Minimum dietary diversity of children and adolescents with short stature, born small for gestational age, undergoing growth hormone treatment
DOI:
https://doi.org/10.62827/nb.v25i1.3081Keywords:
Growth Hormone; Child; Adolescent; Infant; Small for Gestational Age.Abstract
Introduction: Children born Small for Gestational Age (SGA) may present insufficient linear growth in height and a higher risk of metabolic problems, with an increased predisposition to chronic diseases in adulthood. Dietary diversity is one of the main pillars of a balanced diet and is fundamental for achieving healthy eating. Objective: It was analyzed the Minimum Dietary Diversity (MDD) of children and adolescents with short stature, born small for gestational age, before and after 18 months of Growth Hormone (GH) treatment. Methods: The study evaluated children and adolescents born undersized for their gestational age, pre-pubertal, undergoing GH therapy before and after 18 months of treatment. Food intake was assessed through a three-day Dietary Record, and MDD was calculated based on the consumption of ten food groups. Results: It was observed a pattern of dietary monotony at both stages, characterized by frequent consumption of grains, roots and tubers, meats, poultry and fish, milk and dairy products, and by the complete absence of fruits and vegetables rich in vitamin A. The prevalence of MDD did not show statistically significant improvement after treatment with GH. Additionally, a significant reduction was observed in the consumption of milk, dairy products and egg products. Conclusion: After the period of therapy with GH, there was no improvement in the quality and MDD of these children and adolescents. This dietary pattern of food monotony underscores the need for complementary and simultaneous nutritional interventions along with the hormonal treatment.
References
Cardoso-Demartini AA, Boguszewski MCS, Alves CAD. Postnatal management of growth failure in children born small for gestational age. J. pediatr. (Rio J). 2019 [cited 2025 Out 30];95(Suppl 1): S23-9. Available from: https://pubmed.ncbi.nlm.nih.gov/30550759/. doi: 10.1016/j.jped.2018.10.015.
Paixão ES, Blencowe MDH, Falção IR, Ohuma EO, Rocha AS, Alves FJO. Risk of mortality for small newborns in Brazil, 2011-2018: A national birth cohort study of 17.6 million records from routine register-based linked data. Lancet Reg Health Am. 2021 [cited 2025 Nov 1]; 3:100045. Available from: https://pubmed.ncbi.nlm.nih.gov/34820675/. doi: 10.1016/j.lana.2021.100045.
Rocha AS, Ribeiro-Silva RC, Silva JFM, Pinto EJ, Silva NJ, Paixão ES, et al. Postnatal growth in small vulnerable newborns: a longitudinal study of 2 million Brazilians using routine register-based linked data. Am J Clin Nutr. 2024 [Cited 2025 Out 27];119(2):444-55. Available from: https://pubmed.ncbi.nlm.nih.gov/38128734/. doi: 10.1016/j.ajcnut.2023.12.009.
Boguszewski CL, Boguszewski MCS. Tratamento com Hormônio de Crescimento em Crianças com Baixa Estatura Nascidas Pequenas para a Idade Gestacional. Arq Bras Endocrinol Metabol. 2008 [cited 2025 Out 28];52(5):846-53. Available from: https://www.scielo.br/j/abem/a/CXb7HQxsVHDc8ZRXkDcqMPn/?lang=pt. doi: 10.1590/S0004-27302008000500011.
Netchine I, de Lemos-Sloane N, Be C, Azzi S, Pima D, Le L, et al. New horizons in short children born small for gestational age. Front Pediatr. 2021 [cited 2025 Nov 1]; 9:655931. Available from: https://pubmed.ncbi.nlm.nih.gov/34055692/. doi: 10.3389/fped.2021.655931.
Wall CR, Murphy R, Waldie KE, Mitchell EA, Wati P, Thompson JMD. Dietary intakes in children born small for gestational age and appropriate for gestational age: A longitudinal study. Matern Child Nutr. 2017[cited 2025 Out 25];13(3):e12373. Available from: https://pubmed.ncbi.nlm.nih.gov/27860346/. doi: 10.1111/mcn.12373.
Ortelan N, Neri DA, Benicio MHD. Práticas alimentares de lactentes brasileiros nascidos com baixo peso e fatores associados. Rev Saude Publica. 2020 [cited 2025 Out 25]; 54:14. Available from: https://www.scielo.br/j/rsp/a/GsCMt9xctbhyjGDFdTHR4nR/?lang=pt. doi: 10.11606/s1518-8787.2020054001028.
Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Promoção da Saúde. Diretrizes e recomendações do guia alimentar para crianças brasileiras menores de 2 anos: documento de evidências. Brasília (DF): Editora MS; 2024. 164 p. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_recomendacoes_guia_alimentar_criancas.pdf.
Yakoob MY, Lo CW. Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research. J Dev Behav Pediatr. 2017; [cited 2025 Out 27]t;38(8):665-79. Available from: https://pubmed.ncbi.nlm.nih.gov/28746059/. doi: 10.1097/DBP.0000000000000482.
Esposito S, Leonardi A, Lanciotti L, Cofini M, Muzi G, Penta L. Vitamin D and growth hormone in children: a review of the current scientific knowledge. J Transl Med. 2019 [cited 2025 Out 28]; 17:87. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6421660/. doi: 10.1186/s12967-019-1840-4.
Kühl AM. Impacto da terapia com hormônio do crescimento recombinante na composição corporal de crianças nascidas pequenas para a idade gestacional [tese]. Curitiba: Universidade Federal do Paraná; 2022 [cited 2025 Out 2020]. Available from: https://acervodigital.ufpr.br/xmlui/handle/1884/81310?show=full.
Siqueira IMBJ. Diversidade alimentar mínima de mulheres em idade reprodutiva e fatores associados em estudo de base populacional, Campinas, São Paulo [dissertação]. Curitiba: Universidade Federal do Paraná; 2021 [cited 2025 Out 26] Disponível em: https://acervodigital.ufpr.br/xmlui/handle/1884/73458.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Orientações Para a Coleta e Análise de Dados Antropométricos Em Serviços de Saúde: Norma Técnica Do Sistema de Vigilância Alimentar e Nutricional - SISVAN. Brasília (DF): Ministério da Saúde; 2011 [cited 2025 Out 31]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/orientacoes_coleta_analise_dados_antropometricos.pdf.
World Health Organization. WHO AnthroPlus: software for assessing growth of the world's children and adolescents. Geneva: WHO; 2009 [cited 2025 Out 28]. Available from: https://www.who.int/tools/growth-reference-data-for-5to19-years/application-tools.
World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: WHO; 2006 [cited 2025 Nov 3]. Available from: https://www.who.int/publications/i/item/924154693X.
World Health Organization. Indicators for assessing infant and young child feeding practices: conclusions of a consensus meeting held 6–8 November 2007 in Washington D.C., USA. Geneva: WHO; 2008 [cited 2025 Out 27]. Disponível em: https://www.who.int/publications/i/item/9789241596664.
Kühl AM, Dias MRMG, Pereira RM. Effect of treatment with growth hormone on body composition and metabolic profile of short children born small for gestational age. Rev Paul Pediatr. 2024 [cited 2025 Out 29];42:e2023073. Available from: https://www.scielo.br/j/rpp/a/8pDjyFJCDJyZNrvx7wNXXTN/?format=html&lang=en. doi: 10.1590/1984-0462/2024/42/2023073.
George CM, Coglianese N, Bauler S, Perin J, Kuhl J, Williams C, et al. Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program). Matern Child Nutr. 2022 [cited 2025 Out 28];18(3):e13340. Available from: https://pubmed.ncbi.nlm.nih.gov/35313062/. doi: 10.1111/mcn.13340.
Arsenault JE, Yakes EA, Munirul I, Mohammad B, Hossain TA, Hotz C. Very Low Adequacy of Micronutrient Intakes by Young Children and Woman in Rural Bangladesh Is Primarily Explained by Low Food Intake and Limited Diversity. J Nutr. 2012[cited 2025 Nov 3];143(2):197-203. Available from: https://pubmed.ncbi.nlm.nih.gov/23256144/. doi: 10.3945/jn.112.169524.
Hong S. Essential micronutrients in children and adolescents with a focus on growth and development: a narrative review. J Yeungnam Med Sci. 2023 [cited 2025 Nov 5];40(1):33-41. Available from: https://pubmed.ncbi.nlm.nih.gov/39895255/. doi: 10.12701/jyms.2022.00762.
Molla W, Adem DA, Tilahun R, Shumye S, Kabthymer RH, Kebede D, et al. Dietary diversity and associated factors among children (6–23 months) in Gedeo zone, Ethiopia: cross - sectional study. Ital J Pediatr. 2021 [cited 2025 Out 29];47(1):233. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8665621/. doi: 10.1186/s13052-021-01181-7.
Bueno AL, Czepielewski MA. A importância do consumo dietético de cálcio e vitamina D no crescimento. J Pediatr (Rio J). 2008 [cited 2025 Nov 2];84(5):386-94. Disponível em: https://www.scielo.br/j/jped/a/NM4xCDcZPWLGWmKFgpzhVzm/abstract/?lang=pt. doi: 10.2223/JPED.1816
Veiga GRS, Padilha BM, Barbosa LB, Brandão TBC, Florêncio TMMT, Lima MC. Dietary patterns of children living in slums and their associated factors: a cross-sectional study, 2019-2022. Epidemiol Serv Saude. 2024 [cited 2025 Out 28];33(1):e20231275. Available from: https://www.scielo.br/j/ress/a/DB9YnK84DJbY7TxxnQqdfFr/?lang=en. doi: 10.1590/S2237-96222024v33e20231275.en
Bortolini GA, Vitolo MR, Gubert MB, Santos LM. Iniquidades sociais influenciam a qualidade e a diversidade da dieta de crianças brasileiras de 6 a 36 meses. Cad Saude Publica. 2015 [cited 2025 Out 23];31(11):2413-24. Available from: https://www.scielo.br/j/csp/a/tqqLH8tytM93C9dsT5pgtnH/?format=html&lang=p. doi: 10.1590/0102-311X00153414.
Carvalho RBN, Louzada MLDC, Rauber F, Levy RB. Characteristics associated with dietary patterns in Brazilian children under two years of age. Rev Saude Publica. 2022 [cited 2025 Out 20];56:118. Available from: https://www.scielo.br/j/rsp/a/nrHYNH5Sz3Wjfbw8FRTTPGH/?lang=en. doi: 10.11606/s1518-8787.2022056003757.
Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural Northwest Ethiopia. Sci Rep. 2022 [cited 2025 Nov 9];12(1):19293. Available from: https://pubmed.ncbi.nlm.nih.gov/36369357/. doi: 10.1038/s41598-022-23981-5.
Wirthlin R, Linde JA, Trofholz A, Tate A, Loth K, Berge JM. Associations between parent and child physical activity and dietary behaviours: a secondary data analysis. BMC Public Health. 2020 [cited 2025 Out 19];20(1):1345. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC7483145/. Doi: doi: 10.1017/S136898002000052X
Gol RM, Kheirouri S, Alizadeh M. Association of dietary diversity with growth outcomes in infants and children aged under 5 years: a systematic review. J Nutr Educ Behav. 2022 [cited 2025 Out 20];54(1):65-83. Available from: https://pubmed.ncbi.nlm.nih.gov/35000681/. doi: 10.1016/j.jneb.2021.08.003.
Ren X, Liu Y, Wang X, Li R, Guo X, Zhao S. Gender-, age-, and region-specific associations between dietary diversity, physical activity and nutritional outcomes in Chinese students. Nutrients. 2024 [cited 2025 Out 24];16(3):367. Available from: https://www.mdpi.com/2072-6643/17/13/2214. doi: 10.3390/nu16030367.
Baldasso JG, Galante AP, Ganen AP. Impact of actions of food and nutrition education program in a population of adolescents. Rev Nutr. 2016 [cited 2025 Nov 7];29(1):65-75. Available from: https://www.scielo.br/j/rn/a/Lkz3Vf4JDKJzRHMzxNrPJtm/?lang=en. doi: 10.1590/1678-98652016000100007.
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