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Feeding, weight gain, and faulure-to-thrive. VCFS is caused by a deletion of 22q11.2. One of our 2 copies of chromosome 22 loses 40 genes. DGCR6 PRODH2 DGCR5 CALS2 IDD TSK-P TSK-1 DGS-I GSCL CTP CTLD HIRA NLVCF VCF-A UFD1L CDC45L TMVCF PNUTL GP1B Β TBX-1 WDR14 TRXR2 COMT

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VCFS is caused by a deletion of 22q11.2

One of our 2 copies of chromosome 22 loses 40 genes


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DGCR6

PRODH2

DGCR5

CALS2

IDD

TSK-P

TSK-1

DGS-I

GSCL

CTP

CTLD

HIRA

NLVCF

VCF-A

UFD1L

CDC45L

TMVCF

PNUTL

GP1BΒ

TBX-1

WDR14

TRXR2

COMT

ARVCF

T10

DGCR8

HTF9C

RANBP1

KIAA1292

VCF-B

VCF-C

NOGOR

PRODH2-p

DGCR6-L

USP18-p

ZNF74

SRECII

VCF-D

PCQAP

SERPIND1

SNAP29

CRKL

VCF-E

LZTR

VCF-F

VCF-G

P2RXL1

SLC7A4

Genome at 22q11.2

R

R

R

R

Genes (40)

Pseudogenes (8)

Low copy repeats (4)

R

Most individuals with VCFS are missing 40 genes on one copy of chromosome 22. One or more of these genes may contribute to normal growth or normal growth velocity as regulated by hormones or some other timing mechanism


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Many (most) children with VCFS have low weight and short stature when compared to the CDC growth charts that are normed for the general population. This is especially true for infants, toddlers and young children.


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Is it appropriate to compare children with VCFS (people missing 40 genes) to growth velocity curves that are normed for people who do not have VCFS (who are not missing 40 genes)?


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Research has already demonstrated that muscle mass in people with VCFS is reduced for at least some parts of the body. There are fewer muscle fibers and the each muscle fiber is smaller than normal.



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Weight proportion is different in VCFS than in the general population

subcutaneous fat

True failure-to-thrive

VCFS baby with failure-to-thrive based on CDC data

subcutaneous fat



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Down syndrome Down syndrome and Williams syndrome.


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Williams syndrome Down syndrome and Williams syndrome.


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Growth Data for VCFS Down syndrome and Williams syndrome.


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Method Down syndrome and Williams syndrome.

  • Retrospective data from 1,085 patients with VCFS who had multiple documented heights and weights

  • All data pooled according to age and sex

  • Presence or absence of heart anomalies assessed as variables

  • Presence or absence of feeding difficulties, G-tubes, etc., were assessed as variables



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VCFS Growth Chart, Length and Weight, of age

boys 0 - 36 months of age compared to CDC norms used for the general population



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VCFS Growth Chart, Height and Weight, of age

males 2 - 20 years of age compared to CDC norms used for the general population



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VCFS Growth Chart, Height and Weight, of age

females 0 - 36 months of age compared to CDC norms used for the general population



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VCFS Growth Chart, Height and Weight, of age

females 2 - 20 years of age compared to CDC norms used for the general population


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Comparisons of age

  • The presence of heart anomalies was not a factor in long-term growth except in early infancy and in severe cases with pulmonic stenosis/atresia

  • Males reached averaged parental heights, females tended to fall slightly short

  • In childhood, weight was low compared to height (typically between the 10th to 25th centile) according to CDC norms

  • Following puberty, weight was proportionate to height

  • Growth velocity in VCFS differs from the general population


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Comparisons of age

  • Head circumference growth was independent of somatic growth and weight

  • Early feeding difficulties were not predictive of short stature or low weight as an adolescent or adult

  • The presence of alternative feeding in infancy did not increase linear growth velocity

  • In other words, the effects of the deletion was the major influence on growth


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The overwhelming majority of people with chromosomal rearrangements involving multiple genes have abnormal growth patterns, and the large majority of them have growth velocities that do not look like the general population. Comparing people with genetic or chromosomal rearrangements to growth charts based on the general population in order to recommend treatment is not appropriate.


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Therefore, treating children with VCFS in a manner that is designed to have them fit the norms for the general population is inappropriate.


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