[Somatic development of asthmatic children and youth].
Systemic diseases especially the chronic ones, causing substance and oxygen insufficiency may lead to disturbances in growth, in the nutritional status and slowing of the maturation processes. Bronchial asthma is the most frequent inflammatory chronic disease of the respiratory system and it is estimated, that 5-10% of the population in the development period suffers from it. Somatic development retardation, disturbances in the nutritional status and maturation may be caused by respiratory insufficiency leading to anoxia, improper nutritional habits, recurrent or chronic infections, long-term physical and mental stress, limited physical activity and also pharmacological therapy. THE AIM of this work was to conduct, in children with bronchial asthma, the evaluation of: somatic development, body proportions, nutritional status, sexual maturation depending on the duration and degree of severity of the disease. The second aim was to assess whether the assumed standard for complex treatment depending on the severity of the diseases may lead to normal somatic development.


METHODS
In the research comprised 508 children (3 1 5 boys and 93 girls) between 7 and 1 5 years of age, treated for bronchial asthma in the Paediatric Department of the Institute of Tuberculosis and Lung Diseases in Rabka. Due to the multiplicity of factors influencing the course of development, the following were observed in the studied groups: birth weight and length, average height of parents (selected genetic factors); place of domicile and educational level of the parents (social-economic factors). The study concerned children born with normal birth weight and length. Evaluation of the impact of genetic factors, was based on the analysis of parent's height; it did not differ in the studied groups with regard to the women's or men's height in the average population. The majority of the studied children lived in towns, every third child lived in the country. Parents of the studied children suffering from asthma had a higher educational level than the Polish population.


METHODS
The level of somatic development and body proportions were evaluated with reference to direct anthropometric measurements: body height and weight, head and chest circumference, length of trunk, width of shoulders and hips, width and depth of the chest, and indexes of the trunk length, shoulder-hip and chest. The nutritional status was evaluated by the following anthropometric measurements, according to WHO/FAO recommendations: circumference of the arm and thigh, subscapular and abdominal skinfold thickness, BMI and the arm muscle circumference, according to Frisancho. All the above anthropometric measurements and indices were analyzed in groups of children depending on the severity and duration of the disease (classification according to the Global Strategy for Asthma Management and Prevention NHLBI/WHO, NIH Publication, 1998) group I -- episodic and mild asthma (I and II degree) duration up to 3 years, group II -- moderate and severe asthma (III and IV degree) duration up to 3 years, group III -- episodic and mild asthma (I and II degree) duration over 3 years group IV -- moderate and severe asthma (III and IV degree) duration over 3 years. The obtained results were compared with data for healthy Warsaw population. In order to compare the level and variation of different somatic measurements and indices in children at different ages measurement results were transformed to standard normal distribution with a mean of 0 and standard deviation of 1. Moreover, in order to evaluate the variation of features with normal distribution within the groups and between the studied groups, analysis of variance ANOVA was used (acc. to the STATISTICA programme). This enabled the comparison of anthropometric measurements and indices in children with bronchial asthma in the four studied groups. To determine the statistical significance between the arithmetical means of the studied features in children with bronchial asthma and in healthy children, the t-Student test for independent samples was applied. These differences between selected groups depending on the degree of severity of the disease and its duration and between the four groups, based on the severity of the disease and its duration, on one hand and healthy children on the other were evaluated. The features and anthropometric indexes with naturally skewed distribution of measurement results were evaluated using centile values and medians. The subscapular and abdominal skinfold thickness after calculating centile values, were estimated on centile charts for this feature in the Warsaw population. The value of the skinfold thickness in centile intervals in isolated groups depending on severity of the illness and its duration and in the four groups, considering severity and duration of illness, was also analyzed. (ABSTRACT TRUNCATED)
Szilágyi-Pagowska
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I
Zakład Rozwoju Dzieci i Młodziezy, Instytut Matki i Dziecka, ul. Kasprzaka 17a, 01-211 Warszawa, Poland. medroz@imid.med.pl
D000293:Adolescent; D001249:Asthma / Q000150:complications; D001724:Birth Weight; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002657:Child Development; D002908:Chronic Disease; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008403:Mass Screening; D009752:Nutritional Status; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012885:Skinfold Thickness; D012959:Socioeconomic Factors