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Primary care physicians play an important role in identifying children with abnormal growth. Proper dietary choices you make today very well might play a major role in preventing obesity, cancer, heart disease, osteoporosis and type 2 diabetes later in your life. The term nutrition refers to the science of how living organisms obtain and use food to support all the processes required for their existence.
Nutrients are needed by your body to provide structure, regulate chemical reactions (metabolism) and supply energy. Vitamins are abundant in most naturally occurring foods – especially fruits, vegetable, and grains. Enter your email address to subscribe to this blog and receive notifications of new posts by email.
The final destination of a journey is not, after all, the last item on the agenda, but rather some understanding, however simple or provisional, of what one has seen. In these modern times, with the plethora of blood-sugar-related diseases, we need tools like GI and GL to help us understand ways to control blood sugar.
The self-testing, graphic approach to food testing developed in the balance of the newsletter is a less scientific but a more dynamic way to explore postprandial (post-meal) blood glucose levels (BGLs).
GI measures the blood glucose impact of foods eaten in isolation, yet we rarely consume foods this way. GI readings vary with the individual—blood sugar and insulin reactions are more extreme for diabetics, for example (See Charts 2A and 2B). GIs are calculated in the science lab as the day’s first meal after a 12-hour fast and using a fixed serving that includes 50 grams of carbohydrate.  Most of our daily calories, however, are consumed in combination and throughout the day, when our blood sugar is affected by other foods that we have eaten earlier, as well as by our level of activity. Of the following numbered charts, the first three are based upon scientific research journal articles (Charts 1, 2A, 2B), while the last four (Charts 3-6) are constructed from my own self-testing of foods4 using a simple blood glucose monitor. Chart 1:  Blood Sugar Curves of White Bread Compared to Bread with Added Fiber, Sourdough, and Vinegar. Chart 3:  Instant Oatmeal, Whole Oats (Soaked and Not Soaked), and Whole Oats Combined with a Protein and Fat. To fully appreciate the impact of two back-to-back carbohydrate breakfasts please notice that the scale used for Chart 6 is twice that of Charts 3-5. Resetting the Table–to Control Blood Sugar (For a discussion of other strategies, see April 2011).
Ramekins filled with condiments like nuts and seeds (GI=0).  Nuts and seeds provide healthy fats, fiber, vitamins, minerals, and antioxidants, while they slow digestion and curb blood sugar. Sourdough bread or whole-grain bread with whole kernels; butter from grass-fed cows and organic nut and seed butters such as tahini and pumpkin seed butter. A pitcher of water and glasses for all—sometimes we mistake hunger for what is in fact thirst.  You might flavor the water with a little lemon juice or other flavoring. Because 12-hour fasting, pre-meal blood sugar reading can vary, all data points at time zero prior to the first morning meal were indexed to zero in order to illustrate the change from a neutral starting point. I use the label “traditional” carbohydrates, just as we call unrefined fats, “traditional” fats. Height that is less than the 3rd percentile or greater than the 97th percentile is deemed short or tall stature, respectively. In most cases, short or tall stature is caused by variants of a normal growth pattern; however, serious underlying pathology is present in some patients.


Short stature is defined as height that is two standard deviations below the mean height for age and sex (less than the 3rd percentile) or more than two standard deviations below the midparental height.4 A growth velocity disorder is defined as an abnormally slow growth rate, which may manifest as height deceleration across two major percentile lines on the growth chart. Emphases of the history include maternal health and habits during pregnancy, the duration of gestation, birth weight and length, and onset and duration of catch-up or catch-down growth.
It is important to distinguish tall patients who are otherwise healthy from those who have underlying pathology.
The second factor—the postwar shift from traditional to refined carbohydrates—is largely due to the growing role of the commercial food industry and processed, convenience foods.  Convenience foods must have a long shelf-life, so food companies rely upon refined flours and oils, which do not go rancid. Visual pictures of postprandial blood sugar behavior, while less scientific than GI measurements, are nevertheless powerful learning tools, providing a real flavor for how our body reacts when we eat different kinds of foods.
This chart illustrates the second meal effect– that what we eat at one meal affects postprandial blood sugar behavior at the next. What we do to our children when we give them a sugary cereal or a Pop-tart for breakfast extends beyond this first meal to affect their blood sugar, hunger, concentration, and desire to overeat throughout the rest of the day.
One of the best herbs and spices to moderate blood sugar.  It can be sprinkled on hot cereals and desserts such as puddings, custards, and stewed fruits. In two thirds of children, the growth rate percentile shifts linearly until the child reaches his or her genetically determined growth channel or height percentile.3A  Some children move up on the growth chart because they have tall parents, whereas others move down on the growth chart because they have short parents.
The child should stand erect, with the back of the head, back, buttocks area, and heels touching the vertical bar of the stadiometer; the horizontal measuring bar is lowered to the child's head to obtain the measurement. Serial height measurements over time documented on a growth chart are key in identifying abnormal growth. By 18 to 24 months of age, most children's lengths have shifted to their genetically determined percentiles. Children younger than three years should be measured on a firm horizontal platform that contains three essential components: an attached yardstick, a fixed headplate, and a movable footplate. A thorough physical examination helps differentiate abnormal growth patterns from normal variants and identifies specific dysmorphic features of genetic syndromes. This is why diabetes and obesity often go hand-in-hand (90% of diabetics are either overweight or obese). David Ludwig regarding high-glycemic foods and overeating, cited in the Recommended Reading section at the conclusion of this newsletter. Short or tall stature is usually caused by variants of a normal growth pattern, although some patients may have serious underlying pathologies. Growth hormone deficiency from hypopituitarism may cause micropenis, midface hypoplasia, and midline defects. A comprehensive history and physical examination can help differentiate abnormal growth patterns from normal variants and identify specific dysmorphic features of genetic syndromes. Cushing syndrome can cause obesity, moon facies, violaceous striae, and cessation of linear growth. In infants with macrosomia, a history of maternal gestational diabetes and family history of dysmorphology should be explored.Physical Examination.
As with short stature, a thorough physical examination differentiates abnormal growth patterns from nonpathologic variants. Severe hypothyroidism can cause increased BMI from profound growth arrest with continued weight gain, sallow complexion, and delayed relaxation of the deep tendon reflexes. Accurate height measurements over time plotted on a growth chart is the best tool for assessing abnormal growth velocity.Assessment of genetic potential helps differentiate familial from pathologic tall stature.


Girls with classic Turner syndrome present with short stature, a webbed neck, shield-shaped chest, and a low posterior hairline; whereas those with mosaic Turner syndrome may have no stigmata.
Depending on the age of the child, rickets may cause craniotabes, bulbous wrists, and bowing of the extremities. In pathologic tall stature, such as that caused by growth hormone excess, the child's projected height greatly exceeds the midparental height.24The evaluation of body proportions is essential in the differential diagnosis of tall stature or growth acceleration. Children with fetal alcohol syndrome present with short stature, low birth weight, poor weight gain, microcephaly, epicanthal folds, smooth philtrum, a flat nasal bridge, and a thin upper lip. A complete diagnostic evaluation should be performed, and certain patients should be referred to a pediatric endocrinologist (Table 4).
Marshall-Smith syndrome is characterized by unusually quick physical growth, advanced bone age, and abnormal facies. In addition to screening tests, thyroid function tests and karyotyping should be performed in all girls with short stature, even in the absence of clinical stigmata of Turner syndrome. Beckwith-Wiedemann syndrome is associated with pre-and postnatal overgrowth, advanced bone age, macroglossia, omphalocele, and hypoglycemia.Laboratory Studies. The choice of laboratory studies for the evaluation of tall stature or accelerated growth velocity should be dictated by history and physical examination findings. As with short stature, general screening studies evaluate the functional capacity of organ systems, and focused diagnostic testing evaluates specific concerns. 21, 2007.Children who are growing below the 3rd percentile or who cross percentiles after 24 months of age regardless of height should be evaluated. Therefore, supine length should always be plotted on a supine chart (used in patients from birth to three years of age), and standing height plotted on a height chart (used in patients two to 20 years of age).8In children born prematurely, height and weight adjusted for gestational age should be plotted in the first two years of life. This adjustment is calculated by subtracting the number of weeks premature the child was born from the child's current age (with 40 weeks' gestation being a full-term birth). Malnutrition (the most common cause of poor growth in children) can be diagnosed in a child two years or younger whose weight for length is less than the 5th percentile or in a child older than two years whose body mass index (BMI) for age is less than the 5th percentile.
A BMI for age greater than the 95th percentile is consistent with overweight, and a BMI for age between the 85th and 95th percentiles indicates a risk of becoming overweight.GENETIC POTENTIALBecause adult stature is usually genetically determined,9A  a child's adult height potential can be estimated by calculating the midparental height. If the estimated final height is within 5 cm (2 in) of the mid-parental height, the child's current height is appropriate for the family.
The lower body segment is subtracted from the child's height to obtain the upper body segment value. The ratio is then derived by dividing the upper body segment value by the lower segment value. A more accurate way of determining the upper-to-lower body segment ratio is to measure the upper body segment (sitting height).
The sitting height is subtracted from the patient's standing height to obtain the lower body segment value. In girls and boys, the arm span is shorter than height before puberty and greater than height after midpuberty.



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Comments

  1. Gunesli_Kayfush

    Harajuku moment, learn your e book, made fats around my center attributable cool.

    04.05.2014

  2. orxideya_girl

    Low carb to maintain the insulin better than high-fats/low-carb for dropping physique neuritis.

    04.05.2014

  3. Princ_Baku

    Pollution, consuming habits, lack of train.

    04.05.2014