| 11. |
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| 12. |
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| 13. |
- Proos, Lemm A., 1943-
(author)
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Growth & development of Indian children adopted in Sweden
- 2009
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In: Indian Journal of Medical Research (IJMR). - 0971-5916. ; 130:5, s. 646-650
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Research review (peer-reviewed)abstract
- More than 6800 children from India have been adopted in Sweden over the last four decades. At arrival many were undernourished and suffered from infectious diseases. Catch-up growth was common. Unexpectedly, cases of early pubertal development were subsequently reported. In order to investigate the growth and development of adopted children more in detail we studied 114 children adopted from India prospectively during two years. The majority were stunted at arrival and caught up in height and weight after two years. Psychomotor retardation and common infections diminished fairly soon. Those that were stunted did not attain the higher catch-up levels of those not stunted at arrival. Low birth weight also limited the degree of catch-up growth. 107 girls were analysed retrospectively in another study. The median menarcheal age was 11.6 yr (range 7.3-14.6 yr) which is significantly earlier than the mean in Swedish and privileged Indian girls (13.0 and 12.4-12.9 yr, respectively). The pubertal linear growth component was normal in duration and magnitude but likewise started 1.5 yr earlier. The final height/age was 154 cm (-1.4 SDS) and the weight/age 46.9 kg (-1.1 SDS) 8 per cent were 145 cm or shorter. Stunting limited catch-up growth and final height. Those that were most stunted at arrival, and had the fastest catch-up growth, had the earliest menarche. Good maternal and child nutrition is necessary for full expression of a child's growth potential. What is lost in growth early in life can only partially be recovered by catch-up growth. Such growth is associated with risk for early pubertal development which abbreviates the childhood growth period and limits final height. The mechanism underlying the early pubertal development, and the optimal management of nutrition rehabilitation after chronic malnutrition, need to be clarified by further studies.
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| 14. |
- Proos, Lemm A., 1943-, et al.
(author)
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Increased perinatal intracranial pressure and brainstem dysfunction predict early puberty in boys with myelomeningocele
- 2011
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 100:10, s. 1368-1372
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Journal article (peer-reviewed)abstract
- Background: Children with myelomeningocele (MMC) run an increased risk of developing early or precocious puberty (E/PP).Aim: To identify risk factors for E/PP in boys with MMC.Methods: Boys born between 1970 and 1992, treated for MMC at the University Children's Hospital, Uppsala, were identified. Thirty-eight boys were eligible to be included. Medical records were examined retrospectively. Early puberty was defined as pubertal signs before the age of 10 years and 2 months. Precocious puberty was defined as the appearance of these signs before 9 years of age. Increased intracranial pressure perinatally was defined as wide sutures, bulging fontanelles and increased/increasing head circumference at birth and/or during the first week after birth. Early brainstem dysfunction was defined as severe and persistent feeding and respiratory problems before the age of 3 months despite proper control of the hydrocephalus.Results: Of the 38 boys, 8 (21%) had E/PP, which was strongly associated with increased intracranial pressure perinatally and also with early brainstem dysfunction. Multivariate regression analysis showed early brainstem dysfunction to have the highest explanatory value regarding the occurrence of early puberty.Conclusion: Increased intracranial pressure perinatally and brainstem dysfunction early in life are strong predictors of E/PP in boys with MMC.
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| 15. |
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| 16. |
- Proos, Lemm A., 1943-, et al.
(author)
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Is Early Puberty Triggered by Catch-Up Growth Following Undernutrition?
- 2012
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 9:5, s. 1791-1809
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Research review (peer-reviewed)abstract
- Undernutrition during fetal and postnatal life is still a major problem in many low- and middle-income countries. Even in high-income countries malnutrition may exist in cases of intrauterine growth retardation, as well as in chronic conditions such as anorexia nervosa and inflammatory bowel disease. Children adopted from developing countries are often chronically malnourished. Nutritional rehabilitation, resulting in catch-up growth, is often complicated by influences originating in fetal life as well as during postnatal growth. This may result in hormonal and metabolic changes as well as alterations in pubertal development. The present review focuses on fetal, postnatal and fetal-postnatal undernutrition and subsequent catch-up growth as well as catch-up growth in relation to pubertal development. Catch-up growth in children can be associated with early puberty following fetal or combined fetal-postnatal undernutrition. However, early puberty does not seem to occur following catch-up growth after isolated postnatal undernutrition. Gonadotropins have been reported to be elevated in prepubertal adopted girls as well as during catch-up growth in animals. Even if other factors may contribute, linear catch-up growth seems to be associated with the timing of pubertal development. The mechanisms behind this are still unknown. Future research may elucidate how to carry out nutritional rehabilitation without risk for early pubertal development.
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| 17. |
- Proos, Lemm A., 1943-, et al.
(author)
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Menarcheal age and growth pattern of Indian girls adopted in Sweden. I. Menarcheal age.
- 1991
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In: Acta paediatrica Scandinavica. - 0001-656X. ; 80:8-9, s. 852-8
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Journal article (peer-reviewed)abstract
- The median menarcheal age of 107 girls adopted from India by families in Sweden was 11.6 years, which was significantly lower than in Swedish and most Indian studies. Five girls had menarche before the age of 9 years, the earliest at 7.3 years. Those who arrived at a later age had earlier menarche. No differences in menarcheal age were found with respect to geographic origin. The reasons for the earlier pubertal maturation are not clear. Factors associated with the rapid transition from an underprivileged to a privileged environment are probably involved, besides genetic determinants. The serious medical, social and emotional consequences of very early pubertal development necessitate further clarification of the underlying mechanisms.
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| 18. |
- Proos, Lemm A., 1943-, et al.
(author)
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Menarcheal age and growth pattern of Indian girls adopted in Sweden. II. Catch-up growth and final height.
- 1991
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In: Indian Journal of Pediatrics. - 0019-5456 .- 0973-7693. ; 58:1, s. 105-14
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Journal article (peer-reviewed)abstract
- Adopted girls (n = 107) previously studied regarding menarcheal age in relation to age at arrival, were analysed as to growth pattern and final height related to nutritional status at arrival and menarcheal age. It was found that most girls had catch-up growth regarding height and half of them regarding weight. Faster catch-up and later arrival age in Sweden were associated with earlier menarche. The catch-up growth was, however, incomplete, and lower the initial height for age, lower was the height for age at the succeeding measurements, and the final height. The mean final height was 154 cm, but 8% of the girls were 145 cm or shorter. The data suggest that linear growth and final height is influenced by the preadoptive nutritional condition, as well as by the degree and timing of subsequent catch-up growth, and the timing of puberty. Pubertal onset is related to the degree and timing of catch-up growth.
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| 19. |
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| 20. |
- Tuvemo, Torsten, et al.
(author)
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Final height after combined growth hormone and GnRH analogue treatment in adopted girls with early puberty
- 2004
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 93:11, s. 1456-1462
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Journal article (peer-reviewed)abstract
- Background: Girls adopted from developing countries often have early or precocious puberty, requiring treatment with gonadotrophin-releasing hormone (GnRH) analogues. During such treatment, decreased growth velocity is frequent. Aim: To study whether the addition of growth hormone (GH) to GnRH analogue treatment improves final height in girls with early or precocious puberty. Methods: Forty-six girls with early or precocious puberty (age ≤9.5 y) adopted from developing countries were randomized for treatment for 2-4 y with GnRH analogue, or with a combination of GH and GnRH analogue. Results: During treatment, the mean growth velocity in the GH/GnRH analogue group was significantly higher compared to the control group. Combined GH/GnRH analogue treatment resulted in a higher final height: 158.9 cm compared to 155.8 cm in the GnRH analogue-treated group. Three out of 24 girls (13%) in the combined group and nine of the 22 girls (41%) treated with GnRH analogue alone attained a final height below -2 standard deviation scores (SDS). Conclusion: The difference between the two groups is statistically significant, and possibly of clinical importance. A future challenge is to identify a subgroup with clinically significant advantage of GH addition to GnRH analogue treatment. Being very short on arrival in Sweden and being short and young at start of treatment are possible indicators.
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