Andrada Otvos-Moldovan, Iulia Armean, Elena Tanase, Vlad Frandes

University of Medicine and Pharmacy, Targu-MuresScientific coordinators: Pascanu Ionela, Pop Raluca

Short stature in school-aged children

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Growth charts based on data collected in different populations and time periods are key tools to assess children’s linear growth. 

The recommended standard for our country is the Swiss one, developed in 1989, but it may be outdated because of the secular trend in height

Introduction

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National growth charts are unavailable in numerous countries, including Romania.

Impaired growth is a major global public health issue , and its correct diagnosis is crucial to prompt timely intervention.

Introduction

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1. Primary growth abnormalities:A. OsteochondrodysplasiasB. Chromosomal abnormalitiesC. Intrauterine growth retardation

Causes of short stature

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2. Secondary growth disorders:A. MalnutritionB. Chronic diseaseC. Endocrine disorders such as:

a. Hypothyroidismb. Cushing sindromec. Pseudohypoparathyroidismd. Ricketse. IGF deficiency

Causes of short stature

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3. Idiopathic short stature: Familial

Non-familial

Causes of short stature

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to evaluate the different standards used for height measurement of children in Romania

The purpose of the study

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cross-sectional study

target population - children 6-14 years of age

randomized sample - 1168 children from 8 schools in Mures County

evaluated from November 2013- January 2014

Material and Methods

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variables: age, sex, height,environment, height standard deviations using WHO and Swiss standards

height was measured with a stadiometer

Material and Methods

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Statistical analysis: GrowthAnalyzer, AnthroPlus, M.O. Excel and GraphPadInStat3.06

each legal representative signed an informed consent to participate

The study was approved by the Ethics Committee UMF Targu Mures

Material and Methods

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Results

Rural area Urban area

51.80%

48.58%48.19%

51.41%

Fig.1 Environment

BoysGirls

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Results

Swiss chart WHO chart

0.0840000000000001

0.039

Fig.2 Short stature incidence

Series1

p< 0.001

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Results

Boys Girls

8.30% 8.50%

4.10% 3.60%

Fig.3 Short stature according to sex ratio

SwissWHO

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To determine whether the longitudinal growth pattern of a child is normal, height should be compared to an appropriate reference population. [2]

The variation in linear growth charts appeared to be related both to the era of data collection and to true population differences.

Population differences could be related to environmental, socio-economical, genetic factors or differences in the extent of the secular trend. [2]

Discussions

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There is an important difference in the incidence of short stature depending on the standards used.

The choice of reference charts substantially affects the clinical decision whether a child is considered short-for-age.

The low rate of agreement between the standards might show a source of error when defining short stature according to a certain standard and underlines the need for national references.

Conclusions

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[1] Mary M. Lee, M.D., Idiopathic Short Stature, N Engl J Med 2006;354:2576-82.

[2] Marjolein Bonthuis, Karlijn J. van Stralen, Enrico Verrina, Alberto Edefonti, Elena A. Molchanova, Anita C. S. Hokken-Koelega, Franz Schaefer, Kitty J. Jager, Use of National and International Growth Charts for Studying Height in European Children: Development of Up-To-Date European Height-For-Age Charts, www.plosone.org August 2012 ; 7:1-11

[3] David B. Allen, M.D., and Leona Cuttler, M.D., Short Stature in Childhood — Challenges and Choices, N Engl J Med 2013;368:1220-8.

[4] Otilia Marginean, Ioan Simedrea, Dana Bucuras, Ecaterina Pavel, Adrian Craciun, Ioana Maris, Camelia Daescu, The etiologic profile of short stature in the south west of Romania between 2004-2009, www.endocrin abstracts.org 2010

[5] www.who.int/growthref/who2007_height_for_age/en/

Bibliography

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THANK YOU!