This Article Full Text Full Text (PDF) All Versions of this Article: 91/6/2081    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Han, J. C. Articles by Mauras, N. Search for Related Content PubMed PubMed Citation Articles by Han, J. C. Articles by Mauras, N. Related Collections Neuroendocrinology and Pituitary Pediatric Endocrinology Metabolism

Evidence for Hypermetabolism in Boys with Constitutional Delay of Growth and Maturation

Division of Pediatric Endocrinology (J.C.H., D.D., N.M.) and Biomedical Analysis Laboratory (P.B., S.S.), Nemours Children’s Clinic, Jacksonville, Florida 32207; Developmental Endocrinology Branch (J.C.H.), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892; and Human Nutrition Research Center (D.D.), Institut National de la Santé et de la Recherche Médicale, 44093 Nantes, France

Address all correspondence and requests for reprints to: Nelly Mauras, M.D., Chief, Division of Endocrinology, Nemours Children’s Clinic— Jacksonville, 807 Children’s Way, Jacksonville, Florida 32207. E-mail: nmauras{at}nemours.org.

Context: Children with constitutional delay of growth and maturation (CDGM) tend to be thin and have a growth pattern reminiscent of nutritional insufficiency.

Objective: Our objective was to compare differences in nutrition, body composition, bone mineral density, and resting and total energy expenditure (REE/TEE) in boys with CDGM and controls. We hypothesized that an imbalance between energy intake and expenditure may contribute to the pathogenesis of CDGM.

Design and Setting: We conducted an observational, cross-sectional study at an outpatient clinical research center.

Patients: Patients included 36 boys (8–17 yr): 12 with CDGM (short stature, delayed bone age and puberty, and no other pathology) and 12 height-matched (pre- or early-pubertal) and 12 age-matched (pubertal) healthy controls.

Main Outcome Measures: Outcome measures included doubly labeled water studies (TEE), serum nutritional/hormonal markers, dual-energy x-ray absorptiometry, dietary analysis, and indirect calorimetry (REE).

Results: Nutritional markers were comparable among the groups. CDGM subjects had bone mineral density lower than age-matched controls (P < 0.01) but comparable with height-matched controls. Even though REE did not differ between groups, CDGM subjects had 25% higher caloric intake adjusted for fat-free mass (FFM) than height-matched controls (P < 0.05) and 78% higher caloric intake per kilogram FFM compared with age-matched controls (P < 0.00001). CDGM subjects had 46% (P < 0.05) and 91% (P < 0.001) higher TEE per kilogram FFM than height- and age-matched controls, respectively. CDGM subjects had lower IGF-I and testosterone than age-matched controls (P < 0.001) but levels were comparable with height-matched controls.

Conclusions: Boys with CDGM have higher rates of overall energy expenditure compared with age- and size-matched controls. This increased metabolism may result in impaired tempo of growth. Additional studies are needed to determine whether augmenting nutrition to match their energy needs (with or without hormonal therapy) can improve linear and ponderal growth in patients with CDGM.

This article has been cited by other articles:

				K. Wehkalampi, E. Widen, T. Laine, A. Palotie, and L. Dunkel Patterns of Inheritance of Constitutional Delay of Growth and Puberty in Families of Adolescent Girls and Boys Referred to Specialist Pediatric Care J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 723 - 728. [Abstract] [Full Text] [PDF]

				R. C. Olney, T. C. R. Prickett, T. G. Yandle, E. A. Espiner, J. C. Han, and N. Mauras Amino-Terminal Propeptide of C-Type Natriuretic Peptide and Linear Growth in Children: Effects of Puberty, Testosterone, and Growth Hormone J. Clin. Endocrinol. Metab., November 1, 2007; 92(11): 4294 - 4298. [Abstract] [Full Text] [PDF]

				J. Baron Growth Hormone Therapy in Childhood: Titration Versus Weight-Based Dosing? J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2436 - 2438. [Full Text] [PDF]