Growth Hormone Treatment in SGA : More than meets the eye

Growth hormone (GH) treatment effectively induces catch-up growth and improves adult height in short children born small for gestational age (SGA). Besides this visual effect, GH treatment also has several other effects which occur inside the body. This doctoral thesis presents the effects of GH treatment, with or without additional gonadotropin-releasing hormone analog (GnRHa) treatment, on metabolic and cardiovascular risk factors. The effects of GnRHa treatment, in addition to GH treatment, on pubertal development are described. Further, the long-term effects of discontinuation of GH treatment are assessed in young adults born SGA. Finally, a new genetic cause for persistent short stature after SGA birth is revealed. The results presented in this thesis illustrate that there is more to GH treatment than meets the eye

Longitudinal Study on Metabolic Health in Adults SGA During 5 Years After GH With or Without 2 Years of GnRHa Treatment

BACKGROUND: In children born small for gestational age (SGA) with persistent short stature, 2 years of gonadotropin-releasing hormone analogue (GnRHa), in addition to long-term growth hormone (GH) treatment, can improve adult height. We assessed safety on metabolic and bone health of GnRHa/GH treatment during 5 years after cessation of GH. METHODS: A total of 363 young adults born SGA, previously treated with combined GnRHa/GH or GH-only, were followed for 5 years after attainment of adult height at GH cessation and 2 and 5 years thereafter. Data at 5 years after GH cessation, at age 21 years, were also compared with 145 age-matched adults born appropriate for gestational age (AGA). Frequently sampled intravenous glucose tolerance (FSIGT) tests were used to assess insulin sensitivity, acute insulin response, and β-cell function. Body composition and bone mineral density (BMD) was determined by dual-energy x-ray absorptiometry (DXA) scans. FINDINGS: In the GnRHa/GH and GH-only groups, fat mass increased during the 5 years after GH cessation, but the changes in FSIGT results, body composition, blood pressure, serum lipid levels, and BMD were similar in both groups. At age 21 years, the GnRHa/GH group had similar fat mass, FSIGT results, blood pressure, serum lipid levels and BMD-total body as the GH-only group and the AGA control group, a higher BMD-lumbar spine and lower lean body mass than the AGA control group. INTERPRETATION: This study during 5 years after GH cessation shows that addition of 2 years of GnRHa treatment to long-term GH treatment of children short in stature born SGA has no unfavorable effects on metabolic and bone health in early adulthood. CLINICAL TRIAL REGISTRATION: ISRCTN96883876, ISRCTN65230311 and ISRCTN18062389

Fat mass and fat-free mass track from infancy to childhood:New insights in body composition programming in early life

OBJECTIVE: Early life is a critical window for adiposity programming. This study investigated whether fat mass percentage (FM%), fat mass index (FMI), abdominal fat, and fat‐free mass (FFM) in early life track into childhood and whether there are sex differences and differences between infant feeding types. METHODS: Detailed body composition was longitudinally measured by air‐displacement plethysmography, dual‐energy x‐ray absorptiometry, and abdominal ultrasound in 224 healthy, term‐born children. Measurements were divided into tertiles. Odds ratios (OR) of remaining in the highest tertile of FM%, FMI, abdominal subcutaneous and visceral fat, and FFM index (FFMI) were calculated from early life to age 4 years. RESULTS: High FM% and FMI tracked from age 3 and 6 months to age 4 years (OR = 4.34 [p = 0.002] and OR = 6.54 [p < 0.001]). High subcutaneous abdominal fat tracked from age 6 months to age 4 years (OR = 2.30 [p = 0.012]). High FFMI tracked from age 1, 3, and 6 months to age 4 years (OR = 4.16 [p = 0.005], 3.71 [p = 0.004], and 3.36 [p = 0.019]). In non‐exclusively breastfed infants, high FM% tracked from early life to age 4 years, whereas this was not the case for exclusively breastfed infants. There was no tracking in visceral fat or sex differences. CONCLUSIONS: Infants with high FM%, FMI, subcutaneous abdominal fat, and FFMI in early life are likely to remain in the highest tertile at age 4 years. Exclusive breastfeeding for 3 months is potentially protective against having high FM% at age 4 years

Bone Mineral Density After Cessation of GH Treatment in Young Adults Born SGA: A 5-Year Longitudinal Study

Context: Short children born small for gestational age (SGA) have below-average bone mineral density (BMD). Growth hormone (GH) treatment improves height and BMD in short SGA children. Longitudinal data on BMD in adults born SGA, after GH cessation (GH-stop), are lacking.Objective: To determine BMD in young adults born SGA during 5 years after GH-stop.Methods: In 173 GH-treated adults born SGA (SGA-GH), BMD of total body (BMDTB) and bone mineral apparent density of lumbar spine (BMADLS) were measured longitudinally at adult height (AH) and 6 months, 2 years, and 5 years thereafter. At 5 years after GH-stop (age 21 years), data were compared with 45 untreated short SGA adults (SGA-S), 59 SGA adults with spontaneous catch-up (SGA-CU), and 81 adults born appropriate for gestational age (AGA).Results: At GH-stop (mean age 16.4 years), estimated mean (standard error) BMDTB standard deviation score (SDS) was -0.40 (0.1) in males and -0.51 (0.1) in females, followed by a trend toward a decrease of BMDTB in males to -0.59 (0.1) at 5 years after GH-stop (P = 0.06), whereas it remained stable in females [-0.57 (0.1); P = 0.33]. At GH-stop, BMADLS SDS was -0.01 (0.1) in males and -0.29 (0.1) in females, followed by a decrease in males and females to -0.38 and -0.55, respectively, at 5 years after GH-stop (P < 0.001). At 5 years after GH-stop, BMDTB and BMADLS in SGA-GH were similar compared with SGA-S, SGA-CU, and AGA.Conclusion: After GH-stop, there is a gradual decline of BMADLS, but at the age of 21 years, BMDTB and BMADLS are similar as in untreated short SGA adults

Psychologies du succès et de l'échec

Hors série spécial psychologie du sportif. La préparation mentale, esprit d'équipe et dynamique de groupe, le rôle de la famille (des parents du sportif), les tests, la motivation, l'inhibition (le 'petit bras'), surmenage et surentraînement, les dépendances et autres problèmes psychiques, la retraite du sportif, le suicide

Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications

Children born small for gestational age (SGA), defined as a birth weight and/or length below -2 SD score (SDS), comprise a heterogeneous group. The causes of SGA are multifactorial and include maternal lifestyle and obstetric factors, placental dysfunction, and numerous fetal (epi)genetic abnormalities. Short-term consequences of SGA include increased risks of hypothermia, polycythemia, and hypoglycemia. Although most SGA infants show catch-up growth by 2 years of age, ∼10% remain short. Short children born SGA are amenable to GH treatment, which increases their adult height by on average 1.25 SD. Add-on treatment with a gonadotropin-releasing hormone agonist may be considered in early pubertal children with an expected adult height below -2.5 SDS. A small birth size increases the risk of later neurodevelopmental problems and cardiometabolic diseases. GH treatment does not pose an additional risk