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• W3186607685 abstract "Fischhoff J, Whitten CF, Pettit MG. A Psychiatric Study of Mothers of Infants with Growth Failure Secondary to Maternal Deprivation. J Pediatr 1971;79:209-15. Pediatric malnutrition has been defined as the negative imbalance between what is required for a child’s healthy growth and development and what is delivered effectively.1Mehta N.M. Corkins M.R. Lyman B. Malone A. Goday P.S. Carney L.N. et al.Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions.JPEN J Parenter Enteral Nutr. 2013; 37: 460-481Crossref PubMed Scopus (321) Google Scholar This 1971 article by Fischhoff et al describes 16 full-term infants who were found to be malnourished at 3-24 months after birth. These children had no evidence of organic cause for failure to thrive and showed marked improvement after a period of adequate food provision. The study evaluated the psychological status of the mothers of these infants, and determined that the infants were malnourished owing to inadequate nutritional intake associated with maternal deprivation, rather than defects in their absorption or their metabolism of nutrients. Fifty years later, although childhood neglect remains a potential etiology for pediatric malnutrition, our understanding of physiologic and hormone-related changes during periods of decreased intake continues to evolve. It has now been determined that a child’s nutritional status plays an important role on the growth hormone-insulin-like growth factor-1 (IGF-1) axis. Insufficient food intake leads to a catabolic state in which the body develops lower levels of IGF-1 (a hormone produced by the liver), leading to lower muscle bulk and linear growth.2Haspolat K. Ece A. Gurkan F. Atamer Y. Tutanç M. Yolbaş I. Relationships between leptin, insulin, IGF-1 and IGFBP-3 in children with energy malnutrition.Clin Biochem. 2007; 40: 201-205Crossref PubMed Scopus (33) Google Scholar IGF binding protein-3 is a protein that regulates the transport of IGF-1 in the blood circulation, controlling delivery of the hormone to body tissues.2Haspolat K. Ece A. Gurkan F. Atamer Y. Tutanç M. Yolbaş I. Relationships between leptin, insulin, IGF-1 and IGFBP-3 in children with energy malnutrition.Clin Biochem. 2007; 40: 201-205Crossref PubMed Scopus (33) Google Scholar IGF binding protein-3 has been found to act in parallel to levels of IGF-1 during periods of malnutrition, with levels decreasing during periods of inadequate nutrition and recovering during refeeding.3Livingstone C. The insulin-like growth factor system and nutritional assessment.Scientifica (Cairo). 2012; 2012: 768731PubMed Google Scholar It has been suggested that this serum protein is a more sensitive marker for nutritional status than IGF-1.4Ozen M. Cokugras H. Ozen H. Camcioglu Y. Akcakaya N. Relation between serum insulin-like growth factor-I and insulin-like growth factor-binding protein-3 levels, clinical status and growth parameters in prepuberal cystic fibrosis patients.Pediatr Int. 2004; 46: 429-435Crossref PubMed Scopus (20) Google Scholar Scientific investigation over the last several decades has also determined that children in a catabolic state have low baseline insulin and leptin levels with elevated growth hormone, cortisol, and ghrelin levels, directing the body toward fat catabolism and glucose production, rather than energy storage and growth.5Bartz S. Mody A. Hornik C. Bain J. Muehlbauer M. Kiyimba T. et al.Severe acute malnutrition in childhood: hormonal and metabolic status at presentation, response to treatment, and predictors of mortality.J Clin Endocrinol Metab. 2014; 99: 2128-2137Crossref PubMed Scopus (110) Google Scholar These hormonal imbalances reverse with adequate caloric intake. Malnutrition in children is associated with illness-related catabolic states and can also occur in non-illness-related situations such as neglect, environmental instability (food insecurity, low socioeconomic status), and in behavioral conditions (oral aversion, disordered eating patterns). Thought to be under-recognized, the American Society for Parenteral and Enteral Nutrition guidelines now recommend 5 key domains to evaluate for adequate nutritional assessment: anthropometrics, growth patterns, chronicity, etiology, and functional status.1Mehta N.M. Corkins M.R. Lyman B. Malone A. Goday P.S. Carney L.N. et al.Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions.JPEN J Parenter Enteral Nutr. 2013; 37: 460-481Crossref PubMed Scopus (321) Google Scholar With advancement in our understanding of pediatric malnutrition, protein markers and hormone levels are becoming increasingly important components of the nutritional evaluation. We expect that our field of knowledge will continue to evolve as we learn more about the intricate biochemical pathways of the human body." @default.
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