Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. e52-e57 (doi:10.1542/10.1542/peds.2004-1684)
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ELECTRONIC ARTICLE

Children With Idiopathic Short Stature Are Poor Eaters and Have Decreased Body Mass Index

Stefan A. Wudy*, Sandra Hagemann, MD*, Astrid Dempfle, PhD{ddagger}, Gundula Ringler, MSC{ddagger}, Werner F. Blum*,§, Lars D. Berthold, MD||, Gerhard Alzen||, Ludwig Gortner and Johannes Hebebrand#

* Departments of General Pediatrics and Neonatology
|| Pediatric Radiology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
{ddagger} Institute of Medical Biometry and Epidemiology, Philipps University, Marburg, Germany
§ Eli Lilly and Company, Bad Homburg, Germany
Department of General Pediatrics and Neonatology, University of the Saarland, Homburg, Germany
# Department of Child and Adolescent Psychiatry, Rheinische Kliniken Essen, Universität Duisburg-Essen, Essen, Germany

Objective. In children with idiopathic short stature (ISS), studies investigating body mass index (BMI) or parameters of satiety regulation are scarce, and studies analyzing eating behavior are lacking.

Methods. We recruited 214 children (123 index cases and 91 siblings) with ISS from 123 families. Affected children had to have a body height <5th percentile, or, in the case of siblings, the body height of 1 child had to be <5th percentile and the other <15th percentile. Medical histories were recorded by using structured and standardized interviews. Eating behavior was assessed by using the Child Eating Behavior Questionnaire. Percent energy intake as fat was assessed by using the Leeds Food Frequency Questionnaire. Endocrine markers of body weight regulation (leptin, ghrelin) were determined in serum.

Results. Compared with population norms, BMI was significantly lower (mean: –0.33 standard deviation score). Furthermore, there was decreased food responsiveness (mean Child Eating Behavior Questionnaire score: 1.9; population mean: 2.4), reduced enjoyment of food (3.2 vs 3.9), emotional undereating (2.6 vs 3.0), lower desire to drink (2.0 vs 2.8), and increased fussiness over food (3.2 vs 2.9). When the sample was subdivided into the 2 groups of "good" and "poor" eaters according to the mothers' assessment of the current eating behavior, reduction in BMI as well as the behavioral characteristics already delineated in the total sample were found to be even more consistent in the subgroup of poor eaters. In the total sample of our children, as well as in both subgroups, serum leptin (adjusted for gender, BMI, and Tanner stage) was found to be moderately raised but did not differ between poor and good eaters. Total serum ghrelin was not different between poor and good eaters.

Conclusions. Our clinical, behavioral, and endocrinologic findings in patients with ISS point to an altered eating behavior that possibly contributes to their short stature.

Key Words: eating behavior • short stature • body mass index • leptin • ghrelin

Abbreviations: CDGP, constitutional delay of growth and puberty • FSS, familial short stature • ISS, idiopathic short stature • IGF-I, insulin-like growth factor I • IGFBP-3, insulin-like growth factor–binding protein 3 • CEBQ, Child Eating Behavior Questionnaire • SDS, standard deviation score • LFFQ, Leeds Food Frequency Questionnaire

Accepted Dec 29, 2004.


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