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Aim: Growth is a multifarious phenomenon that has been studied by nutritionists, economists, paediatric endocrinologists; archaeologists, child psychologists and other experts. Yet, a unifying theory of understanding growth regulation is still lacking., Method: Critical review of the literature., Results: We summarise evidence linking social competition and its effect on hierarchies in social structures, with the neuronal networks of the ventromedial hypothalamus and body size. The endocrine signalling system regulating growth hormone, Insulin-like-Growth-Factor1 and skeletal growth, is well conserved in the evolution of vertebrata for some 400 million years. The link between size and status permits adaptive plasticity, competitive growth and strategic growth adjustments also in humans. Humans perceive size as a signal of dominance with tallness being favoured and particularly prevalent in the upper social classes., Conclusion: Westernised societies are competitive. People are tall, and "open to change." Social values include striving for status and prestige implying socio-economic domination. We consider the transition of political and social values following revolutions and civil wars, as key elements that interact with the evolutionarily conserved neuroendocrine competence for adaptive developmental plasticity, overstimulate the hypothalamic growth regulation and finally lead to the recent historic increases in average height., (© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: To scrutinize to what extent modern ideas about nutrition effects on growth are supported by historic observations in European populations., Method: We reviewed 19th and early 20th century paediatric journals in the Staatsbibliothek zu Berlin, the third largest European library with an almost complete collection of the German medical literature. During a three-day visit, we inspected 15 bookshelf meters of literature not available in electronic format., Results: Late 19th and early 20th century breastfed European infants and children, independent of social strata, grew far below World Health Organisation (WHO) standards and 15-30% of adequately-fed children would be classified as stunted by the WHO standards. Historic sources indicate that growth in height is largely independent of the extent and nature of the diet. Height catch-up after starvation was greater than catch-up reported in modern nutrition intervention studies, and allowed for unimpaired adult height., Conclusion: Historical studies are indispensable to understand why stunting does not equate with undernutrition and why modern diet interventions frequently fail to prevent stunting. Appropriateness and effect size of modern nutrition interventions on growth need revision., (©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: Poverty has often been associated with malnutrition, stunted growth, impaired cognitive development and poor earnings. We studied whether these associations were found in German men born and raised shortly after World War II during severe and long-standing nationwide malnutrition., Methods: We analysed German old-age pension payments, as a rough measure of lifetime earnings, in German men born from 1932 to 1960 and compared the at-risk-of-poverty rates of German men born in 1945-1948 versus 1935-1938 and 1955-1958., Results: Substantially fewer women worked during this period and their longer life expectancy makes their pension payments difficult to interpret. We therefore limited our analysis to men. Men born in the 1930s received the highest monthly old-age pensions and these declined slightly in men born from 1945 to 1948, indicating a minute impairment in work-related income in cohorts born shortly after the war. We also found that there was no evidence for increased at-risk-of-poverty rates in men born in 1945-1948 versus those born in 1935-1938 and in 1955-1958., Conclusion: Being born and raised following World War II was associated with a minute work and pension impairment that was not visible in the at-risk-of-poverty rates. These findings question statements associating early childhood nutrition and future lifetime earnings., (©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: We aimed to develop the first references for body height, body weight and body mass index (BMI) for boys based on the individual developmental tempo with respect to their voice break status., Methods: We re-analysed data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS study) on body height, body weight and body mass index based on the voice break, or mutation, in 3956 boys aged 10-17 years. We used the LMS method to construct smoothed references centiles for the studied variables in premutational, mutational and postmutational boys., Results: Body height, body weight and BMI differed significantly (p < 0.001) between the different stages of voice break. On average, boys were 5.9 cm taller, 5.8 kg heavier and had a 0.7 kg/m² higher BMI with every higher stage of voice break. Currently used growth references for chronological age in comparison with maturity-related references led to an average of 5.4% of boys being falsely classified as overweight., Conclusion: These newly developed growth references allowed convenient classifications of underweight and overweight or obese boys with respect to their voice break status. They should be added to currently used references centiles for the body mass index to avoid misclassifying boys' weight., (©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: Growth is both a matter of amplitude and tempo. We aimed to develop references for body height, body weight and body mass index (BMI) with respect to tempo of maturity., Methods: Data obtained from the German KiGGS study (2003-2006) on body height, body weight and presence or absence of the menarche were re-analysed in 3776 girls, aged 10-17 years. We developed smoothed centiles for BMI-, body-height- and body-weight-for-age using the LMS method for premenarcheal and postmenarcheal girls., Results: Body height, body weight and BMI differed significantly between premenarcheal and postmenarcheal girls. On average, postmenarcheal girls aged 11-17 years were 5.3 cm taller and 9.7 kg heavier, and their BMI was 2.9 kg/m² higher than in premenarcheal girls of the same calendar age., Conclusion: Adolescent BMI rises with calendar age and biological age. New reference charts for adolescent girls aged 10-18 years were generated to be inserted into the currently used references to avoid misclassifying underweight and overweight pubertal girls., (© 2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: National European growth references differ. We aimed to convert (harmonize) currently used charts into a single unified interchangeable LMS format for each European nation., Methods: Nine currently used national European growth references from Belgium (2009), France (1979), Poland (2001), Sweden (2002), Switzerland (1989), the UK (1990), Italy (2006) and Germany (1979 and 1997) were harmonized and compared with the international WHO child growth standards and WHO growth reference data for 5-19 years., Results: European growth charts can be harmonized. The approach appears useful as height, and body mass index (BMI) is inappropriately represented by WHO references. European height references exhibit warping when plotted against the WHO reference. The French appears too short, the other Europeans too tall. Also, the BMI is not appropriately represented by the WHO references., Conclusions: Harmonizing references is a novel, convenient and cost-effective approach for converting historic and/or incomplete local or national growth reference charts into a unified interchangeable LMS format. Harmonizing facilitates producing growth references 'on demand', for limited regional purposes, for ethnically, socio-economically or politically defined minorities, but also for matching geographically different groups of children and adolescents for international growth and registry studies., (© 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.)

Aim: This study investigates the effect of rapid weight gain in term children, adolescents and young adults born appropriate for gestational age., Methods: In all, 173 girls and 178 boys aged 6.1-19.9 (12.5 +/- 3.1)years participated. Rapid weight gain (group 1) was defined as a change in weight-SDS (standard deviation score) from birth till two years >0.67, 'no change' as > or =-0.67 and < or =0.67 (group 2) vs 'slow weight gain' as <-0.67 (group 3). BMI-SDS, waist circumference (WC) z-score, fat mass (FM)/fat free mass (FFM; Air-Displacement-Plethysmography), resting energy expenditure (REE; ventilated hood system), cardio-metabolic risk factors, serum leptin and adiponectin were assessed. >90th age-/sex-specific BMI-percentile was defined as overweight. Parental BMI, socio-economic status and lifestyle were assessed as confounders., Results: A total of 22.8% gained weight rapidly, and 15.7% was overweight. Group 1 compared with group 2 and 3 subjects was taller, heavier and had a higher prevalence of overweight (girls/boys: 26.2%/28.9% vs 11.6%/19.0% vs 2.8%/5.0%; p < 0.01/p < 0.05). Concomitantly, a higher WC, %FM and FFM were observed. Rapid weight gain was positively associated with REE (adjusted for FFM) in boys (r = 0.26; p < 0.01), but not with cardio-metabolic risk factors., Conclusion: Rapid weight gain was related to increases in height, weight, a higher prevalence of overweight and central fat distribution. In addition, rapid weight gain was related to a higher REE in boys, but not to cardio-metabolic risk factors.

Aim: To discuss a hypothesis regarding the impact and possible side effects of glutamate in paediatric parenteral nutrition., Results: Published evidence suggests that the arcuate nucleus, which is a potent site of leptin action, is severely damaged by elevated glutamate levels. Early administration of glutamate (GLU) to the neonatal rat disrupts the hypothalamic signalling cascade of leptin action., Conclusion: We are concerned that GLU-containing parenteral nutrition may not only increase the risk of hypothalamic damage in neurosurgical patients with an impaired blood-brain barrier, and in patients with periventricular leukomalacia, but may also permanently damage the arcuate nucleus neurones in the very immature infant. This may result in later impairment of feeding regulation, obesity, hyperleptinaemia, and other symptoms that characterize the "thrifty phenotype" and the dysmetabolic syndrome. We strongly suggest reconsidering the recommended daily allowances of amino acids, particularly the use of GLU, in current paediatric parenteral nutrition.

Aim: Child growth is modulated by numerous factors and, particularly in infancy and early childhood, often tends to follow apparently irregular patterns, with many centiles crossed before the later growth channels are reached. The aim of this study was to visualize the diversity of individual growth., Design: The study investigated 333 girls and 329 boys without chronic illnesses from four paediatric practices in Kiel, Germany. The children were measured on natural, i.e., on various occasions, when they were presented to their doctors for preventive care examinations and for minor illnesses, at the age of 0.25 (range +/- 0.08) y, 0.5 (range +/- 0.16) y, 0.75 (range +/- 0.16) y, 1.0 (range +/- 0.25) y, and at the ages of 1.5, 2, 3, 4 and 5 (range +/- 0.25) y. Each individual growth curve was converted into a series of height SDS (standard deviation scores) using one of the most reputable longitudinal German growth studies as background reference. Height SDS was then converted into residual height SDS (differences between height SDS of each measurement and average personal height SDS of the respective child). Cluster analysis was used to identify groups of children (clusters) with similarities in residual height SDS patterns (growth tracks). The clusters contained a minimum of at least 10 children. Single children or small sets of individuals below the minimum number were rejected from further analysis., Results: In males, 10 growth tracks were identified, each consisting of 11 to 52 boys. Growth in 111 boys was so heterogeneous that they could not be assigned to growth tracks. In females, 11 growth tracks were identified, each consisting of 12 to 48 girls; 112 girls could not be assigned. Approximately 7% of boys and 15% of girls showed evidence of a mild intermittent growth spurt at the end of infancy. Some growth tracks were almost horizontal, or showed declining residual height SDS up to the age of 3 and 4 y, with no evidence of growth spurts during early childhood. Others showed sharply declining growth in early infancy, or irregular patterns. Similar results were obtained when using cross-sectional standards as background reference., Conclusion: Cluster analysis provides evidence that the substantial diversity in infant and early child growth, is limited to a small number of narrow but characteristic tracks of yet unknown biological significance.

Distance standards of height (growth charts) tend to get out of date and must be actualized from time to time. The aim of the present meta-analysis was to investigate characteristics of the cross sectional incremental pattern of body stature, evaluating the possibility of generating distance standards of height without the need for extensive de novo measurements. In view of the differences in growth in early and late childhood, we divided the total period of child development into the period between birth and the age of 6y, and between 6 and early adulthood (15y in females, 18 y in males). With respect to birth length, we meta-analysed 50 European and US American growth studies; with respect to growth in early childhood, 14 studies were analysed; and with respect to growth in late childhood, we meta-analysed 40 male and 51 female growth studies, from 14 European countries and the USA. Variations in body stature were meta-analysed in very large data samples, including the 1992 German birth cohort with more than 500 000 measurements of newborns, 10 000 measurements of 2-y-old German children, more than 500 000 measurements of German school children, and 6 large growth surveys of Japan and Czechoslovakia, with altogether more than 24 000 000 measurements. We found a rigid pattern of cross sectional body stature increment between birth and early adulthood that could be expressed by age-specific linear regression coefficients. Body stature was found to be related between sexes. Male birth length correlated with female length (r = 0.933, p < 0.001, slope = 4.62, intercept = 0.89), stature of 6-y-old boys correlated with stature of 6-y-old girls (r = 0.96, p < 0.001, slope = 1.05, intercept= -6.75), and stature of 18-y-old boys correlated with stature of 15-y-old girls (r=0.96, p < 0.001, slope = 0.90, intercept = 2.85). The developmental pace was also strongly related in both sexes. In conclusion, age-specific linear regression coefficients can be utilized synthetically to generate distance standards for height (synthetic growth reference charts). Synthetic growth reference charts can help to actualize current growth charts without much additional effort, and they may also be used for populations for which autochthonous growth standards are not available.

Gonadotropin-releasing hormone (GnRH)-analogues are widely used for treating precocious puberty, and occasionally in short patients and patients with growth-hormone deficiency, in order to delay pubertal development and increase final height. Yet, many of these children only decelerate growth velocity and neither improve in final height nor even in height prediction. As GnRH-analogue treatment dramatically reduces sexual steroid levels, I hypothesized the need for steroid hormone substitution during this treatment. Growth promotion was tried in a healthy girl, with a very unsatisfying height prediction of only 144 cm, using a combination of GnRH-analogue (75 micrograms/kg/4 weeks), plus growth hormone (4 IU/m2/d), plus oxandrolone (1 mg/d). Knemometric measurements of lower leg growth velocity demonstrated that GnRH-analogue alone depresses growth. Additional GH administration only sporadically increases growth velocity, and not until the additional substitution of oxandrolone does growth velocity catch up and return to near pretreatment level. In spite of a 10.3 cm increase in body height during the 15-month period of observation, little bone age progression took place, and height prediction improved from 144 cm to over 149 cm after 9 months, and to 152 cm after 15 months of observation.