A recent study published in the Pakistan Journal of Medical Sciences found that growth hormone deficiency and vitamin D deficiency constituted the major causes of short stature among children and adolescents in Pakistan.
Short stature is defined as height below the 3rd percentile. This means that out of 100 children, the three shortest children would be considered to have short stature.
Short stature can result from normal variants of growth, such as genetics, delayed growth and puberty. It can also be a result of chronic disease, hormonal disorders, malnutrition and skeletal abnormalities. Early detection and treatment of remediable causes of short stature, such as malnutrition and hormonal imbalances, may lead to proper growth among children.
In Pakistan, 33% of children under five years old are underweight, and 53% have stunted growth. Research has discovered that up to 94% of Pakistani children are vitamin D deficient, leading to reduced bone mineralization and growth rate.
Limited information regarding the etiology of short stature among Pakistani children exists. However, current data suggests delayed growth and puberty, along with genetics represent the major causes.
A new study sought to determine the major remediable causes of short stature among Pakistani children. To do this, the researchers enrolled 70 children and adolescents attending WILCARE Center for Diabetes, Endocrinology & Metabolism, a location in which the researchers expected to find a broader range of hormonal causes for short stature.
All children were considered to be short stature and well-nourished. They all underwent a clinical evaluation, which included retrieving their medical history, a physical examination and relevant biochemical assays. These assays consisted of an extensive number of tests, such as blood count, urine and stool examination, blood glucose, blood urea, liver function tests, cortisol levels, vitamin D status and insulin-like growth factor-1 (a way to assess growth hormone levels). The researchers also performed X-rays on all children’s hands to assess their bone health.
Here is what the researchers found:
- The weight for age was below the 3rd percentile in 81% of the patients.
- Growth Hormone deficiency was the leading cause of short stature with 69% of patients considered deficient.
- Vitamin D deficiency was the second most common hormonal abnormality, present in 63% of all patients.
- Other abnormalities seen in the patients included primary hypothyroidism (9%) and panhypopituitarism (failure of the pituitary gland) (6%).
The researchers concluded,
“Growth hormone and Vitamin D deficiency constitute the major causes of short stature among well-nourished children with short stature in Pakistan.”
They continued to state,
“Early recognition of these pathologies can not only help attain normal stature but also improve their quality of life and social standing. General Physicians need to be cognizant of and refer patients promptly to endocrinologist for timely treatment.”
The researchers also pointed out the study’s main limitation, “This study was conducted at an Endocrine Clinical referral center and may not actually represent the true frequency of causes of short stature in our population.”
Clinical trials are needed to evaluate the efficacy of treating short stature with vitamin D supplementation.
Tovey, A. & Cannell, JJ. Study suggests vitamin D deficiency may be a major cause of short stature in Pakistan. The Vitamin D Council Blog & Newsletter, 2017.