De Simone M, Farello G, Palumbo M, Gentile T, Ciuffreda M, Olioso P, Cinque M, De Matteis F
Dipartimento di Medicina Sperimentale, Universita' di L'Aquila, Italy.
Int J Obes Relat Metab Disord. 1995 Dec;19(12):851-7.
To compare the growth charts of obese subjects (4-18 years) with the Tanner's growth curves and to analyze the growth velocities and bone age of obese children in prepuberty and adolescence. Moreover to compare the relationship between the serum insulinemic and glycemic levels and height standard deviation score (HSDS).
Growth charts: this study included 1250 obese subjects (669 males, 581 females) observed between 1981 and 1993 and divided into seven age categories (4-6, 7-8, 9-10, 11-12, 13-14, 15-16, 17-18 years). Growth velocities: yearly growth velocities of 579 obese subjects (325 males, 254 females) were compared to growth velocities of 473 controlled children of the same sex, chronological age and pubertal stage. Bone age (BA) of 846 obese subjects (470 males, 376 females) was estimated. Blood analysis: insulin secretion of 70 obese children was considered and compared to 70 lean controls of equal chronological age and sex.
Growth rate, standardized height and other physical characteristics of the children were measured by trained examiners. All subjects were evaluated singularly for at least 4 years with a follow-up every 6 months. BA was estimated by radiograph of the left hand and wrist using the Tanner-Whitehouse II system by a single observer. For the insulin secretion study and glycemic levels oral glucose tolerance test (OGTT) was performed using a glucose load of 1.75 g/kg per body weight. Plasma insulin was assessed by a double antibody radioimmunoassay.
In adipose children the growth charts, referred to 97th centile, 50th centile and 3rd centile, were superior to those of the normal population up to the age of 13 and 12.5 years for male and for female respectively; growth decreases at the above age in both sexes. The obese subjects were equal in height to the non obese subjects as they reached their 18th birthday. The growth velocity (cm/yr) of the obese child, in the age range considered here, does not show differences when compared with the lean child in the prepubertal status (P not significant) but decreases during Tanner's stage II, III IV in boys and girls (P < 0.0001). BA is more advanced over chronological age (delta BA-CA) in both sexes. The increase of BA over CA does not show a remarkable difference during pubertal maturation in boys (P not significant); whereas in girls the delta BA-CA decreases with advancing sexual maturation (P < 0.0001). Our obese subjects have significantly higher plasma insulinemic levels compared with the lean controls (P < 0.0001). Moreover there is a positive correlation between plasma insulinemic levels and HSDS (r = 0.881, P < 0.0001). We did not observe a correlation between serum glycemic levels and HSDS.
Our data demonstrate that the growth increase in an obese child starts in the first years of life. The statural advantage acquired in the first years of life would be exploited and maintained up to the beginning of puberty and with a growth velocity equal to that of the lean subject. Skeletal maturation is strongly increased in both sexes. Bone age remained advanced during the entire period of pubertal development. During puberty obese subjects demonstrate a less notable growth spurt when compared with lean subjects. The growth advantage gradually decreases and final adult height of obese and normal subjects is equal.
比较肥胖受试者（4 - 18岁）的生长图表与坦纳生长曲线，并分析青春期前和青春期肥胖儿童的生长速度及骨龄。此外，比较血清胰岛素和血糖水平与身高标准差评分（HSDS）之间的关系。
生长图表：本研究纳入了1981年至1993年间观察的1250名肥胖受试者（669名男性，581名女性），并分为七个年龄组（4 - 6岁、7 - 8岁、9 - 10岁、11 - 12岁、13 - 14岁、15 - 16岁、17 - 18岁）。生长速度：比较了579名肥胖受试者（325名男性，254名女性）的年生长速度与473名年龄、青春期阶段相同的同性对照儿童的生长速度。估计了846名肥胖受试者（470名男性，376名女性）的骨龄。血液分析：考虑了70名肥胖儿童的胰岛素分泌情况，并与70名年龄和性别相同的瘦对照者进行比较。
由经过培训的检查人员测量儿童的生长速率、标准化身高及其他身体特征。所有受试者均单独评估至少4年，每6个月进行一次随访。使用坦纳 - 怀特豪斯II系统，由一名观察者通过左手和手腕的X光片估计骨龄。对于胰岛素分泌研究和血糖水平，采用每千克体重1.75 g的葡萄糖负荷进行口服葡萄糖耐量试验（OGTT）。通过双抗体放射免疫测定法评估血浆胰岛素。
在肥胖儿童中，参考第97百分位、第50百分位和第3百分位的生长图表，男性在13岁、女性在12.5岁之前优于正常人群；在上述年龄后，两性的生长均下降。肥胖受试者在18岁时身高与非肥胖受试者相等。在此处考虑的年龄范围内，肥胖儿童的生长速度（厘米/年）与青春期前状态下的瘦儿童相比无差异（P无统计学意义），但在男孩和女孩的坦纳II期、III期、IV期生长速度下降（P < 0.0001）。两性的骨龄均比实际年龄提前（骨龄 - 实际年龄差值）。男孩在青春期成熟过程中，骨龄相对于实际年龄的增加无显著差异（P无统计学意义）；而女孩的骨龄 - 实际年龄差值随着性成熟的推进而减小（P < 0.0001）。与瘦对照者相比，我们的肥胖受试者血浆胰岛素水平显著更高（P < 0.0001）。此外，血浆胰岛素水平与HSDS之间存在正相关（r = 0.881，P < 0.0001）。我们未观察到血清血糖水平与HSDS之间存在相关性。
我们的数据表明，肥胖儿童从生命的最初几年就开始生长加速。在生命最初几年获得的身高优势会一直持续到青春期开始，且生长速度与瘦受试者相同。两性的骨骼成熟均显著加快。在整个青春期发育期间，骨龄一直提前。与瘦受试者相比，肥胖受试者在青春期的生长突增不太明显。生长优势逐渐减小，肥胖和正常受试者的最终成年身高相等。
