| Objective: At present,malnutrition is more common in children with short stature,which seriously affects the growth and development of children.This research aimed to investigate the relationship between hemoglobin(Hb),body mass index(BMI)and growth hormone(GH)peak in children and adolescents with short stature.Methods: Participant data were collected from cohort GDDSD study(Growth and Development Diseases in Shandong Province: a cohort follow-up study,http://www.chictr.org.cn,Chi CTR1900026510).This cross-sectional study collected 729 children and adolescents with short stature between March 1,2013 and February 28,2019.Anthropometric indicators were measured at baseline including height,weight,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate,BMI,body mass index standard deviation score(BMI SDS).Biochemical indicators including liver and kidney function,blood lipid,fasting blood glucose(FBG)were measured.All patients underwent GH provocation tests with L-dopa and insulin to assess GH peak levels.We divided GH peak levels into two groups,Group1: GH<10ng/m L;Group2: GH≥10ng/m L.The differences of nutrition related markers between the two groups were compared,and the correlation between Hb、BMI SDS and GH peak was analyzed,and perform a stratified analysis in Growth hormone deficiency(GHD)and Idiopathic short stature(ISS).Results:(1)In short stature patients,Hb level in group 2 was significantly higher than that in group 1 with the increase of GH peak level,while BMI,BMI SDS and Total cholesterol(TC)levels were significantly lower than those in the former group(P<0.05);there was no significant difference in Triglyceride(TG)and Albumin(ALB)between two groups.(2)The univariate analysis results showed that Hb was positively associated with GH peak(β 0.06;95%CI 0.02,0.11;P=0.003).BMI SDS(β-0.92;95% CI-1.27,-0.57;P<0.001),TC(β-1.36;95% CI-1.98,-0.74;P<0.001),TG(β-1.59;95% CI-2.78,-0.39;P=0.009)were negatively correlated with GH peak.There was no significant correlation between GH peak and sex,age,ALB,HDL-C or LDL-C.(3)Furthermore,a non-linear relationship was detected between Hb,BMI SDS and GH peak through smooth curve fitting.The threshold effect analysis showed that when Hb ≥ 120 g/L,GH peak increased with the Hb elevation(β 0.07,95% CI 0.01,0.13;P=0.029),and the stratified analysis showed that there was a non-linear relationship between Hb and GH peak in ISS group,and there was no correlation between Hb and GH peak in GHD group.When BMI SDS ≥-0.72,GH peak decreased with the BMI SDS elevation(β-1.43,95% CI-1.97,0.89;P<0.001),the stratified analysis was similar with the whole in both GHD and ISS group.(4)The interaction between BMI SDS and Hb on GH peak was evaluated by the interaction test in patients with short stature.As a result,no significant interaction between BMI SDS and Hb on GH peak was found(P > 0.05).Conclusions: In children and adolescents with short stature,there is a nonlinear relationship between Hb,BMI SDS level and GH peak.when the Hb level reached the inflection point,GH peak was positively associated with the rise of Hb level;when BMI SDS reached the inflection point,GH peak is negatively correlated with BMI SDS.In the diagnosis and treatment of children and adolescents with short stature,we should pay attention to monitoring nutrition-related indicators such as Hb and BMI to evaluate the growth and development of patients more comprehensively. |
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