Ankara University, Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara, Turkey.
Nutr Clin Pract. 2019 Aug;34(4):581-588. doi: 10.1002/ncp.10229. Epub 2019 Jan 15.
Failure to thrive (FTT) is an interruption in the normal pattern of growth. We aimed to evaluate the clinical characteristics, underlying etiologies, diagnostic workup, and frequency of micronutrient deficiencies (MDs) in children with FTT.
This retrospective study was done with 729 children (319 male, mean age 6.8 ± 5.5 years) with FTT (weight for age <3rd percentile) who had visited the Pediatric Gastroenterology outpatient clinic between 2011 and 2016. Children who had previously known chronic diseases, inadequate intake, or inadequate absorption were excluded. Acute malnutrition was considered if weight-for-age z-scores were below -2 and height-for-age z-scores were above -2, and chronic malnutrition was defined if height-for-age z-scores were below -2.
The malnutrition rate was 57.1% (acute: 37.8%, chronic: 19.3%). Of children, 98.7% had laboratory evaluation. We found that 1.1% of laboratory tests, 0.4% of imaging studies, 27% of endoscopic findings, and biopsy results led to a specific diagnosis, equating to a total of 1.3% of diagnostic workup leading to a diagnosis related to FTT. The causes of FTT were inadequate nutrition (61.4%), psychiatric and behavioral disorders (17.2%), endocrinologic disorders (9%), recurrent infections (6.4%), gastrointestinal diseases (1.9%), and cardiac disorders (0.1%). Vitamin A and D deficiencies were the most common MD.
We showed that the most common cause of FTT is "purely nutrition" FFT because of inadequate caloric intake, and extensive diagnostic workup is rarely helpful to reveal the etiology. These results implicate the importance of clinical evaluation and anthropometry to evaluate a child with FTT.
生长不良（FTT）是正常生长模式的中断。我们旨在评估患有 FTT 的儿童的临床特征、潜在病因、诊断检查以及微量营养素缺乏症（MDs）的频率。
这项回顾性研究纳入了 2011 年至 2016 年间在儿科消化科门诊就诊的 729 名 FTT 儿童（319 名男性，平均年龄 6.8±5.5 岁）。排除了以前患有慢性疾病、摄入不足或吸收不足的儿童。如果体重与年龄的 Z 评分低于-2，而身高与年龄的 Z 评分高于-2，则认为存在急性营养不良，如果身高与年龄的 Z 评分低于-2，则定义为慢性营养不良。
营养不良发生率为 57.1%（急性：37.8%，慢性：19.3%）。98.7%的儿童进行了实验室评估。我们发现，1.1%的实验室检查、0.4%的影像学检查、27%的内镜检查结果和活检结果导致了特定的诊断，相当于总共 1.3%的诊断检查导致了与 FTT 相关的诊断。FTT 的病因是营养不足（61.4%）、精神和行为障碍（17.2%）、内分泌障碍（9%）、反复感染（6.4%）、胃肠道疾病（1.9%）和心脏疾病（0.1%）。维生素 A 和 D 缺乏症是最常见的 MD。
我们表明，FTT 最常见的原因是由于热量摄入不足的“纯粹营养”FTT，广泛的诊断检查很少有助于揭示病因。这些结果表明，临床评估和人体测量对于评估患有 FTT 的儿童非常重要。
