Katarzyna Anna Majewska

Background/Objectives: Subtle cognitive alterations have been described in children with type 1 diabetes (T1D), but the association between cognition and real-time glycemia during cognitive testing remains unclear. This study aimed to investigate whether blood glucose level (BGL) measured immediately before the MOXO Continuous Performance Test (MOXO-CPT) is associated with cognitive performance and modified by clinical factors. Methods: A total of 117 children with T1D (aged 6–18 years) completed the MOXO-CPT assessing sustained attention, timeliness, impulsivity, and hyperactivity. Participants were stratified by BGL measured immediately before testing (p = 0.036) and timeliness scores (p = 0.040) than those with BGL < 200 mg/dL. However, these differences did not remain statistically significant after Benjamini–Hochberg correction and were not confirmed after adjustment for relevant covariates. No differences were observed in impulsivity or hyperactivity. In multivariable models, higher BGLs were independently associated with higher impulsivity scores (B = 0.013, p = 0.007), with higher scores indicating better impulse-control performance. A significant BGL–sex interaction was observed for timeliness. Sex-stratified analyses showed that higher BGLs were associated with better attention and timeliness in girls, whereas the association with impulsivity observed in boys was not confirmed using robust analysis. No significant interactions between BGL and HbA1c, age, treatment modality, or diabetes duration were observed after robust analysis. Conclusions: Real-time glycemia during cognitive testing was associated with subtle, domain-specific differences in cognitive performance in children with T1D. These findings do not establish causality or indicate that higher glucose levels improve cognitive performance. Concurrent glucose levels may be worth considering when interpreting cognitive assessments, although this should be confirmed in prospective studies.

Purpose The aim of this study was to reanalyze our previous results in terms of GH1 gene allele frequencies in children with short stature using a new approach with more diverse growth hormone (GH) peak level ranges along with an increased number of patients, and included height velocity analysis in the first year of recombinant human GH treatment. Methods The study group included 202 children with short stature, divided into three subgroups according to the serum GH peak level: GH1 gene were sequenced by the Sanger method. Results Allele frequencies were established for all 13 studied SNPs. Only for one intronic SNP (rs41295245, G>A) frequencies differed significantly when compared patients with GH peak ≥ 10 ng/ml versus controls (P = 0.0224) and when compared patients with GH peak ≥ 10 ng/ml and patients with GH peak < 5 ng/ml (P = 0.0317). In a single patient, two additional missense variants were found. In exon 4 (11:g.63917914) the A>T substitution leads to p.Leu101His exchange, while in exon 5, the rs1423321088 A>G (p.Asp179Gly) was detected. Conclusion Our study showed that intronic SNP in the GH1 gene may be associated with short stature despite normal GH serum concentrations. Two GH1 variants found in a single patient with low GH secretion could potentially affect structural properties of the protein, leading to short stature and GH deficiency.

Background/Objectives: Attention is a fundamental cognitive parameter, essential for developmental processes. It enables the selective processing of environmental stimuli and guides behavioral responses. Obesity, apart from its broad influence on human somatic health, is also associated with mental and cognitive functioning. In childhood obesity, detailed attention assessment could help elucidate the relationship between the condition and cognitive development, and perhaps also help predict specific difficulties during treatment. The aim of the study was to investigate attention functioning in children and adolescents with obesity using the computerized continuous performance test (CPT). Methods: The study involved 71 children, including 23 with obesity and 48 healthy children with normal body weight. The MOXO CPT was used to assess attention parameters in all participants. The test covered four parameters: sustained attention, timing, impulsivity, and hyperactivity. Results: Children with obesity obtained significantly lower CPT results in terms of timing (p = 0.024), hyperactivity (p = 0.001), and impulsivity (p < 0.001), while the difference in sustained attention did not reach statistical significance (p = 0.074). Conclusions: Attention efficiency appears to be reduced in children with obesity compared with their healthy peers. Assessment of attention parameters in this group of patients could be valuable in the context of planning and implementing therapeutic interventions. Children with coexisting obesity and impaired attention functioning would probably require more assistance in following daily behavioral and nutritional recommendations.

Objectives: Dental eruption is a complex process influenced by various factors, including endocrine factors as growth hormone (GH). The aim of this study was to assess differences in the advancement of tooth eruption between growth hormone-deficient (GHD) and idiopathic short-statured (ISS) children and a control group of children with normal growth patterns. Methods: A total of 156 children participated in this study: 78 patients with short stature (50 boys and 28 girls) and 78 healthy and age- and sex-matched control subjects. Each permanent tooth was classified according to its clinical eruption stage by one trained and calibrated dentist. Results: The mean age was 10.22 ± 2.42 years for the study and 10.15 ± 2.45 for the control group. In our study, we observed eruption delay during the early mixed dentition stage. A significant difference was found in the degree of eruption for all incisors and first permanent molars between the GHD before treatment group and the control group (p = 0.045). The difference was apparent at the initial stage of permanent tooth eruption, in the group of children who had not yet initiated growth hormone treatment. The eruption of remaining tooth groups did not differ significantly between the children with growth failure and the control group (p > 0.05). Conclusions: Our findings indicate that the delay in tooth eruption observed in short-statured children, particularly affecting the first permanent molars and incisors, may reflect the direct influence of growth hormone deficiency on early dental development. The clinical relevance of this finding underlines the importance of individualized dental care and careful timing of orthodontic assessments in short-statured patients, especially prior to the initiation of GH therapy.

Background and Objectives: Growth failure is the main symptom of growth hormone deficiency (GHD) in children. The standard treatment for GHD is the administration of recombinant human growth hormone (rhGH). However, this therapy seems to be less effective in undernourished children. Our study aimed to investigate if professional dietary counseling could affect the parameters of growth response in GHD children undergoing rhGH treatment. Methods: The study group involved 29 prepubertal children with GHD (20 boys and 9 girls) aged 8.7 ± 2.50, who were subject to a year of individualized nutritional counseling from a dietician, which included three sessions in 6-month intervals, starting at the beginning of rhGH treatment. The control group consisted of 47 children with GHD (33 boys and 14 girls) aged 8.8 ± 1.73 who were not under the care of the dietician during their rhGH treatment. Parameters of growth response, including the variation of height standard deviation score (ΔhSDS) and height velocity (HV), were compared between the groups during the first two years of rhGH therapy. Results: The mean HV and ΔhSDS were slightly higher in the study group than in the control group during both the first and the second year of rhGH therapy, however, those differences did not reach a statistical significance. BMI z-score was stable throughout the observation period. Conclusions: One-year of dietary counseling, starting at the beginning of rhGH treatment, and conducted in 6-month intervals did not significantly improve the parameters of growth response in prepubertal GHD children during the first two years of the therapy.

Purpose: Growth hormone deficiency (GHD) causes growth disturbances during childhood. The most recommended treatment of GHD is the administration of recombinant human growth hormone (rhGH). Recent studies have proved that well-nourished GHD children respond better to rhGH therapy compared to undernourished individuals. The aim of this study was to analyze nutritional status along with height velocity in GHD children during the first two years of rhGH therapy, and to estimate the optimal BMI z-score range in which these children achieve the best growth results. Methods: This retrospective analysis included 80 prepubertal idiopathic GHD children treated with rhGH. Anthropometric data were obtained from medical records made at an initial visit and then follow-up visits after 12 and 24 months of treatment. The body mass index (BMI) was calculated and standardized into z-score, basing on Cole’s LMS method. Then, the BMI z-score was analyzed in relation to the parameters of growth response. Results: The higher the BMI z-score at treatment entry, the greater the increase in height during the first twelve months of rhGH therapy. BMI z-score ≥0 noted at the beginning of each year of the treatment are associated with significantly better growth increments throughout the first and the second years of the therapy. Conclusion: Prepubertal idiopathic GHD children with BMI z-score below 0 would probably benefit from the improvement of their nutritional status prior to the rhGH treatment beginning. It seems that increasing BMI z-score to obtain values between 0 and 1 would be optimal for the growth process.

Short stature affects approximately 2.5% of children. Some of them, when diagnosed with growth hormone deficiency (GHD), benefit from recombinant human growth hormone (rhGH) therapy; in others, this treatment is controversial. We aimed to present the clinical characteristics of Polish short stature children in the context of current GHD diagnostic standards, as obtaining more data gives a broader foundation for the potential modifications of diagnostic and therapeutic recommendations. This retrospective analysis was based on a cohort of 277 short stature children divided into two subgroups depending on their peak growth hormone (GH) cutoff level, set at 10 ng/mL: 138 had growth hormone deficiency (GHD) and 137 had normal growth hormone secretion (GHN). These subgroups were then compared based on the extracted clinical data. In the obtained result, no significant differences between the GHD and GHN subgroups were found in any of the variables, including the following: gender distribution, birth weight, bone age delay, height SDS, IGF-1 SDS, vitamin D levels, celiac disease indices, prevalence of hypothyroidism or anemia. As our results point to major clinical similarities between the GHD and GHN children, it seems that distinguishing patients with normal GH secretion from those with deficient GH secretion based on a 10 ng/mL cutoff value might not be clinically relevant.