Modificaciones en variables antropométricas, analíticas de riesgo metabólico y composición corporal en un grupo de niños pequeños para la edad gestacional en tratamiento con hormona de crecimiento

Abstract

Se estima que entre un 3 y un 5 % de los recién nacidos son pequeños para la edad gestacional (PEG). Determinados estímulos producidos durante un periodo crítico de desarrollo como puede ser la vida fetal y neonatal, pueden implicar consecuencias a largo plazo para la salud de un individuo. En este sentido, se ha observado en numerosos estudios asociaciones entre los niños PEG y muchas enfermedades del adulto, entre las que destaca el síndrome metabólico. Es decir, que existe una relación entre el ambiente nutricional temprano, los patrones de crecimiento postnatal y la cantidad y distribución del tejido adiposo en la vida adulta. El nacer PEG se asocia a aumento en el riesgo de enfermedades cardiovasculares, todo esto explicado por la hipótesis de la “programación temprana fetal” y el “modelo ahorrador de los niños PEG”, que señala cambios en la composición del cuerpo afectando a la distribución de la grasa con depósito en las zonas tronculares. Un 80-90 % de los niños PEG efectuarán un crecimiento recuperador normalizando su altura hacia los 2 años de edad. No obstante, un 10-20 % de estos niños no lo realizarán, desconociéndose la causa. El tratamiento de los niños PEG sin crecimiento recuperador es actualmente una indicación de empleo de la hormona de crecimiento (rhGH), aprobada por la FDA y la EMA. Los estudios muestran que un 85% de ellos alcanzan una talla adulta normal superior a -2DE, y un 98% una talla dentro del rango de su talla genética. Además del efecto del tratamiento sobre el crecimiento lineal, la GH es una hormona anabólica que modifica el metabolismo de las grasas y de los hidratos de carbono, produciendo cambios en la composición corporal de los individuos. Por lo tanto, el estudio de los niños pequeños para la edad gestacional es un tema que está en auge dada la reciente indicación de tratamiento con hormona de crecimiento. Aunque se están realizando diversos estudios en relación a la eficacia y efectividad de la hormona en este tipo de pacientes, resultaría de especial interés, no solo valorar los cambios antropométricos que se producen, sino evaluar como su composición corporal va modificándose a lo largo del tratamiento. En el caso de que se detectaran cambios en la composición corporal, debería estudiarse la posible asociación entre dichos cambios y otras variables analíticas relacionadas con el riesgo metabólico. Al ser pacientes con un aumento del riesgo cardiovascular, el estudio de la morfología y función cardiacas pueden ser de utilidad para determinar posible morbilidad cardiovascular en la edad adulta. BIBLIOGRAFÍA 1.Lee PA, Chernausek SD, Hokken-Koelega ACS, Czernichow P. International Small for Gestacional Age Advisory Board Consensus Development Conference Statement: Management of Short Children Born Small for Gestational Age. Pediatrics. 2003;111:1253-61. 2. 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