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Growth and nutrition in children with ataxia telangiectasia
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  • Published on:
    Re: Conclusions not justified by findings
    • Jayesh M Bhatt, Consultant Respiratory Paediatrician Nottingham Children's Hospital, National Paediatric Ataxia Telangiectasia Clinic, QMC, Derby Road, Nottingham NG7 2UH, UK

    Dear Editor,

    We thank Professor Wright for her comments, and we welcome the opportunity to provide some clarification and further analysis. 

    We reported Z-scores rather than percentiles, although some comments on approximate percentiles can be made.  Assuming that Z scores of -1.96 and -3 represent approximately the 2.5th and 0.2nd centiles respectively, 36/101 children were below the 2.5th centile, and 17/101 were below the 0.2nd centile for weight.  Additionally, our mixed effects model (accounting for multiple measurements) modelling the group trend over time estimated the mean weight Z score at 11 years to be -1.63 (approximately 5th centile). 

    Despite the overall short stature of the group, 24/101 children had a BMI Z score of less than -1.96.  So, by this approach, their weight was low even after taking into account stature.  We agree that we cannot infer causality from this observational study, but we believe a proportion of the stunted growth is explained by low weight. We are exploring other measures of malnutrition, such as skin-fold thickness. 

    Whilst our patient numbers are small, they do give some weight to the argument that PEG feeding halts the progression of malnutrition.  We investigated the rate of decline of weight after PEG insertion.  In a mixed effects model with a random intercept for individual patients, the rate of wei...

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    Conflict of Interest:
    None declared.
  • Published on:
    Conclusions not justified by findings
    It is encouraging to see a clinical service making an effort to examine the patterns of growth found in their condition. However the conclusions drawn from their data seem greatly overstated. They describe a pattern of 'progressive growth failure' in nearly a quarter of children with ataxia telangiectasia (AT), yet there is an average decline across all children of less than half a centile space over 3 years. These children are...
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    Conflict of Interest:
    None declared.