Height velocity in the detection of growth disorders reconsidered: a retrospective analysis of the DONALD study

Ibrahim Duran; Maja Zimmermann; Jonathan Buggisch; Heike Hoyer-Kuhn; Ute Alexy; Eckhard Schoenau

doi:10.1515/jpem-2025-0225

Artikel

Height velocity in the detection of growth disorders reconsidered: a retrospective analysis of the DONALD study

Ibrahim Duran , Maja Zimmermann , Jonathan Buggisch , Heike Hoyer-Kuhn , Ute Alexy und Eckhard Schoenau

Veröffentlicht/Copyright: 20. Juni 2025

Veröffentlicht von

Veröffentlichen auch Sie bei De Gruyter Brill

Manuskript einreichen Informationen für Autor*innen Erkunden Sie dieses Fachgebiet

Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 38 Heft 9

Abstract

Objectives

To generate current reference values for height velocity (HV, cm/year) in German children and adolescents and to evaluate the sensitivity of auxological parameters in the evaluation of short stature (referral criteria).

Methods

The study population consisted of healthy German participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study (1985–2022). In total, data was available from n=453 girls (mean age 9.1 ± 2.4 years) and n=473 boys (mean age of 9.6 ± 2.5 years). As the participants were measured repeatedly, 4,557 HV assessments for girls and 5,224 HV assessments for boys were analyzed (median number of observations in female was nine and in male 11). The reference percentiles were created using the LMS method. The referral criteria of the German Society for Pediatric and Adolescent Endocrinology and Diabetology (DGPAED) and of the Growth Hormone Research Society (GHRS) for further endocrinological evaluation were evaluated in a subsample.

Results

The specificity of the referral criteria “HV<25th centile for 1 year” (DGPAED) was 10.4 % in girls and 4.3 % in boys. When this criterion was changed to “HV<3rd centile for 1 year” the specificity increased to 75.5 % in girls and 76.1 % in boys. With omission of the 5th criterion (“height> −2.0 SD AND HV< −2.0 over 1 year”) of the six referral criteria of the GHRS, the specificity of the remaining five referral criteria was 91.4 % in girls and 90.5 % in boys.

Conclusions

New reference centiles for HV are presented. With modification of the already proposed GHRS criteria, the specificity of the assessment of HV in the evaluation of short stature could be increased significantly.

Keywords: children; adolescents; height velocity; reference centiles; referral criteria; specificity

Corresponding author: PD Dr. Ibrahim Duran, Center of Prevention and Rehabilitation, University of Cologne, University of Cologne, Medical Faculty and University Hospital, UniReha, Lindenburger Allee 44, 50931 Cologne, Germany; and Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany, E-mail: Ibrahim.duran@unireha-koeln.de

Ute Alexy and Eckhard Schoenau contributed equally to this work.

Funding source: Ministry of Science and Research of North Rhine-Westphalia

Acknowledgments

We would like to thank the families and children who took part in the DONALD study and made this study possible.

Research ethics: The DONALD study was approved by the Ethics Committee of the University of Bonn, Germany (project identification: 185/20), according to the guidelines of the Declaration of Helsinki (https://drks.de/search/de/trial/DRKS00029092).
Informed consent: Informed consent from the legal representatives of the parents and older participants (>15 years) themselves were obtained.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: The DONALD study is financially supported by the Ministry of Science and Research of North Rhine-Westphalia, Germany.
Data availability: Restrictions apply to the availability of some or all data generated or analyzed during this study to preserve patient confidentiality or because they were used under license. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.

References

1. Binder, GWJ. S1-Leitlinie Kleinwuchs [short stature] [stand: 13.08; 2024. Available from: https://register.awmf.org/assets/guidelines/174-004l_S1_Kleinwuchs_2023-07.pdf.Suche in Google Scholar

2. Society GR. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH research society. J Clin Endocrinol Metab 2000;85:3990–3. https://doi.org/10.1210/jc.85.11.3990.Suche in Google Scholar

3. Brandt, I, Reinken, L. Die Wachstumsgeschwindigkeit gesunder Kinder in den ersten 16 Lebensjahren: longitudinale Entwicklungsstudie Bonn – Dortmund [The growth rate of healthy children in the first 16 years of life: longitudinal developmental study Bonn – Dortmund]. Klin Pädiatr 1988;200:451–6. https://doi.org/10.1055/s-2008-1033752.Suche in Google Scholar PubMed

4. Reinken, L, van, OG. Longitudinal physical development of healthy children 0 to 18 years of age. Body length/height, body weight and growth velocity. Klin Pädiatr 1992;204. Verfügbar unter: https://pubmed.ncbi.nlm.nih.gov/1614176/.Suche in Google Scholar

5. Hesse, V, Schnabel, O, Judis, E, Cammann, H, Hinkel, J, Weissenborn, J. Längsschnittstudie des aktuellen Wachstums 0- bis 6-jähriger deutscher Kinder: Teil 1 [Longitudinal study of the current growth of 0- to 6-year-old German children: Part 1]. Monatsschr Kinderheilkd 2016;164:478–96. https://doi.org/10.1007/s00112-016-0067-1.Suche in Google Scholar

6. Cole, TJ. Secular trends in growth. Proc Nutr Soc 2000;59:317–24. https://doi.org/10.1017/s0029665100000355.Suche in Google Scholar PubMed

7. Gohlke, B, Woelfle, J. Growth and puberty in German children: is there still a positive secular trend? Dtsch Arztebl Int 2009;106:377–82. https://doi.org/10.3238/arztebl.2009.0377.Suche in Google Scholar PubMed PubMed Central

8. Rubin, C, Maisonet, M, Kieszak, S, Monteilh, C, Holmes, A, Flanders, D, et al.. Timing of maturation and predictors of menarche in girls enrolled in a contemporary British cohort. Paediatr Perinat Epidemiol 2009;23. https://doi.org/10.1111/j.1365-3016.2009.01055.x.Suche in Google Scholar PubMed

9. Sørensen, K, Aksglaede, L, Petersen, JH, Juul, A. Recent changes in pubertal timing in healthy Danish boys: associations with body mass index. J Clin Endocrinol Metab 2010;95. https://doi.org/10.1210/jc.2009-1478.Suche in Google Scholar PubMed

10. German clinical trial register. Dortmund nutritional and anthropometric longitudinally designed study [stand: 18.09.2023]. Available from: https://drks.de/search/de/trial/DRKS00029092.Suche in Google Scholar

11. Perrar, I, Alexy, U, Nöthlings, U. Cohort profile update–overview of over 35 years of research in the Dortmund nutritional and anthropometric longitudinally designed (DONALD) study. Eur J Nutr 2024;63:727–40. https://doi.org/10.1007/s00394-023-03290-x.Suche in Google Scholar PubMed PubMed Central

12. Kroke, A, Manz, F, Kersting, M, Remer, T, Sichert-Hellert, W, Alexy, U, et al.. The DONALD Study. History, current status and future perspectives. Eur J Nutr 2004;43. https://doi.org/10.1007/s00394-004-0445-7.Suche in Google Scholar PubMed

13. Tanner, JM, Whitehouse, RH, Marshall, WA, Carter, BS. Prediction of adult height from height, bone age, and occurrence of menarche, at ages 4 to 16 with allowance for midparent height. Arch Dis Child 1975;50. https://doi.org/10.1136/adc.50.1.14.Suche in Google Scholar PubMed PubMed Central

15. Hermanussen, M, Cole, J. The calculation of target height reconsidered. Horm Res 2003;59:180–3. https://doi.org/10.1159/000069321.Suche in Google Scholar PubMed

16. Neuhauser, H, Schienkiewitz, A, Schaffrath, AR, Dortschy, R, Kurth, BM. Referenzperzentile für anthropometrische Maßzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS) [Reference percentiles for anthropometric measures and blood pressure from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Gesundheitsbericht Des Bundes 2013;2:12–23.Suche in Google Scholar

17. Cole, T, Green, P. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992;11:1305–19. https://doi.org/10.1002/sim.4780111005.Suche in Google Scholar PubMed

18. Rigby, RA, Stasinopoulos, DM. Generalized additive models for location, scale and shape. J Roy Stat Soc Series C (Appl Statistics) 2005;54:507–54. https://doi.org/10.1111/j.1467-9876.2005.00510.x.Suche in Google Scholar

19. Royston, P, Wright, EM. Goodness-of-fit statistics for age-specific reference intervals. Stat Med 2000;19. https://doi.org/10.1002/1097-0258(20001115)19:21<2943::aid-sim559>3.0.co;2-5.10.1002/1097-0258(20001115)19:21<2943::AID-SIM559>3.0.CO;2-5Suche in Google Scholar

20. van, BS, Fredriks, M. Worm plot: a simple diagnostic device for modelling growth reference curves. Stat Med 2001;20. https://doi.org/10.1002/sim.746.Suche in Google Scholar

21. De, OM. WHO child growth standards - length/height-for-age, weight-for-age, weight-for-length. In: Weight-for-height and body mass index-for age: methods and development. Geneva: World Health Organization; 2006.Suche in Google Scholar

22. Prader, A, Largo, RH, Molinari, L, Issler, C. Physical growth of Swiss children from birth to 20 years of age. First Zurich longitudinal study of growth and development. Helv Paediatr Acta Suppl 1989;52:1–125.Suche in Google Scholar

23. Cheng, TS, Ong, KK, Biro, FM. Trends toward earlier puberty timing in girls and its likely mechanisms. J Pediatr Adolesc Gynecol 2022;35:527–31. https://doi.org/10.1016/j.jpag.2022.04.009.Suche in Google Scholar

24. Brook, CG, Hindmarsh, PC, Healy, MJ. A better way to detect growth failure. Br Med J (Clin Res ed.) 1986;293. https://doi.org/10.1136/bmj.293.6556.1186.Suche in Google Scholar

25. Scherdel, P, Matczak, S, Léger, J, Martinez-Vinson, C, Goulet, O, Brauner, R, et al.. Algorithms to define abnormal growth in children: external validation and head-to-head comparison. J Clin Endocrinol Metab 2019;104:241–9. https://doi.org/10.1210/jc.2018-00723.Suche in Google Scholar

26. Grote, FK, van, DP, Oostdijk, W, de, MK-SS, Verkerk, PH, Wit, JM, et al.. Developing evidence-based guidelines for referral for short stature. Arch Dis Child 2008;93. Verfügbar unter: https://pubmed.ncbi.nlm.nih.gov/17908714/.10.1136/adc.2007.120188Suche in Google Scholar

27. Gascoin-Lachambre, G, Brauner, R, Duche, L, Chalumeau, M. Pituitary stalk interruption syndrome: diagnostic delay and sensitivity of the auxological criteria of the growth hormone research society. PLoS One 2011;6:e16367. https://doi.org/10.1371/journal.pone.0016367.Suche in Google Scholar

28. Voss, LD, Wilkin, TJ, Bailey, BJ, Betts, PR. The reliability of height and height velocity in the assessment of growth (the Wessex Growth Study). Arch Dis Child 1991;66. https://doi.org/10.1136/adc.66.7.833.Suche in Google Scholar PubMed PubMed Central

Received: 2025-04-23

Accepted: 2025-06-06

Published Online: 2025-06-20

Published in Print: 2025-09-25

Sie haben derzeit keinen Zugang zu diesem Inhalt.

Artikel in diesem Heft

https://doi.org/10.1515/jpem-2025-0225

Schlagwörter für diesen Artikel

children; adolescents; height velocity; reference centiles; referral criteria; specificity