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Portal-vein obstruction in children leads to growth retardation
Insights
Extrahepatic portal vein obstruction in children causes significant growth stunting, even with normal nutrition. This condition severely impacts height development over time, highlighting a critical need for early intervention.
Area of Science:
- Pediatric Gastroenterology
- Growth and Development
- Vascular Surgery
Background:
- The portal vein is crucial for liver blood supply and hepatotrophic factors.
- Partial portal vein ligation in rats impairs liver growth.
- Extrahepatic portal vein obstruction (EVPVO) in childhood may affect human growth.
Purpose of the Study:
- To investigate the impact of childhood EVPVO on human growth.
- To compare anthropometric and nutritional data of EVPVO patients with healthy controls.
Main Methods:
- Prospective anthropometric and nutritional assessments in 61 children with EVPVO.
- Comparison with 183 matched healthy controls using National Center for Health Statistics (NCHS) references.
- Analysis of growth velocity and Z scores over a 15.5-month follow-up.
Main Results:
- 51% of children with EVPVO exhibited stunted growth (height-for-age < 90% of normal) vs. 16% in controls (p<0.01).
- Severe growth retardation correlated with longer duration of portal hypertension (>5 years).
- Despite comparable energy intake and weight-for-height index, height velocity was only 56% of expected, while weight gain was 98%.
Conclusions:
- Childhood EVPVO is associated with significant growth retardation, independent of nutritional intake.
- Longer duration of portal hypertension exacerbates growth impairment.
- EVPVO markedly affects linear growth, necessitating further investigation into management strategies.
Abstract:
The portal vein is the main source of blood and hepatotrophic factors to the liver. Partial portal-vein ligation in rats results in reduced growth compared with that in control rats. To investigate whether extrahepatic portal vein obstruction occurring in early childhood influences growth in humans, anthropometric and nutritional assessments were prospectively carried out in 61 patients with extrahepatic portal vein obstruction. Comparisons were made with 183 matched healthy controls using National Center of Health Statistics reference. Fifty-one percent of children with extrahepatic portal vein obstruction had stunted growth (height for age less than 90% of normal), compared with 16% of controls (p less than 0.01). Growth retardation was severe in patients with longer (greater than 5 yr) than with shorter (less than 2.5 yr) duration of clinical portal hypertension (height for age, 88.0 +/- 3.2 vs. 95.1 +/- 3.0; p less than 0.01). Little difference was seen in the energy intake (1,302 +/- 463 kcal/day vs. 1,335 +/- 449 kcal/day; p = not significant) and weight for height index (83.6 +/- 9.3 vs. 88.0 +/- 7.9; p = not significant) between extrahepatic portal vein obstruction patients and controls. This suggested that despite comparable nutrition, marked growth retardation occurred in extrahepatic portal vein obstruction patients. Incremental growth velocity was studied in 31 patients; in 24 (73%) the baseline Z score (-2.1 +/- 0.2) had decreased further (-2.4 +/- 0.2) at the end of follow-up (15.5 +/- 1.6 mo). Although the incremental height velocity was only 56% of the expected height, incremental weight gain was 98% of the expected weight for the attained height.(ABSTRACT TRUNCATED AT 250 WORDS)