Growth in prepubertal children - short term changes and endocrine regulation. The one-year growth study

Human growth is a dynamic process characterized by accelerations and decelerations. The hypothalamus directs longitudinal growth, through the pulsatile secretion of growth hormone (GH) from the pituitary. GH induces differentiation of epiphyseal cells in the growth plate of long bones and stimulates the autocrine and paracrine action of insulin-like growth factor I (IGF-I). Local IGF-I stimulation increases cell numbers and volumes. It is not known if the dynamic short-term growth changes are related to changes in endocrine regulation. Improved methods for non-invasive measurement of short-term growth provide tools to study growth in parallel with markers of its endocrine regulation.The general aims of the study was to investigate changes in short-term growth, to explore short-term changes in the GH-IGF-I axis, and to elucidate if any such variations show a time correlation.Healthy prepubertal children were followed longitudinally. In a pilot study, measurements of the lower leg length (LLL) with knemometry were evaluated in 50 children. Since it was found that short-term growth in LLL could be measured accurately with knemometry over 1-month interval, while height demands 3-months interval, the main study was undertaken with monthly follow-up intervals. In the main study, growth was followed in 84 children, together with urinary GH and serum measurements of GH-binding protein (GHBP), IGF-I, IGF-binding protein-3 (IGFBP-3) and leptin, the hormone related to fat cells.Monthly variations were found, not only in growth, but also in growth factors involved in the GH-IGF-I axis as well as in leptin. Serum concentrations of GHBP, IGF-I, IGFBP-3 and leptin could be doubled, or reduced by half, when samples was taken with 1 month interval. An even larger variation was found in urinary GH excretion, which could be reduced when excretion values were adjusted for the influence of urine volume.Besides monthly changes, seasonal variation exists for growth in LLL, with a similar pattern, but larger amplitude, than for height. An opposite monthly pattern was found for GHBP. Indication that changes in IGF-I and IGFBP-3 are related to season was also found, since such changes correlate to changes in outdoor temperature.The monthly variation in longitudinal growth was only correlated to changes in IGF-I and IGFBP-3. Instead, weight changes correlated to changes in GHBP, leptin and urinary GH as well as IGF-I and IGFBP-3, while intermittent illness influenced measurements of GHBP and IGF-I but not IGFBP-3. Changes in serum concentrations of IGF-I and IGFBP-3 are closely related, although they provide different information. IGF-I gives strongest information about influences during the previous month and IGFBP-3 during the last three months. The finding that measurements of GH in urine did not correlate to growth, IGF-I or IGFBP-3, but to urine volume, and in addition, that serum GHBP correlate inversely with urinary GH suggest that renal factors affects the fraction of GH excreted in the urine.Despite the large monthly variations, the individual annual mean serum concentrations of GHBP, IGF-I, IGFBP-3 and leptin were related to the size of the child, either as height or as weight.In conclusion, monthly measurements reveals dynamic changes not only in growth, but also in urinary GH, serum GHBP, IGF-I, IGFBP-3 and leptin. Correlation in time between these changes indicate that changes have biological significance

Additional file 1: of Insight into human pubertal growth by applying the QEPS growth model

The first two sections explain pubertal variables of the QEPS-model in more detail in texts, figures and tables for the general pubertal growth, section A.1:1 and the individual variation in pubertal growth, section A.1:2, and the PQ -ratio in A1:3. The construction of the mathematical selection criterion, MathSelect, is described in section A.2:1, in texts, figures and tables, and extreme possible values of the nine input variables corresponding with MathSelect values are computed in section A.2:2. (ZIP 4423 kb

Swedish Child Health Services Register: a quality register for child health services and children’s well-being

Background Swedish child health services (CHS) is a free-of-charge healthcare system that reaches almost all children under the age of 6. The aim for the CHS is to improve children’s physical, psychological and social health by promoting health and development, preventing illness and detecting emerging problems early in the child’s life. The services are defined in a national programme divided into three parts: universal interventions, targeted interventions and indicated interventions.The Swedish Child Health Services Register (BHVQ) is a national Quality Register developed in 2013. The register extracts data from the child’s health record and automatically presents current data in real time. At present, the register includes 21 variables.Aim We aim to describe data available in the BHVQ and the completeness of data in BHVQ across variables.Methods Child-specific data were exported from the register, and data for children born in the regions were retrieved from Statistics Sweden to calculate coverage.Results The register includes over 110 000 children born between 2011 and 2022 from 221 child healthcare centres in eight of Sweden’s 21 regions. In seven of the eight regions, 100% of centres report data.The completeness of data differs between participating regions and birth cohorts. The average coverage for children born in 2021 is 71%.Conclusions The BHVQ is a valuable resource for evaluating Child Health Services nationally, with high coverage for the youngest children. As a result of continuous improvement of the services, the possibility to follow the development of children’s health in Sweden is possible through the register. When fully expanded, the register will be a natural and essential part of developing preventive services, improving healthcare for children below 6 years of age and a tool for developing evidence-based child health interventions