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Objective: The objective of this study was to evaluate the impact of probiotic supplementation therapy on anthropometric values and body composition of children and adolescent with obesity. Subjects and methods: This is a nonrandomized controlled, prospective, double-blind interventional clinical trial with primary data analysis. The sample comprised 44 pubertal children and adolescent (8-17 years old) with obesity. The patients were allocated to probiotic (Lactobacillus rhamnosus) or placebo group, with matching of gender and chronological age. Both groups received nutritional guidance, and were followed for six months. In all patients the anthropometric assessment was carried out by a nutritionist and data on weight, height and waist circumference (WC) were collected. Body composition was assessed using dual emission X-ray absorptiometry (DXA). Results: After six months, both groups had increased weight, height but reduced body index mass (BMI) standard deviation score, with no differences between groups. After the intervention, both groups showed a reduction in the percentage of total body fat and an increase in lean mass, but only the placebo group showed a reduction in the percentage of trunk fat. However, the variation in these parameters did not differ between groups. Conclusions: The probiotic group does not seem to have benefited from supplementation. However, we suggest that this reduction in BMI SDS in both groups may have occurred due to improvements in diet because of the nutritional advice given throughout the therapy. We concluded that supplementation with this strain of probiotic was not effective in promoting weight loss or improving the body composition of this population.

Objectives To describe population reference values for shoes size, and to identify possible disproportional foot growth during GH therapy.Materials and methods Construction of percentile chart based on 3,651 controls (male: 1,838; female: 1,813). The GH treated group included 13 children with idiopathic short stature (ISS) and 50 children with normal height, but with height prediction below their target height; male: 26 and female: 37 mean ± SD age 13.3 ± 1.9 and 12.9 ± 1.5 years, respectively. GH (0.05 mg/kg/day) was used for 3.2 ± 1.6 years, ranging from 1.0-10.3 years. Height expressed as SDS, target height (TH) SDS, self-reported shoes size and target shoes size (TSS) SDS were recorded.Results Reference values were established showed as a foot SDS calculator available online at www.clinicalcaselearning.com/v2. Definitive shoes size was attained in controls at mean age of 13y in girls and 14y in boys (average values 37 and 40, respectively). In the study group, shoes size was -0.15 ± 0.9 and -0.02 ± 1.3 SDS, with target feet of 0.08 ± 0.8 and -0.27 ± 0.7 SDS in males and females, respectively. There was a significant positive correlation between shoes size and familial TSS, between shoes size and height and between TSS and TH. There was no correlation between duration of GH treatment and shoes size. Our data suggest that during long-term treatment with GH, patients maintain proportional growth in shoes size and height, and the expected correlation with the familial target.Conclusions We conclude that there is no excessive increase in the size of foot as estimated by the size of shoes in individuals under long term GH therapy.

INTRODUCTION: Intrinsic limitations of glucocorticoid therapy in patients with congenital adrenal hyperplasia (CAH) determine frequent loss in final height. The association of secondary central precocious puberty and early epiphyseal fusion is also frequent. In these conditions, GnRHa treatment alone or in combination with GH has been indicated. OBJECTIVES: This is a retrospective study, describing the estatural findings of CAH patients with significant decrease in height prediction, who were submitted to combined GH plus GnRHa therapy up to near-final height. SUBJECTS AND METHODS: We studied 13 patients, eight females and five males, eight with the classical and five with the nonclassical form of the disorder. Treatment with hydrocortisone (10-20 mg/m²/day) or prednisolone (3-6 mg/kg/day) was associated with GnRHa (3.75 mg/months) for 4.0 (1.5) years, and GH (0.05 mg/kg/day) for 3.6 (1.4) years. RESULTS: Stature standard deviation score for bone age improved significantly after GH treatment, becoming similar to target height at the end of the second year of GH treatment. CONCLUSION: We conclude that combined GH plus GnRHa therapy can be useful in a subset of CAH patients with significant reduction of predicted final height associated with poor hormonal control and central precocious puberty. INTRODUÇÃO: As limitações intrínsecas da terapia com glicocorticoides em pacientes com hiperplasia adrenal congênita (HAC) frequentemente determinam menor altura final. Também é frequente a associação de puberdade precoce central secundária e fusão epifisária precoce. Nessas condições, tem sido indicado o tratamento com GnRHa sozinho ou em combinação com o GH. OBJETIVOS: Este é um estudo retrospectivo que descreve os achados de altura em pacientes com HAC que apresentavam diminuição significativa na altura predita e que foram submetidos ao tratamento combinado de GH com GnRHa até a altura quase normal. SUJEITOS E MÉTODOS: Estudamos 13 pacientes, oito do sexo feminino e cinco do sexo masculino, oito com a forma clássica e cinco com a forma não clássica da doença. O tratamento com hidrocortisona (10-20 mg/m²/dia) ou prednisolona (3-6 mg/kg/day) foi associado com GnRHa (3,75 mg/meses) por 4,0 (1,5) anos, e GH (0,05 mg/kg/dia) por 3,6 (1,4) anos. RESULTADOS: O escore de desvio-padrão da estatura para a idade óssea melhorou significativamente após o tratamento com GH, tornando-se similar à altura normal ao final do segundo ano desse tratamento. CONCLUSÃO: Concluímos que o tratamento de combinação com GH e GnRHa pode ser útil em um subgrupo de pacientes com HAC que apresentem redução significativa da altura final predita, associado com controle hormonal inadequado e puberdade central precoce.

O tratamento com hormônio de crescimento recombinante humano (hrGH) tem sido realizado há mais de 20 anos, visto que seu perfil de segurança é considerado excelente. Nos principais bancos de dados internacionais, os eventos adversos relatados são raros, principalmente em pacientes com deficiência isolada do hormônio de crescimento e na baixa estatura idiopática. Em relação à associação com risco de malignidade ou de recorrência tumoral, os dados sugerem que não há maior incidência em pacientes em uso de hrGH do que na população geral. A hipertensão intracraniana benigna é rara, porém sua incidência é maior em pacientes com insuficiência renal crônica. Apesar de os eventos adversos serem raros, é importante manter a monitorização cuidadosa dos pacientes em uso do hrGH, principalmente aqueles em uso de doses farmacológicas ou com patologias associadas que confiram maior risco de complicação. Recombinant human growth hormone (hrGH) has been used for treatment of growth hormone deficient children over 20 years and it can be considered to have an excellent safety profile. The main international surveys show few adverse drug reactions reported, specially in idiopathic growth hormone deficiency and in idiopathic short stature. With regard to cancer risk or tumor recurrence, it seems that there is no greater risk with hrGH treatment in comparison to general population. The idiopathic intracranial hypertension is a rare condition, but its incidence is higher in patients with chronic renal failure. The adverse events are rare in patients treated with hrGH, but these patients should be carefully monitored, specially those with pharmacologycal doses or with another clinical condition of greater risk.