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Vitamin A and iron supplementation is as efficient as hormonal therapy in constitutionally delayed children
1Pediatric Endocrine Unit, Kaplan Medical Center, Rehovot, Israel. zvivadik@012.net.il
Insights
Nutritional supplementation, specifically vitamin A and iron, effectively promotes growth and puberty in children with constitutional delay. This approach is as effective as hormonal therapies for these common childhood developmental issues.
Area of Science:
- Pediatric Endocrinology
- Nutritional Science
- Growth and Development
Background:
- Constitutional delay in growth and puberty is a common concern in pediatric endocrinology.
- Identifying etiological factors is crucial for effective management.
- Suboptimal nutrient intake can impact pubertal maturation.
Purpose of the Study:
- To evaluate the impact of nutritional supplementation on growth and pubertal development in children with constitutional delay.
- To compare the efficacy of nutritional interventions with hormonal therapies.
Main Methods:
- A randomized controlled trial involving 102 boys (13.6-15.5 years) with short stature and delayed puberty.
- Interventions included oxandrolone, testosterone depot, nutritional programs (vitamin A and iron), or observation.
- Outcome measures included height, weight, pubertal signs, and serum nutrient levels.
Main Results:
- Vitamin A supplementation significantly accelerated growth, comparable to hormonal treatments.
- Puberty was induced within 12 months in the vitamin A-supplemented group.
- Hormonal therapies also induced significant pubertal development, while the observation group showed no changes.
Conclusions:
- Subnormal vitamin A intake is a contributing factor to delayed pubertal maturation.
- Nutritional supplementation with vitamin A and iron is a viable and effective alternative to hormonal therapy for inducing growth and puberty in selected children.
- This highlights the importance of nutritional status in pubertal development.
Objective:
To assess the effect of nutritional supplementation on growth and puberty in constitutionally delayed children.
Patients:
One hundred and two boys, 13.6-15.5 years of age, who were referred because of short stature and delayed puberty.
Methods:
The boys were randomly allocated to one of the following treatment groups: oxandrolone therapy, 5 mg/day for 6 months (n = 15), testosterone depot, 100 mg monthly for 3 months (n = 15) or for 6 months (n = 20), nutritional programme (n = 17), oxandrolone and nutritional programme (n = 15) or passive observation (n = 20). Boys in the nutritional programmes received 12 mg/day iron and 6000 IU/week of vitamin A. Outcome measurements were of height, weight, pubertal signs, dietary intake, serum vitamin A, iron, GH and IGF-1.
Results:
Six months of vitamin A supplementation induced growth acceleration similar to that seen in the oxandrolone- and testosterone-treated children, and significantly greater than in the observation group (9.3 +/- 2.9 vs. 4.0 +/- 0.9 crn/yr, P < 0.001). Whereas in the vitamin A-supplemented group, puberty (increase in testicular volume >/= 12 ml) was induced within 12 months. In all testosterone-treated patients, pubic hair was noted within 3 months and a testicular volume of >/= 12 ml was observed 9-12 months after the initiation of therapy. No pubertal signs were noted in the observation group during this time.
Conclusions:
Subnormal vitamin A intake is one of the aetiological factors in delayed pubertal maturation. Supplementation of both vitamin A and iron to normal constitutionally delayed children with subnormal vitamin A intake is as efficacious as hormonal therapy in the induction of growth and puberty.
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