at least 3 months (CH, n=7). Six postpubertal CD patients were also studied at diagnosis.

RESULTS

In prepubertal children IGF-I levels were significantly reduced (by 29%) in D vs sex- and age-matched normal control (NC) subjects, with reductions being more pronounced before 3 years of age. Likewise, serum IGFBP-3 concentrations were decreased by 22%, whereas circulating IGFBP-1 levels were increased by 60%, compared with NC, with more marked IGFBP changes in older children. Similar alterations were observed in postpubertal patients. Changes in the circulating IGF system disappeared in GFD subjects and reappeared in CH children, as positivity of disease-specific antibodies. Body mass index (BMI) also improved in GFD subjects, but did not decrease in CH children. Changes in IGF-I and IGFBPs did not correlate with each other. Levels of IGF-I, but not of IGFBPs, maintained the relation with age and correlated significantly with BMI and positivity of antibodies.

CONCLUSIONS

These results demonstrate that CD patients show significant changes in serum IGF-I, in younger children, and IGFBPs (particularly IGFBP-1), in older children and adolescents, correlating with clinical course and response to dietary treatments. The alteration in the circulating IGF system could be implicated in the pathogenesis of growth retardation occurring in CD and may provide an additional tool in monitoring of the disease.

Determinants of plasma concentrations of insulin-like growth factor-I and albumin and their hepatic mRNAs: the role of dietary protein content and tumor necrosis factor in malnourished rats

Protein restriction decreases plasma concentrations of albumin and insulin-like growth factor-I (IGF-I) by reducing their hepatic mRNA levels, whereas protein restriction increases IGF-I binding protein-2 (IGFBP-2) gene expression in the liver. Tumor necrosis factor (TNF), as an inducer of the injury response, decreases plasma albumin concentration and albumin mRNA in the liver. The present study was designed to evaluate the effects of protein repletion and TNF on plasma albumin and IGF-I and their mRNAs and IGFBP-2 mRNA in the liver of protein-restricted rats. After 2 weeks of feeding a 2% casein diet, rats were assigned to four groups according to either being refed with a 2% or 20% casein diet or receiving saline or TNF by intraperitoneal injection (50 microg/kg x d) for 4 days. Plasma IGF-I and albumin were assayed. Hepatic mRNAs of IGF-I, albumin, and IGFBP-2 were determined. Protein repletion increased plasma concentrations of IGF-I and albumin and their mRNA content in the liver, but decreased IGFBP-2 mRNA. TNF did not alter plasma IGF-I concentration but did increase hepatic IGF-I mRNA in protein-repleted animals, and plasma albumin concentration was significantly decreased with unaltered hepatic albumin mRNA. Thus, protein repletion of malnourished rats increased plasma IGF-I and albumin concentrations in association with increased expression of their mRNAs in the liver. However, plasma albumin but not IGF-I decreased following TNF in protein-restricted rats, whereas TNF increased hepatic IGF-I mRNA in protein-repleted rats. Thus, only plasma albumin concentration responds to both principal determinants, diet and injury, in the development of malnutrition.

Growth and puberty in chronic inflammatory bowel disease

The consequences of IBD during childhood and adolescence may be devastating in terms of loss of growth potential, particularly if there has been a clinical course of frequent relapses resulting in inadequate nutrition and associated with repeated courses of steroid treatment. There is to date, however, a paucity of data recording final adult heights in such patients. The anticipation of relapse should become easier with increasing awareness of the importance of parameters of growth and pubertal development. Early and intensive nutritional support, and the use of steroid-sparing agents should help reduce the frequency and severity of any height deficit. The performance and timing of surgery must take into account the child's status in terms of height velocity and pubertal development. The importance of inducing the remission before the onset of puberty is stressed and this remission should be sustained at all costs during the pubertal years so that valuable height is not lost as a consequence of a missed pubertal growth spurt. Thus, increasing awareness of the issues of growth and development in these patients should improve the accuracy of initial diagnosis and early recognition of relapse, such that these children are ensured the best possible provision for achieving their full height potential.

Insulin like growth factor-I, insulin like growth factor binding protein-1, and insulin in childhood Crohn's disease

Twenty nine children with Crohn's disease were studied before and after treatment with steroids or an elemental diet to assess the effect of disease activity and treatment on serum insulin like growth factor I (IGF-I), insulin like growth factor binding protein (IGFBP-1), and insulin concentrations. The median serum IGF-I concentration was lower in patients with active disease than in matched controls, and lower in stunted than well grown patients, but insulin and IGFBP-1 concentrations were not significantly different between any group. After four weeks of either treatment there was an increase in the median serum IGF-I concentration; this was greater in the steroid group than the elemental diet group. The median serum insulin concentration increased and median serum IGFBP-1 concentration decreased in the steroid treated group but not in the elemental diet group. These changes were accompanied by a greater and more sustained increase in energy intake in the steroid group. Despite this the median height velocity SD score was greater in the elemental diet group than in the steroid group.

Growth failure and decreased levels of insulin-like growth factor I in obstructive jaundice are reversed by bile diversion

Insulin-like growth factor I (IGF-I) is one of the principal stimuli of linear growth. Growth failure in children with chronic cholestatic jaundice may be related to decreased hepatic synthesis of IGF-I. It was hypothesized that (1) biliary obstruction would lead to growth retardation and decreased circulating IGF-I levels; and (2) surgical drainage of the obstructed biliary system would reverse these effects. To test this hypothesis, the following study of male Sprague-Dawley rats (135 g; 10 animals per group) was performed. Group I underwent common bile duct ligation (CDL); group II underwent choledochoduodenostomy 2 weeks following CDL; group III were sham-operated and fed with CDL rats; and group IV were sham-operated and fed ad libitum. Daily food intake and weekly body weight were recorded. Statistical analysis was by repeated-measures analysis of variance and individual comparisons were evaluated by Student's t test. Biliary obstruction results in decreased food intake, rate of weight gain, and IGF-I levels. A significant reduction in IGF-I levels was also noted in the pair-fed sham-operated rats (group III). Relief of obstructive jaundice by surgical drainage results in a reversal of these changes. It is concluded that the growth failure and decreased IGF-I levels associated with obstructive jaundice can be reversed by surgical drainage of the obstructed biliary system and, in part, are due to inadequate nutrition.

Somatomedin-C levels in growth-impaired children and adolescents with chronic inflammatory bowel disease

The relationship between caloric insufficiency and impaired growth in children with chronic inflammatory bowel disease has been increasingly recognized in recent years. The mechanism by which nutritional insufficiency leads to decreased growth in these children is unclear. Our study suggests that chronic undernutrition lowers circulating somatomedin-C, which is known to exert anabolic effects on peripheral tissues. Therapeutic intervention that increases caloric intake results in improved somatomedin-C levels and growth velocity. Monitoring somatomedin-C levels in growth-impaired children with inflammatory bowel disease provides an important marker of nutritional sufficiency and reversibility of growth retardation.

Neuroendocrine alterations in systemic disease

Systemic disorders clearly may exert a significant influence on neuroendocrine function. Disorders that cause significant stress to the body, either physical or psychological, may cause a resetting upward of the HPA axis to provide sufficient cortisol to counteract the stress and to help sustain energy substrate levels. GH levels also increase in many of these situations, again promoting sufficient energy substrate levels. In some circumstances the concomitantly low somatomedin activity may be speculated to be adaptative to prevent the insulin-like agonist activity of these substances as well as to prevent energy expenditure in body growth. However, in other situations such as chronic renal failure and cirrhosis, the decreased somatomedin activity may be primary, causing decreased feedback at the hypothalamic-pituitary level and increased GH levels. The stress-induced rise in PRL may also play a minor role in preserving energy substrate since high levels may promote insulin resistance. In most illnesses the 'euthyroid sick syndrome' develops. Whether such patients are 'euthyroid' or mildly hypothyroid is a matter of controversy. The fact that protein losses are increased during fasting when the lowered T3 levels are returned to normal with exogenous T3 supplementation suggests that these patients are indeed hypothyroid and this hypothyroidism serves to conserve energy substrate by decreasing the metabolic rate. The reproductive axis is often impaired with systemic illness. Again, teleologically this may be viewed as an inactivation of non-essential functions in times of stress. It would appear that the changes that occur with systemic illness, in general, are favourable to the organism in that they promote survival. The detailed neurotransmitter and hypophyseotrophic hormone changes resulting in the alteration in pituitary function remain to be elucidated for the most part.

Somatomedins and other serum growth factors: a review of current concepts

Growth hormone is essential for sustaining longitudinal growth in man. However, during the last 20 years, it has become evident that the actions of growth hormone, at a cellular level, are mediated by specific growth promoting factors. This paper describes the nature and actions of mammalian growth factors and summarises the immense contribution that the measurement of these substances has made towards the elucidation of many problems in the science of human growth and development.

Plasma somatomedin activity in vitamin A deficient children

A role for vitamin A in the sulphation of mucopolysaccharides has been suggested. Somatomedin, a growth hormone dependent serum factor, has also been shown to stimulate the uptake of sulphate by cartilage. Therefore studies were undertaken on vitamin A deficient children to examine the possible interrelationship between vitamin A and somatomedin activity. Plasma somatomedin activity was markedly lowered in vitamin A deficient children and plasma HGH levels were in the normal range. The data suggest that vitamin A and somatomedin may be interrelated and also that plasma somatomedin activity may not always be determined by plasma growth hormone levels.