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Use of Percentiles and Z-Scores in Anthropometry
Abstract
Percentiles and Z-scores are often used to assess anthropometric measures to help evaluate children’s growth and nutritional status. In this chapter, we first compare the concepts and applications of percentiles and Z-scores and their strengths and limitations. Compared to percentiles, Z-scores have a number of advantages: first, they are calculated based on the distribution of the reference population (mean and standard deviation), and thus reflect the reference distribution; second, as standardized quantities, they are comparable across ages, sexes, and anthropometric measures; third, Z-scores can be analyzed as a continuous variable in studies. In addition, they can quantify extreme growth status at both ends of the distribution. However, Z-scores are not straightforward to explain to the public and are hard to use in clinical settings. In recent years, there has been growing support to the use of percentiles in some growth and obesity references. We also discuss the issues related to cut point selections and outline the fitting/smoothing techniques for developing reference curves. Finally, several important growth references and standards including the previous and new WHO growth reference/standards and the US 2000 CDC Growth Charts, are presented and compared. They have been developed based on different principles and data sets and have provided different cut points for the same anthropometric measures; they could, thus, provide different results. This chapter will guide readers to understand and use percentiles and Z-scores based on recent growth references and standards.
... Percentiles and Z-scores in different measures have been widely used to help assess young people's nutritional status and growth. Often, percentiles (such as the 5th, 25th, 50th, 90th, and 95th percentiles) and Z-scores (e.g., −3 and +3) are used to classify various health conditions, and sex-age-specific measures cut-points (based on Z-scores or percentiles) are provided in tables and as smoothed curves on growth charts (Pettersen et al., 2008;Wang & Chen, 2012). Wu and Tu (2016) explained that the body mass index, defined as weight/height 2 , had been widely used in clinical investigations as a measure of human adiposity. ...
... The other curved lines are z-score lines (i.e., z = −3, −2, −1, 1, 2, 3), which indicate distance from the average. The median and Z-score lines are derived from the measurement of BSA (Wang & Chen, 2012). ...
... For the comparison of both growth charts, we use the 85 th percentile curve from Figure 1 and z = +1 curve from Figure 2 (Wang & Chen, 2012). From both figures, it is observed that initially both curves (85th percentile & z = +1) show the same pattern and increase rapidly. ...
Introduction: In the current study, we construct growth charts of body surface area (BSA) for adults using the quantile regression (QR) approach and growth charts of different Gaussian Percentiles (Z-scores) against age. Methods: A cross-sectional data consisting of 3,473 individuals aged 5 or more, both males and females were taken from Multan city. Quantile regression (QR) was used to construct BSA growth charts. Growth charts for different Z-scores were also constructed. Results: For our data set, the mean BSA is 0.48750. The BSA percentiles show a trending higher after the age of 5 until the age of 22, then decrease between age 22 and 35, and then finally increase after age 35. The Z-score curve increases slightly after age 5 and then proceeds higher until age 22. After age 22 and before 35 it plateaus and then increases slightly after age 35. Conclusion: Since the use of empirical BSA percentiles and Z-scores with grouped age provides a discrete approximation for the population percentiles and Z-scores, it is more accurate to use continuous BSA percentile and Z-score, curves against given ages while using quantile regression and Z-score approach. Furthermore, this approach can also be adopted to construct many other growth charts for physiological and medical sciences.
... For interventional trials, ETI was compared to control (either placebo or tezacaftor/ivacaftor). * Anthropometrics based on Wang et al. (2012) Handbook [20]. BMI = body mass index; RCT = randomized controlled trial, CFTR = cystic fibrosis transmembrane conductance regulator; ETI = elexacaftor/tezacaftor/ivacaftor; LS = least squares mean; CFRD = cystic fibrosis related diabetes. ...
... For interventional trials, ETI was compared to control (either placebo or tezacaftor/ivacaftor). * Anthropometrics based on Wang et al. (2012) Handbook [20]. BMI = body mass index; RCT = randomized controlled trial, CFTR = cystic fibrosis transmembrane conductance regulator; ETI = elexacaftor/tezacaftor/ivacaftor; LS = least squares mean; CFRD = cystic fibrosis related diabetes. ...
The course of cystic fibrosis (CF) as a nutritional illness is diverging since the introduction of highly effective modulator therapy, leading to more heterogeneous phenotypes of the disease despite CF genetic mutations that portend worse prognosis. This may become more evident as we follow the pediatric CF population into adulthood as some highly effective modulator therapies (HEMT) are approved for those as young as 1 year old. This review will outline the current research and knowledge available in the evolving nutritional health of people with CF as it relates to the impact of HEMT on anthropometrics, body composition, and energy expenditure, exocrine and endocrine pancreatic insufficiencies (the latter resulting in CF-related diabetes), vitamin and mineral deficiencies, and nutritional health in CF as it relates to pregnancy and lung transplantation.
... Finally, 51 participants were selected in the NW group, and 39 (overweight, 18; obesity, 21) were selected in the EW group. Since BMI percentiles are non-linear, age-and sex-specific BMI z-scores were calculated for statistical analyses (Bhutani et al., 2021;Wang & Chen, 2012). ...
Objective
The vicious circle model of obesity proposes that the hippocampus plays a crucial role in food reward processing and obesity. However, few studies focused on whether and how pediatric obesity influences the potential direction of information exchange between the hippocampus and key regions, as well as whether these alterations in neural interaction could predict future BMI and eating behaviors.
Methods
In this longitudinal study, a total of 39 children with excess weight (overweight/obesity) and 51 children with normal weight, aged 8 to 12, underwent resting-state fMRI. One year later, we conducted follow-up assessments of eating behaviors and BMI. Resting-state functional connectivity and spectral dynamic casual modeling (spDCM) technique were used to examine altered functional and effective connectivity (EC) of the hippocampus in children with overweight/obesity. Linear support vector regression, a machine learning method, was employed to further investigate whether these sensitive hippocampal connections at baseline could predict future BMI and eating behaviors.
Results
Compared to controls, children with excess weight displayed abnormal bidirectional inhibitory effects between the right hippocampus and left postcentral gyrus (PoCG), that is, stronger inhibitory hippocampus→PoCG EC but weaker inhibitory PoCG→hippocampus EC, which further predicted BMI and food approach behavior one year later.
Conclusion
These findings point to a particularly important role of abnormal information exchange between the hippocampus and somatosensory cortex in pediatric obesity and future food approach behavior, which provide novel insights into the neural hierarchical mechanisms underlying childhood obesity and further expand the spDCM model of adult obesity by identifying the directionality of abnormal influences between crucial circuits associated with appetitive regulation.
... Traditional methods employ Z-score and percentile calculations to assess a child's growth, weight, and BMI status relative to a reference population, to identify stunted growth, obesity and accelerated growth [1,2]. In addition to the described somatic monitoring, the early detection and management of pediatric and adolescent hypertension are vital due to the potential long-term health risks of unrecognized and hence untreated hypertension [3]. ...
Background
Monitoring of somatic development through the assessment of anthropometric variables such as weight, height, and BMI is vital for evaluating the physical development and nutritional status of children. This approach aids in the early identification of somatic developmental disorders, enabling timely medical interventions. It traditionally relies on Z-scores, which compare anthropometric variables with reference standards. In addition to somatic development monitoring, the early detection and management of pediatric and adolescent hypertension are crucial due to potential long-term health risks. However, manual calculations of Z-scores are time-consuming and error-prone, impeding timely interventions for at-risk children. This article introduces an innovative open-code solution for real-time Z-score assessments directly within the electronic data capture platform, Research Electronic Data Capture, (REDCap™), aiming to streamline the monitoring of somatic development in children.
Methods
Leveraging the World Health Organization (WHO) growth standards and National Health and Nutrition Examination Survey (NHANES) references, our approach integrates Z-score computations directly into REDCap, providing a secure and user-friendly environment for healthcare professionals and researchers. We employed Bland-Altman analyses to compare our method with established calculators (Knirps and Growth XP™) using synthetic data values for all variables.
Results
Bland-Altman plots demonstrated strong agreement between our REDCap calculations and the Knirps and Growth XP systems. Z-scores for height, BMI, and blood pressure consistently aligned, affirming the accuracy of our approach across the measurement range.
Conclusion
The integration with REDCap streamlines data collection and analysis, eliminating the need for separate software and data exports. Moreover, our solution uses the World Health Organization (WHO) growth standards and National Health and Nutrition Examination Survey (NHANES) references. This not only ensures calculation accuracy but also enhances its suitability for diverse research contexts. The Bland-Altman analyses establish the reliability of our method, contributing to a more effective approach to child growth and blood pressure monitoring.
... BMI percentiles are recommended when assessing weight in children and adolescents, as they take into account developmental norms and sex at different ages (American Psychiatric Association, 2013). Additionally, we used the corresponding zscores from the BMI percentiles, as percentiles have limited utility when applied to cohorts that include participants with extreme BMI values (e.g., below the first percentile; Wang & Chen, 2012). In a normal distribution, a z-score indicates the distance in standard deviations (SDs) from a specific value to the average value of the distribution, with a z-score of 0 representing an average score, and a z-score of þ1/-1 meaning the score is one SD above/under population average (Martinez-Millana et al., 2018). ...
Objective
Impairments in personality functioning (PF) according to the Alternative Model of Personality Disorders (AMPD) may affect anorexia nervosa (AN) and its treatment. However, PF impairments in adolescents with AN have not been studied. This case‐control study analysed PF impairments in adolescent inpatients suffering from AN compared to a clinical control group (CC) and investigated the relationship of PF with AN severity.
Method
Adolescent patients with AN ( n = 43) and CC ( n = 127) were matched by age, sex, and global functioning. Validated interviews were applied to assess impairments in PF (Semi‐Structured Interview for Personality Functioning, STiP‐5.1) and severity of AN (Eating Disorder Examination, EDE), as well as weight measures. Group comparisons of PF impairment and the relationship between PF impairment and AN severity were analysed using multiple linear regression.
Results
AN patients showed greater impairment in the facet ‘ self‐esteem ’ ( p = 0.033, Cohen's f 2 = 0.036) than CC. In AN patients, impairments in the domain ‘ self‐functioning’ ( p = 0.003, Cohen's f 2 = 0.254) and its underlying element ‘ identity ’ ( p = 0.016, Cohen's f 2 = 0.172) were associated with AN severity (EDE). Additionally, higher impairments in two facets of ‘ empathy ’ ( p = 0.019, Cohen's f 2 = 0.223) and ‘ intimacy ’ ( p = 0.026, Cohen's f 2 = 0.199) were associated with higher AN severity (lower BMI percentiles).
Conclusions
These results support theoretical frameworks of AN and highlight the importance of PF impairments in understanding and treating AN. Future research should investigate how impairments in PF affect AN development and treatment response through longitudinal studies.
... Weights were recorded using a Camry model EB1003 scale, accurate to the nearest tenth of a kilogram. 29,32 The anthropometric measurements for both children and parents were collected by nurses or doctors in waves 2-4 and trained interviewers in wave 5. 29,31 The BMI Z-score, which served as an indicator of general adiposity, was calculated in accordance with the World Health Organization (WHO) growth standards, using the age-and sex-specific WHO Anthro plugin. 33 ...
The global surge in childhood obesity is also evident in Indonesia. Parental body mass index (BMI) values were found to be one of the major determinants of the increasing prevalence of childhood obesity. It is uncertain if parental BMI during their offspring’s childhood significantly affects their children’s BMI trajectories into adulthood. We aimed to investigate the influence of parental BMI Z -scores on BMI trajectories of Indonesian school-aged children, with a focus on sex-specific effects. This study utilized data from the Indonesian Family Life Survey and tracked the same respondents over four time points, from wave 2 (1997–1998) to wave 5 (2014–2015). The sample of this study consisted of children aged 5–12 years in wave 2 for whom height and weight data were available. We utilized a two-level growth curve model to account for the hierarchical structure of the data, with time nested within individual children. Fathers’ BMI Z-scores in wave 2 had a pronounced influence ( β = 0.31) on female children’s BMI Z -scores compared to the influence of mothers’ BMI Z-scores ( β = 0.17). Mothers’ BMI Z -scores in wave 2 showed a stronger positive association with male children’s BMI Z -scores ( β = 0.22) than did the father’s BMI Z -scores ( β = 0.19). A significant interaction of fathers’ BMI Z -scores and years of follow-up was found for male children. As male children’s BMI Z -scores increased by year, this effect was stronger in those whose fathers’ BMI Z -scores were at a higher level. In conclusion, we found that parental BMI values profoundly influenced their children’s BMI trajectories.
... Although there are more accurate 30 markers of adiposity, the z score remains valuable at a population level due to its ability to measure 31 deviation from the population average BMI. (6) Nearly 90% of children who were obese (BMI Z >3 SD) 32 at age 3 remained overweight or obese during adolescence, with the highest increase in annual BMI 33 increments occurring between ages 2 and 6. (7) 34 Excess body weight or obesity in childhood is associated with increased cholesterol, triglycerides, and 35 lower high-density lipoprotein cholesterol and subsequently developing atherosclerosis in later 36 childhood and adolescence. (8), (9; 10) Furthermore, these conditions are indicative of poor 37 cardiometabolic health, evidenced by elevated metabolic syndrome risk scores at ages 10-11. ...
Childhood overweight is not only an immediate health concern due to its implications but also significantly increases the risk of persistent obesity and consequently cardiovascular diseases in the future, posing a serious threat to public health. The objective of this study was to examine the trends and associated factors of childhood overweight in India, using nationally representative data from three rounds of the National Family Health Survey. For the primary analysis, we used data from 199,375 children aged 0 - 59 months from NFHS-5. Overweight was defined as Body mass index-for-age Z (BMI Z) score >+2 SD above the World Health Organization growth standards median. We compared the prevalence estimates of childhood overweight with NFHS-3 and NFHS-4. Potential risk factors were identified through multiple logistic regression analyses. The prevalence of overweight increased from 1·9% in NFHS-3 to 4·0% in NFHS-5, a trend seen across most states and union territories, with the Northeast region showing the highest prevalence. The BMI Z-score distributions from the latest two surveys indicated that the increase in overweight was substantially larger than the decrease in underweight. The consistent upward trend in the prevalence across different demographic groups raises important public health concerns. While undernutrition rates have remained relatively stable, there has been a noticeable rise in the incidence of overweight during the same time frame. The increasing trend of overweight among children in India calls for immediate action.
... Using a clinically measured BMI z-score as an anchor, we found parental reporting accuracy to gradually improve when controlling for the TG within 7 days, followed by a compounded increase in accuracy when controlling for the source of the home measure. Several reviews have identified a high prevalence of parental weight misclassification for their children (60)(61)(62)(63)(64). A review by Sherry et al. found parental reporting of BMI to be 55-76% sensitive for identification, and the prevalence of overweight decreased by −0.4 to −17.7% when calculated BMI was derived from parental reports, indicating chronic underreporting (65). ...
Introduction
Remote anthropometric surveillance has emerged as a strategy to accommodate lapses in growth monitoring for pediatricians during coronavirus disease 2019 (COVID-19). The purpose of this investigation was to validate parent-reported anthropometry and inform acceptable remote measurement practices among rural, preschool-aged children.
Methods
Parent-reported height, weight, body mass index (BMI), BMI z-score, and BMI percentile for their child were collected through surveys with the assessment of their source of home measure. Objective measures were collected by clinic staff at the child’s well-child visit (WCV). Agreement was assessed using correlations, alongside an exploration of the time gap (TG) between parent-report and WCV to moderate agreement. Using parent- and objectively reported BMI z-scores, weight classification agreement was evaluated. Correction equations were applied to parent-reported anthropometrics.
Results
A total of 55 subjects were included in this study. Significant differences were observed between parent- and objectively reported weight in the overall group (−0.24 kg; p = 0.05), as well as height (−1.8 cm; p = 0.01) and BMI (0.4 kg/m²; p = 0.02) in the ≤7d TG + Direct group. Parental reporting of child anthropometry ≤7d from their WCV with direct measurements yielded the strongest correlations [r = 0.99 (weight), r = 0.95 (height), r = 0.82 (BMI), r = 0.71 (BMIz), and r = 0.68 (BMI percentile)] and greatest classification agreement among all metrics [91.67% (weight), 54.17% (height), 83.33% (BMI), 91.67% (BMIz), and 33.33% (BMI percentile)]. Corrections did not remarkably improve correlations.
Discussion
Remote pediatric anthropometry is a valid supplement for clinical assessment, conditional on direct measurement within 7 days. In rural populations where socioenvironmental barriers exist to care and surveillance, we highlight the utility of telemedicine for providers and researchers.
... However, the use of percentiles ranging from the 95 th to 99 th is a common practice to define normality in anthropometry and other health conditions such as obesity. 30 In contrast to these limitations, our study has two major strengths, the size of cohort (N=24,803) and that it was generally representative of the U.S. adult population. ...
... So, by taking the arithmetic mean equals zero with a unit variance of annual potato crop yield data the obtained values of z-score were used to classify the observed yield. The normalized Z-score [20,21] is formulated as follows: ...
... Although there are more accurate 30 markers of adiposity, the z score remains valuable at a population level due to its ability to measure 31 deviation from the population average BMI. (6) Nearly 90% of children who were obese (BMI Z >3 SD) 32 ...
... Child nutritional status was determined using the WHO 2006 growth standards to calculate Z-scores for height for age (HAZ), body mass index for age (BAZ), and weight for age (WAZ). A low HAZ indicates stunting or chronic malnutrition, a low BAZ indicates wasting or acute malnutrition, and a low WAZ indicates underweight, which can be a combination of acute and chronic malnutrition [32]. Overweight was defined as BAZ > + 2 but less than or equal to + 3 for children under age five, and BAZ > + 1 but less than or equal to + 2 for children age five and older; obesity was defined by BAZ > + 3 for children under age five, and BAZ > + 2 for children age five and older [33][34][35]. ...
Background
The global nutrition transition is associated with increased consumption of ultra-processed snack foods and sugar-sweetened beverages (UPF/SSB), contributing to the double burden of child obesity and undernutrition.
Methods
This cross-sectional study describes the prevalence of maternal and child UPF/SSB consumption and the factors associated with frequent consumption in a convenience sample of 749 children ages 6 months through 6 years and their mothers participating in a community-based child oral health program in five informal settlement communities in Mumbai, India. Mothers were interviewed regarding maternal and child oral health and nutrition characteristics, including consumption of beverages and foods associated with tooth decay—milk, soda, tea with sugar, sweets, and chips/biscuits—using standardized questionnaires. Spearman correlations were used to assess for associations between various social factors and the frequency of maternal and child consumption of the five food categories. Chi-square tests were used to assess differences in child consumption patterns by age groups.
Results
Though reported soda consumption was low among both mothers and children, nearly 60% of children consumed sweets and chips/biscuits daily, four to five times the rate of mothers. Factors associated with children’s frequent consumption of UPF/SSB included lower maternal education level, frequent maternal consumption of UPF/SSB, greater number of household members, greater amount of money given to the child, and closer proximity to a store.
Conclusion
Our findings demonstrate social factors that may promote UPF/SSB consumption. The nutritional dangers of sugary drinks and non-nutritious snacks for mothers and young children should be addressed across maternal–child health, education, and social service programs. Early childhood nutrition interventions should involve the entire family and community and emphasize the need to limit children’s consumption of unhealthy foods and beverages from an early age.
... They are applied in pediatric growth follow up to detect the presence of any growth impairment or disease [26]. For population-based surveys, the z-score has proven more advantageous compared to the other methods (27). It quantifies a measurement's standard deviation from the mean. ...
Background
Sleep is a vital physiological function for the maintenance of health and quality of life by ensuring body rest and restoring its energy levels. Remarkably, some children have sleep disordered breathing (SDB) that can disturb their normal sleep and affect the quality of their lives.
Objective
The aim of this study was to assess the correlation between SDB and growth impairments and wether the growth parameters vary among genders.
Methods
This study was conducted in two steps: 1500 questionnaires were distributed to children aged 3 to 12 years. The questionnaire covered personal information, medical history, and the Pediatric Sleep Questionnaire. The latter was used to evaluate the incidence of sleep-disordered breathing and was completed by parents of the involved children. Growth assessment was then determined for the population to find the correlation between sleep disorders and growth impairments.
Results
A total of 931 completed questionnaires were returned (70.7% response rate). Among the respondents, 56.3% were females whereas 43.3% were males. The mean age was 8 years. The result showed that 16.11% of children were at high risk of sleep-disordered breathing. A significant effect of SDB syndrome on growth parameters (weight-for-age parameter z-score and BMI for age z-score) was observed among males. Concerning the weight for age z-score, a significant difference was found between the means of control and SDB individuals (P = 0.0302). In male groups, the difference was significant (P=0.043), while non-significant difference was found in female groups (P = 0.69).
Conclusion
This study highlights a significant effect of SDB on growth parameters among males aged between 3 and 12 years.
... Overweight is defined as a child's BMI falling between the 85 and 95 percentile. [31] Using a disposable syringe (5 mL), venous blood samples were obtained from the controls and patients. The levels of asprosin and ceramides in the patients and control groups were determined by using BT lab enzyme linked immunosorbent assay (ELISA) kits and following the manufacturer's instructions. ...
Background
Growth hormone deficiency (GHD) is an endocrine condition, which is defined as a reduction in growth hormone (GH) synthesis; this study aims to evaluate the level of asprosin and ceramides in children (patients) with idiopathic isolated GHD.
Materials and Methods
The present study was designed as a case–control study; 43 patients (24 males and 19 females) with idiopathic isolated GHD were involved in this study. Forty-five subjects (26 males and 19 females) who were apparently healthy control that enrolled in this study were matched with patients of the same sex and age.
Results
The present study revealed a significant decrease ( P < 0.05) in the levels of asprosin, ceramides, and glucose in patients with GHD when compared with its control group.
Conclusions
Asprosin may be one of the underlying causes of GHD through its indirect role in releasing GH. GHD may decrease the level of ceramides by the effect of GH on lipid metabolism.
... Take the z-score for example. While the use of the z-score has been suggested for comparisons of the relative standings of variables (Wang & Chen, 2012), z-scores do not translate information well because (1) the original scales, especially those with cutoff values that no longer exist (e.g., Figure 5), and (2) the negative numbers produced in z-score transformation may give a wrong impression to uninitiated readers (Soloman & Sawilowsky, 2009). For example, a population-based survey on cigarette use quantity is likely to be positively skewed; thus, nonsmokers and nonfrequent smokers will obtain a negative z-score, which will seem like the "worse" cases in smoking. ...
... [33][34][35][36] While the BMI percentile is a comparison of a child's weight to other children their age and sex-matched peers, the BMI z-score is a measure of a child's weight in standard deviations from the median value. 37 Children were also asked a follow-up question related to motivation for beginning treatment during the clinical interview and prompted to select from a list of options such as improved self-image, improved nutrition, to be healthier to name a few. This list (see Table 5 for all possible response options) was developed from similar studies assessing motivations for weight loss in youth. ...
Background
Family based treatment is an effective, multipronged approach to address obesity as it plagues families.
Objective
To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study.
Methods
Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline.
Results
A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (−0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, −0.10, p < 0.05), and Other, non‐Hispanic (−0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non‐Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change.
Conclusions
Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions.
... For instance, when improving fine motor skills from poor to excellence on fine motor skill scale, children experience one standard deviation change in number knowledge and attentional skills. This means that children with high motor skills (above 1 SD from the mean) is more likely to reach the 84th percentile (Wang & Chen, 2012) on the number knowledge and attentional scales. Thus, improving fine motor skills might be one way to cross one major percentile line and ultimately, to improve attentional skills and number knowledge during early school years. ...
This study investigated the contribution of fine and gross motor skills to academic and attentional performance at school entry among 832 boys and girls. Children were tested on their fine and gross motor skills (locomotor, object control) and their academic performance in receptive vocabulary, number knowledge, and attentional skills at 6 to 7 years old. Results from ordinary least square models adjusted for family income, maternal education attainment, and early cognitive skills at 41 to 48 months revealed that fine motor skills significantly predicted receptive vocabulary, number knowledge, and attention skills. The associations between fine motor skills with receptive vocabulary and attention were stronger for girls than boys. Better performance in locomotor also significantly predicted higher levels of receptive vocabulary while object control was positively associated with attentional skills among girls only. Children with better motor abilities, especially fine motor skills, are more likely to be successful in the areas requiring language, numeracy, and attentional skills. Thus, motor skills should be a focus of interest for increasing academic and attentional skills level at school entry, particularly in girls.
... Another limitation is the percentile classification used to divide students into low, medium, and high-test anxiety groups. This technique has some drawbacks whereby it is not comparable to other studies and may not be very suitable for equating individual scores of subtests with the different number of response categories (Satyendra Nath, 2020; Wang & Chen, 2012). ...
... For instance, there was a higher prevalence of stunt-ing but a lower prevalence of wasting in US children while applying the WHO 2006 Growth Standards against the 2000 CDC Growth Charts. On the other hand, there was a higher prevalence of stunting but a lower prevalence of underweight in European children of age 0-12 months while adopting the 2006 WHO Growth Standards against the 2000 CDC Growth Charts [17]. So, valid measurement tools are essential for not only anthropometric measurements but for other measurements as well. ...
The study assesses the prevalence of and factors affecting the anthropometric measurements i.e. stunting-WAZ, wasting-WHZ and underweight-WAZ each below -2 SD from the median of the reference population, among children below 5 years of age group in newly structured seven Provinces of Nepal by different background characteristics using Nepal Demographic and Health Survey (NDHS) Data, 2016. Anthropometric indicators are far worse in Madhesh and Karnali provinces than the national average. The highest share of stunted children is in Karnali Province whose size at birth is very small (70.0%) against the national average of 36 percent. Children in the poorest quintile and born from illiterate mothers of Madhesh Province and Karnali Province have highly suffered from stunting. Data shows that children born to illiterate mothers are highly wasted in Madhesh Province (23.8%). Underweight increased with an increase in the age of the children; increases with birth order in all Provinces. Except for Gandaki Province, underweight is more common in rural areas than in urban areas. The prevalence of underweight children is the highest in the poorest quintile of Madhesh Province i. e. 50 percent as compared to the national average of 27 percent. High birth order has significantly contributed to worsening childhood nutrition. The statistical test infers that childhood stunting and underweight are in aggregate strongly related to all variables except sex while wasting is strongly associated with only children’s age and their mother’s education. The author suggests applying provincial policies and programs based on the findings to tackle their poor anthropometric indicators.
... The z-score is recognised as the best system for analysis and display of data compared to other methods because it is quantified based on the distribution of reference population. Thus, the score reflects the reference distribution and standardised quantities allowing it to be comparable across age, sex, and anthropometric measures [57,58]. However, there may be differences between study population and the reference population used in the calculation of z-scores [38]. ...
The most widespread non-communicable disease in the world is dental caries. Early childhood caries (ECC) is the presence of one or more decayed, missing or filled tooth surfaces in any primary tooth in children between birth and 71 months. The disease has been linked to failure to thrive, impaired speech and reduce food consumption due to pain and discomfort. Nutritional status of a child may also be affected by caries. Thus, we conducted a scoping review to review the association between ECC and nutritional status. A total of 492 articles published until December 2022 from three databases were obtained. 20 relevant articles meeting the inclusion criteria were included. From the included articles, dmft index was the most common dental assessment used, while all articles used anthropometric measurements for nutritional assessment except for two articles that used laboratory methods. Based on the results obtained, majority of the articles stated that there was an association between ECC in children with poor nutritional status, while only one study reported an association between ECC and overweight or obese children. Four papers showed no association. A more standardised and consistent study methodology, sample population and protocol in articles selected may help yield more reliable results.
... This is a common challenge in most pediatric patient care settings, and although according to the Centers for Disease Control and Prevention (CDC) "BMI can be considered a practical alternative to direct measures of body fat", it has not been highly successful as a tool in children (14,16). The use of BMI for age and sex percentile (BMI%) alone, or BMI zscore corrected for age and sex, was found to have only modest value in stratifying patients; this is especially true in cases of extreme obesity (15,(17)(18)(19)(20). In 2014 Skinner et al. proposed extension obesity classifications to include three gradations, and others have developed similar strategies for improved assessments of individuals with extreme obesity and stratify morbidities risks (5). ...
Background:
Identifying at-risk children with optimal specificity and sensitivity to allow for the appropriate intervention strategies to be implemented is crucial to improving the health and well-being of children. We determined relationships of body mass indexes for age and sex percentile (BMI%) classifications to actual body composition using validated and convenient methodologies and compared fat and non-fat mass estimates to normative cut-off reference values to determine guideline reliability. We hypothesized that we would achieve an improved ability to identify at-risk children using simple, non-invasive body composition and index measures.
Methods:
Cross-sectional study of a volunteer convenience sample of 1,064 (537 boys) young children comparing Body Fat Percentage (BF%), Fat Mass Index (FMI), Fat-Free Mass Index (FFMI), determined via rapid bioimpedance methods vs. BMI% in children. Comparisons determined among weight classifications and boys vs. girls.
Results:
Amongst all subjects BMI% was generally correlated to body composition measures and indexes but nearly one quarter of children in the low-risk classifications (healthy weight or overweight BMI%) had higher BF% and/or lower FFMI than recommended standards. Substantial evidence of higher than expected fatness and or sarcopenia was found relative to risk status. Inaccuracies were more common in girls than boys and girls were found to have consistently higher BF% at any BMI%.
Conclusions:
The population studied raises concerns regarding actual risks for children of healthy or overweight categorized BMI% since many had higher than expected BF% and potential sarcopenia. When body composition and FMI and FFMI are used in conjunction with BMI% improved sensitivity, and accuracy of identifying children who may benefit from appropriate interventions results. These additional measures could help guide clinical decision making in settings of disease-risks stratifications and interventions.
... The BMI was calculated by dividing the weight in kilograms by the square height in meters. Then the BMI percentile and Z-score were calculated by an anthropometric calculator depending on the Centers for Disease Control and Prevention (CDC) BMI-for-age growth chart [10], and they were considered abnormal if the value is more than -2 or +2 SD from the mean. ...
... On the basis of the height and weight records of each child, the BMI-for-age Z-score (BMIZ), height-for-age Z-score (HAZ), and weight-for-age Z-score (WAZ) 6 are computed. These have been widely used to assess young people's health status and growth (Thomas, Strauss, and Henriques 1991;Wang and Chen 2012;Mu and de Brauw 2015). For example, HAZ is built by comparing the height data with the distribution of height for a reference population of the same sex and age provided by the World Health Organization (WHO). ...
The effect of maternal education on child health in China is studied by exploiting a change in the Compulsory Education Law from 1986. Data from four waves (2004–2011) of the China Health and Nutrition Survey are used. Variations across cohorts and provinces induced by the timing of the reform are used as instrumental variables to account for the endogeneity of education. Results show that mothers’ educational attainment has significant and sizable positive effects on their children’s health, as measured by height, weight and BMI Z-scores. Maternal education is associated with improved food structure (increased consumption of meat, egg, and dairy products) and healthier nutrient intake (increased share of calorie obtained from fat and proteins) of their offspring. Mothers who were exposed to the education reform are more knowledgeable about healthy diets and healthy behaviours than those not exposed and hence had fewer years of schooling.
... A key strength of this study includes the ranking of children by the LMS calculated z-score for each adiposity indicator. The use of z-scores is advantageous, as it allows for the classification of children based on reference values for sex and age [48]. The direct and objective measurement of skin pigmentation using a spectrophotometer provides valid information on the variations in color resulting from UV exposure over time. ...
Background:
To examine associations between body composition and vitamin D status in children participating in a lifestyle intervention.
Methods:
Children (6-12 y, n = 101) with a body mass index (BMI)-for-age >85th percentile were randomized to six dietitian-led behavior counselling sessions or no intervention. Plasma 25-hydroxyvitamin D (25(OH)D), anthropometry, and body composition using dual-energy X-ray absorptiometry were assessed every 3 months for 1 year. For each anthropometry variable (z-scores), tertiles were created to test for differences in 25(OH)D over time (tertile-by-time), and for changes in the z-score (loss, maintain, gain)-by-time, and according to fat patterning (android vs. gynoid) using mixed effects models.
Results:
The baseline plasma 25(OH)D was 62.2 nmol/L (95%CI: 58.7-65.7), and none < 30 nmol/L. At 6 mo, children with gynoid fat patterning had higher 25(OH)D concentrations than in those with android fat patterning (64.5 ± 1.1 nmol/L vs. 50.4 ± 1.0 nmol/L, p < 0.003, Cohen's f = 0.20). Children with the lowest lean mass index z-score at 9 mo had higher plasma 25(OH)D concentrations than children with the highest z-score at baseline, 3 mo, and 6 mo (p < 0.05, Cohen's f = 0.20). No other significant differences were observed.
Conclusion:
In this longitudinal study, vitamin D deficiency was not present in children 6-12 y of age with obesity. Reductions in adiposity did not alter the vitamin D status.
... BMI Z-scores were classified as normal, underweight (or wasted), and overweight according to WHO recommendation (<−2.0, >-2 and <2, >2.0 respectively); [4]. Weight was measured in the morning for all and after termination of hemodialysis session for dialysis group (dry weight). ...
... The group of overweight or obese children have a BMI belonging to the ≥95th percentile, from the 85th to <95th percentile are children with increased weight, from 5th to <85th percentile are children with normal weight, while all children under <5th percentile belong to the group of malnourished or underweight children. [12,14] The study used references and graphs of percentages and Z-score curves for age and sex from the CDC (Centers for Disease Control and Prevention) for children and adolescents. This included weight (for age and sex), growth (for age and sex), and body mass -BMI (for age and sex). ...
Childhood obesity is assuredly one of the most important health challenges of the 21st century, particularly regarding long-term metabolic complications. In the last four decades, there has been a tenfold increase in childhood and adolescence obesity.
This cross-sectional study aimed to show the prevalence of overweight and obesity compared by age, sex, and ethnicity in n=1034 healthy male and female children, aged 6-13 years in North Macedonia.
Out of the total 1034 children included in the study, 589 (57.0%) were observed with normal weight, 202 (19.5%) children were obese, 140 (13.5%) children were overweight and, 103 (10.0%) children underweight. The study presents an insight that 33% of primary school children are at >85th percentile overweight; or at ≥95th percentile with increased weight due to obesity. The data show that boys have a higher prevalence of obesity and overweight with 37.1%, compared to girls with 29.1%. Also, all age groups demonstrate an exponential increase of the prevalence of overweight: in 6-7 years (5.8%); 8-9 years (12%); 10-11 years (15%); and, 12-13 years old with 19.5%. A jump of prevalence of overweight and obesity between the age groups of 6-7 years, and 8-9 years was observed (17.9% to 25.4% obese and 5.8% to 12.0% overweight). The onset of puberty may be the possible cause.
According to the Global Atlas of Childhood Obesity, North Macedonia is graded with a risk index of 7/11; i.e. it is expected that in the next decade until 2030 the obesity rate will rise to 52.5% for children aged 5-19 years old.
It is with utmost importance to emphasize that continuous monitoring of children’s nutritional status and their risk of obesity is essential, as to further prevent obesity and overweight in the pediatric population.
... Similar to Strobel et al. [51], raw BMI values were further transformed into age-and gender-standardized z-scores using the lambda-mu-sigma (LMS) method [61] and German general population reference data [62,63]. Z-scores indicate the deviation of patient BMI relative to the population mean, allow extremes to be quantified outside the percentile range, and are comparable independent of age and sex [64]. We compared admission zBMI using independent samples t-test. ...
Eating disorders (EDs) are increasingly emerging as a health risk in men, yet men remain underrepresented in ED research, including interventional trials. This underrepresentation of men may have facilitated the development of women-centered ED treatments that result in suboptimal outcomes for men. The present study retrospectively compared pre- vs. post-treatment outcomes between age-, diagnosis-, and length-of-treatment-matched samples of n = 200 men and n = 200 women with Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), or Eating Disorder Not Otherwise Specified (EDNOS), treated in the same setting during the same period, and using the same measurements. Compared to women, men with AN showed marked improvements in weight gains during treatment as well as in ED-specific cognitions and general psychopathology. Likewise, men with BED showed marked weight loss during treatment compared to women with BED; ED-specific cognitions and general psychopathology outcomes were comparable in this case. For BN and EDNOS, weight, ED-specific cognitions, and general psychopathology outcomes remained largely comparable between men and women. Implications for treatments are discussed.
... Both behavior and outcome domains were considered time-varying variables. For children aged 0-19, we defined overweight and obesity using the WHO BMI Z-score international child cutoffs (26). We calculated BMI Z-scores using CDC's SAS codes (27). ...
Background
Obesity is a major public health problem affecting millions of Americans and is considered one of the most potent risk factors for type 2 diabetes. Assessing future disease burden is important for informing policy-decision making for population health and healthcare.
Objective
The aim of this study was to develop a computer model of a cohort of children born in Los Angeles County to study the life course incidence and trends of obesity and its effect on type 2 diabetes mellitus.
Methods
We built the Virtual Los Angeles cohort—ViLA, an agent-based model calibrated to the population of Los Angeles County. In particular, we developed the ViLA-Obesity model, a simulation suite within our ViLA platform that integrated trends in the causes and consequences of obesity, focusing on diabetes as a key obesity consequence during the life course. Each agent within the model exhibited obesity- and diabetes-related healthy and unhealthy behaviors such as sugar-sweetened beverage consumption, physical activity, fast-food consumption, fresh fruits, and vegetable consumption. In addition, agents could gain or lose weight and develop type 2 diabetes mellitus with a certain probability dependent on the agent's socio-demographics, past behaviors and past weight or type 2 diabetes status. We simulated 98,230 inhabitants from birth to age 65 years, living in 235 neighborhoods.
Results
The age-specific incidence of obesity generally increased from 10 to 30% across the life span with two notable peaks at age 6–12 and 30–39 years, while that of type 2 diabetes mellitus generally increased from <2% at age 18–24 to reach a peak of 25% at age 40–49. The 16-year risks of obesity were 32.1% (95% CI: 31.8%, 32.4%) for children aged 2–17 and 81% (95% CI: 80.8%, 81.3%) for adults aged 18–65. The 48-year risk of type 2 diabetes mellitus was 53.4% (95% CI: 53.1%, 53.7%) for adults aged 18–65.
Conclusion
This ViLA-Obesity model provides an insight into the future burden of obesity and type 2 diabetes mellitus in Los Angeles County, one of the most diverse places in the United States. It serves as a platform for conducting experiments for informing evidence-based policy-making.
... Malnutrition is a subacute or chronic state of nutrition, in which a combination of varying degrees of under or over nutrition and inflammatory activity has led to changes in body composition and diminished function (Soeters et al., 2017). It can also be a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue/body form (body shape, size, composition), body function and clinical outcome (Poggiano et al., 2017).The normal height-for-age z-score (HAZ) is said to be 2 SD or greater, normal weight-for-height z-score (WHZ) is said to be 2 SD or greater, and normal weight-for-age z-score (WAZ) is also said to be 2 SD or greater (Wang and Chen, 2017). Globally 6.3 million children under five years of age die every year. ...
Background: Malnutrition prevents children from reaching their full physical and mental potential. Health and physical consequences of prolonged states of malnourishment among children are: delay in their physical growth and motor development; lower intellectual quotient (IQ), greater behavioural problems and deficient social skills; susceptibility to contracting diseases. According to the 2015 Millennium development goal (MDG) report, sub-Saharan Africa (SSA) accounts for one third of all undernourished children globally, highlighting that malnutrition still remains a major health concern for children under 5 years in the sub-region, thus buttressing the need for urgent intervention. Aim: The aim of this study is to explore the risk factors of child malnutrition in sub–Saharan Africa through a scoping review. Methods: The scoping review was conducted using the following specific subject databases: EBSCOhost, google scholar, Pub med, demographic research and research gate. Attention was paid to keywords during navigation to ensure consistency of searches in each database. Two limiters were applied in all five databases. These included the use of the English language and articles published on child malnutrition in sub Saharan Africa. Results: The researchers identified eight themes for inclusion in the findings. The themes fell into four major categories being maternal related, family related, child related as well as context related factors. These themes reflect factors associated with child malnutrition. Conclusion: This scoping review revealed that there are quite a number of risk factors that lead to child malnutrition. Therefore, there is an urgency for strategic interventions aimed at improving child nutrition through female education if the 2030 end malnutrition SDG 2.2 are to be achieved.
... This variable was grouped by sex, assumed nonnegative integer values, with an asymmetric distribution on the left. Variables related to HR-pQCT were standardized in z scores using the Formula: z = (observed value − sample mean)/sample standard deviation 39 . T-scores were used to evaluate bone density compared to normal values in a young adult and formed part of the regression model. ...
Epidemiological studies reveal a link between osteoporosis and the risk of ischemic cardiovascular disease. We illustrate an association between coronary calcification and bone microarchitecture in older adults based on the SPAH study. This cross-sectional research comprised 256 individuals subjected to cardiac coronary computed tomography angiography (CCTA) for coronary artery calcification (CAC), high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia and radius with standardized z score parameters, and dual-energy X-ray absorptiometry (DXA) to evaluate bone status. We used Student’s t test and the Mann–Whitney and Chi-squared tests for comparison of basal measurements. Association analysis was performed using the Poisson regression model with adjustment for CAC and sex. Multivariate analysis revealed different bone variables for predicting CAC in DXA and HR-pQCT scenarios. Although most of the bone parameters are related to vascular calcification, only cortical porosity (Ct.Po) remained uniform by HR-pQCT. Results for were as follows: the tibia—women (exp β = 1.12 (95% CI 1.10–1.13, p < 0.001) and men (exp β = 1.44, 95% CI 1.42–1.46, p < 0.001); the radius—women (exp β = 1.07 (95% CI 1.07–1.08, p < 0.001) and men (exp β = 1.33 (95% CI 1.30–1.37, p < 0.001). These findings suggest an inverse relationship between CAC and cortical bone content, as assessed by HR-pQCT, with higher coronary calcification in individuals older than 65 years.
Background/Objectives: Numerous studies have highlighted the nutritional imbalances that are commonly observed in children and adolescents diagnosed with celiac disease (CD) who follow a gluten-free diet (GFD). However, the development and timeline of these nutritional deficiencies remain unclear. The aim of the present study is to investigate the short-term (≥6 months to <12 months) and long-term (≥12 months) association between adherence to a GFD and nutrient intake as well as micronutrient blood status in children and adolescents aged from 0 to 18 years with CD. Methods: A systematic review was conducted in PubMed and Scopus for observational studies published up to June 2024. Results: A total of 15 studies (case–control, cross-sectional, and prospective studies) with 2004 children and adolescents were included. Their quality was assessed using the ROBINS-E tool. Despite the lack of high-quality data and the heterogeneity of the methods used in the included studies, the results of the cross-sectional/case–control studies show that, in the short term, children and adolescents with CD consumed excessive amounts of protein and carbohydrates compared to controls. After long-term adherence to a GFD, significant changes in the diets of children and adolescents with CD persisted. Fat intake was higher, while protein intake remained excessive compared to controls. Based on prospective studies, vitamin C and iodine intake improved both in the short and long term after adherence to a GFD. However, most other nutrients either remain inadequate or continue to decline, indicating that it is difficult to meet nutrient requirements despite dietary adjustments. Conclusions: Gaps in adherence to dietary recommendations appear to be widespread in children and adolescents with CD, emphasizing the need for improved diet quality and regular monitoring.
Proper nutrition is vital for maintaining good health for all people across their lifespan, especially children and mothers, who are especially vulnerable due to their specific nutrient needs. Despite the necessity of improved nutrition for these groups, some members do not fully meet their recommended daily micronutrient needs, a challenge exacerbated by different socioeconomic, cultural, and communal constraints resulting in malnutrition. Iron deficiency anaemia is a major concern among children and mothers, especially in pastoralist communities, due to poor nutrition and other related factors. Using a community‐based cross sectional study, this study investigated factors associated with hemoglobin levels among children and women in Narok County, Kenya. Anthropometrics were estimated using body mass index measurements for mothers, and the nutritional status of children was calculated using Z‐score measurements. Haemoglobin was measured using a rapid test (Hemocue 301). Multiple logistic regression models were fitted to assess the association between child and maternal risk factors and anaemia. Anaemia in children was associated with age (OR = 1.99, p = 0.047), pastoralism (OR = 2.25, p = 0.002), educational of the mother (OR = 0.74, p = 0.008), severe and moderate undernourishment (OR = 1.14, p = 0.049 and OR = 1.10, p = 0.023), respectively, not meeting children dietary diversity (OR = 1.18, p = 0.027), number of people in a household (OR = 1.84, p = 0.003), and maternal age (OR = 0.30, p = 0.010). On the other hand, the occurrence of anaemia in women was associated with pastoralism (OR = 2.22, p = 0.001), having a primary school level of education (OR = 0.51, p = 0.028), pregnancy status (OR = 5.36, p = 0.002), not meeting maternal dietary diversity (OR = 1.39, p = 0.026), number of household members (OR = 1.93, p = 0.023), age of the mother (OR = 0.53, p = 0.018), and having animals infected with East Coast Fever (Theileria parva) within the household (OR = 1.10, p = 0.023). The results highlight the multifaceted nature of malnutrition, specifically anaemia in pastoral households, with interventions aimed at reducing disease infections in cattle, improved household dietary diversity, and community health education geared towards maternal and child nutrition being best placed to improve the overall household health outcomes relating to anaemia.
Objective
Growth curves are important tools for assessing the growth and development of children in the target population by age. Measuring head circumference (HC) in infants is an important tool in monitoring infant health and brain development. The aims of this study are to construct current 0-2-year-old HC growth curves and percentiles and compare the methods used in the construction of growth curves for HC measurements by gender.
Materials and Methods
The study is a retrospective research that includes the HC measurements of a total of 2832 (n = 1438 girls, n = 1394 boys) children examined between 2018 and 2021 in Başkent University hospital, Ankara. Lambda-Mu-Sigma, LMSP, and LMST methods based on Box-Cox Cole and Green (BCCG), Box-Cox power exponential (BCPE), and Box-Cox t (BCT) distributions respectively, and quantile regression (QR) method were used to construct the fitted growth curves. Model performances were evaluated using the generalized Akaike information criterion. The analyses were conducted using R 4.1.2 version.
Results
According to the LMS and QR methods, percentile values of HC measurements by gender were calculated and the results were compared. Smoothed HC growth curves were constructed and compared for both methods by gender. The present study, Neyzi et al study, and World Health Organization (WHO) standards were compared for the third, 50th and 97th percentiles of HC.
Conclusion
This study showed that the third-97th HC percentiles calculated by LMS and QR methods are very close to each other. Additionally, this study showed that the HC percentiles of Turkish children were slightly different compared to WHO standards.
Background: Universal community engagement interventions can address childhood obesity. Objectives: This review aimed to evaluate the effectiveness of these interventions in improving body mass index (BMI) (primary outcome) as well as dietary choices and activity levels (secondary outcomes) among children and adolescents. Methods: Eight electronic databases were searched from inception dates to January 2024. A meta-analysis was conducted using the random-effect model, when appropriate; otherwise, the findings were narratively synthesized. Heterogeneity was determined by the I² statistics and Cochran’s Q chi-squared test. The Cochrane ROB tool and the GRADE approach were used to assess the quality appraisal at the study and outcome levels, respectively. Results: Twenty-two studies were included in this review. The results showed that these interventions had a limited effect in improving children’s standardized BMI (BMI-z) scores post-intervention. A meta-analysis on BMI-z scores showed that the intervention group had a statistically non-significantly lower BMI-z score than the control group (MD = −0.02, 95%CI = [−0.07, 0.03], Z = 0.83, p = 0.40) at immediate post-intervention. It was also reported that universal community engagement interventions had a limited effect in improving children’s dietary choices and activity levels. Only the meta-analysis on children’s daily sugar-sweetened beverage intake measured using continuous data reported a statistically significant small effect favoring the intervention group (SMD = −0.25, 95%CI = [−0.38, −0.13], Z = 3.98, p < 0.0001) at immediate post-intervention. Conclusions: Universal community engagement interventions have the potential to address childhood obesity. Children and adolescents could benefit more from interventions that focus on implementing both environmental and behavioral changes, and interventions that include parental involvement.
Childhood overweight is not only an immediate health concern due to its implications but also significantly increases the risk of persistent obesity and consequently CVD in the future, posing a serious threat to public health. The objective of this study was to examine the trends and associated factors of childhood overweight in India, using nationally representative data from three rounds of the National Family Health Survey (NFHS). For the primary analysis, we used data from 199 375 children aged 0–59 months from fifth round of the NFHS (NFHS-5). Overweight was defined as BMI-for-age Z (BMI Z) score > +2 sd above the WHO growth standards median. We compared the prevalence estimates of childhood overweight with third round of the third round of NFHS and fourth round of the NFHS. Potential risk factors were identified through multiple logistic regression analyses. The prevalence of overweight increased from 1·9 % in third round of NFHS to 4·0 % in NFHS-5, a trend seen across most states and union territories, with the Northeast region showing the highest prevalence. The BMI Z-score distributions from the latest two surveys indicated that the increase in overweight was substantially larger than the decrease in underweight. The consistent upward trend in the prevalence across different demographic groups raises important public health concerns. While undernutrition rates have remained relatively stable, there has been a noticeable rise in the incidence of overweight during the same time frame. The increasing trend of overweight among children in India calls for immediate action.
Objective
The vicious circle model of obesity proposes that the hippocampus plays a crucial role in food reward processing and obesity. However, few studies focused on whether and how pediatric obesity influences the potential direction of information exchange between hippocampus and key regions, as well as whether these alterations in neural interaction could predict future BMI and eating behaviors.
Methods
In this longitudinal study, a total of 39 children with overweight/obesity and 51 children with normal weight, aged 8 to 12, underwent resting-state fMRI. One year later, we conducted follow-up assessments of eating behaviors and BMI. Resting-state functional connectivity (FC) and spectral dynamic casual modeling technique were used to examine altered functional and effective connectivity (EC) of the hippocampus in children with overweight/obesity. Linear support vector regression, a machine learning method, was employed to investigate whether hippocampal connections at baseline could predict future BMI and eating behaviors.
Results
Compared to controls, children with overweight/obesity displayed abnormal bidirectional inhibitory effects between the right hippocampus and left postcentral gyrus (PoCG), namely, stronger inhibitory EC from the hippocampus to PoCG but weaker inhibitory EC from the PoCG to hippocampus, which further predicted BMI and food approach behavior one year later.
Conclusion
These findings suggest that imbalanced information exchange in the appetitive reward circuitry between the hippocampus to somatosensory cortex may be a sensitive neurobiomarker for childhood obesity and future food approach behavior, which expands the vicious circle model of obesity by revealing the crucial role of hippocampal undirectional and directional connections in childhood obesity. This study is essential for developing effective intervention strategies and for reducing long-term health-care costs associated with obesity.
Background
The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies.
Methods
Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I² statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated.
Findings
The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301–0.496) and HAZ (MD 0.388, 95% CI 0.102–0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078–0.294) and HAZ (0.200, 95% CI 0.036–0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD −0.028, 95% CI −0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD −0.045, 95% CI −0.079 to −0.011) but not in highly educated populations (MD 0.003, 95% CI −0.093 to 0.098).
Interpretation
Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better.
Funding
This study was a student thesis supported financially by 10.13039/501100004484Tehran University of Medical Sciences (TUMS).
Background and Objective
Despite the high burden of respiratory disease amongst Indigenous populations, prevalence data on spirometric deficits and its determinants are limited. We estimated the prevalence of abnormal spirometry in young Indigenous adults and determined its relationship with perinatal and early life factors.
Methods
We used prospectively collected data from the Australian Aboriginal Birth Cohort, a birth cohort of 686 Indigenous Australian singletons. We calculated the proportion with abnormal spirometry (z‐score <−1.64) and FEV 1 below the population mean (FEV 1 % predicted 0 to −2SD) measured in young adulthood. We evaluated the association between perinatal and early life exposures with spirometry indices using linear regression.
Results
Fifty‐nine people (39.9%, 95%CI 31.9, 48.2) had abnormal spirometry; 72 (49.3%, 95%CI 40.9, 57.7) had a FEV 1 below the population mean. Pre‐school hospitalisations for respiratory infections, younger maternal age, being overweight in early childhood and being born remotely were associated with reduced FEV 1 and FVC (absolute, %predicted and z‐score). The association between maternal age and FEV 1 and FVC were stronger in women, as was hospitalization for respiratory infections before age 5. Being born remotely had a stronger association with reduced FEV 1 and FVC in men. Participants born in a remote community were over 6 times more likely to have a FEV 1 below the population mean (odds ratio [OR] 6.30, 95%CI 1.93, 20.59).
Conclusion
Young Indigenous adults have a high prevalence of impaired lung function associated with several perinatal and early life factors, some of which are modifiable with feasible interventions.
The Baby Meal Planner (BMP) application has been developed by the authors since 2020, and in 2022 BMP version 2.0 has been redeveloped. The BMP Version 2.0 application has been equipped with a cut-off point for the baby’s nutritional status with the latest references, calculation of energy and nutrient needs for babies up to 24 months of age, calculation of food needs for MPASI up to 24 months of age, and is equipped with MP-ASI recipes for up to 24 months of age. 24 months. Currently, the Android version of the BMP application has been used by more than 5,000 people, received a rating of 4.9, has 3 copyright certificates, has been published in SINTA-indexed journals, has been processed in international journal reviews, and has been reached to the public in community service activities. Along with the increase in smartphone users with the iPhone Operating System (IOS) operating system, the purpose of this research is to develop an IOSbased Baby Meal Planner Application. The research will be carried out for 8 months from April to December 2023, in collaboration with the Kebon Kalapa Village, Central Bogor District, Bogor City through the PKK and Posyandu as partners in the research. Research activities consist of a preparatory process in the form of discussion activities with partners, licensing, and preparation of proposals. Application development activities include developing application features, processing complementary food menus, and outreach to the community. The method used in application development is the Forward Chaining Method. The output of this study is the IOS-based Baby Meal Planner application, which can be downloaded from the App Store, with a level of technology readiness at level 7 (TKT 7).
We use data from a large sample of low- and middle-income countries to study the association (or "gradient") between child height and maternal education. We show that the gap in height between high- and low-SES children is small at birth, rises throughout childhood, and declines in adolescence as girls and boys go through puberty. This inverted U-shaped pattern is consistent with a degree of catch-up in linear height among children of low- relative to high-SES families, in partial contrast to the argument that height deficits cannot be overcome after the early years of life. This finding appears to be explained by the association between SES and the timing of puberty and therefore of the adolescent growth spurt: low-SES children start their adolescent growth spurt later and stop growing at later ages as well.
Aims:
The overarching aim of this study was to evaluate the Norwegian guidelines for growth monitoring using routinely collected data from healthy children up to five years of age. We analysed criteria for both status (size for age) and change (centile crossing) in growth.
Methods:
Longitudinal data were obtained from the electronic health record (EHR) at the well-baby clinic for 2130 children included in the Bergen growth study 1 (BGS1). Measurements of length, weight, weight-for-length, body mass index (BMI) and head circumference were converted to z-scores and compared with the World Health Organization (WHO) growth standards and the national growth reference.
Results:
Using the WHO growth standard, the proportion of children above +2SD was generally higher than the expected 2.3% for all traits at birth and for length at all ages. Crossing percentile channels was common during the first two years of life, particularly for length/height. By the age of five years, 37.9% of the children had been identified for follow-up regarding length/height, 33% for head circumference and 13.6% for high weight-for-length/BMI.
Conclusions:
The proportion of children beyond the normal limits of the charts is higher than expected, and a surprisingly large number of children were identified for rules concerning length or growth in head circumference. This suggests the need for a revision of the current guidelines for growth monitoring in Norway.
Background:
Excessive weight is associated with the development of childhood asthma. However, trends among preterm and term offspring may differ.
Objective:
To assess whether the association of longitudinal weight for age (WFA) and odds of asthma/recurrent wheeze in early life differ between children born preterm or term.
Methods:
This study used prospectively collected data from the Vitamin D Antenatal Asthma Reduction Trial (VDAART). Children (n=804) were followed-up and anthropometric measurements, including WFA, were taken at birth and annually until 6 years of age. The primary outcome was asthma/recurrent wheeze by 3 and 6 years of age.
Results:
Among offspring, 71 (8.8%) were premature. In all children, the odds of asthma/recurrent wheeze increased by 15% (aOR=1.15, 95%CI:1.10-1.20; p<0.001) by 3 years and 9% (aOR=1.09, 95%CI:1.07-1.11; p<0.001) by 6 years of age for each unit increase in WFA z-score. Odds were different among term and preterm offspring (pinteraction<0.001). In term offspring, the odds of having asthma/recurrent wheeze by 3 and 6 years of age increased by 22% and 15%, respectively (aOR=1.22, 95%CI:1.16-1.27; p<0.001 and aOR=1.15, 95%CI:1.11-1.18; p<0.001). In preterm offspring, by 3 years of age, odds of asthma/recurrent wheeze decreased by 10% for each unit increase in WFA z-score (aOR=0.90, 95%CI:0.81-0.99; p=0.030) and decreased by 27% by 6 years of age (aOR=0.73, 95%CI:0.61-0.86; p<0.001).
Conclusion:
During early life, increasing standardized WFA is associated with higher odds of asthma/recurrent wheeze in term children. Contrary, in preterm children, a higher standardized WFA during catch-up growth may decrease the odds of asthma/recurrent wheeze associated with prematurity.
Objective(s)
To estimate nutritional status in a large cohort of infants with orofacial clefts in the US, overall and by cleft type from birth to 6 months of age.
Study design
We conducted a cross-sectional study in infants with orofacial clefts by examining growth by month between birth and 6 months of age. Infants with at least one weight measurement at a single US regional tertiary care pediatric hospital with an interdisciplinary cleft team between 2010 and 2020 were included. We calculated the average weight-for-age z-scores and weight-for-length z-scores. We calculated the proportion of infants underweight and wasting with z-scores below -2 standard deviations monthly from birth -6 months of age. We used t-tests to compare the distribution of WAZ and WLZ among children with orofacial clefts to a normal distribution.
Results
We included 883 infants with orofacial clefts. Compared with expected proportion of underweight infants (2.3%), a larger proportion of infants with orofacial clefts were underweight between birth -1 months (10.6%), peaking between 2-3 months (27.1%) and remaining high between 5-6 months (16.3%). Compared with the expected proportion of infants with wasting (2.3%), a higher proportion of infants with orofacial clefts experienced wasting between birth -1 month (7.3%), peaking between 2-3 months (12.8%) and remaining high between 5-6 months (5.3%). Similar findings were observed for all cleft types and regardless of comorbidities.
Conclusion(s)
A substantial proportion of infants with orofacial clefts compared with normative peers have malnutrition in the first 6 months of life in the United States.
The outbreak of the COVID-19 pandemic has caused dramatic changes to our lifestyle, particularly affecting our ability to interact “in person” with our social network. These changes have had a detrimental effect on the mental welfare of the global population. The international questionnaire “Pets in Lockdown” was designed to investigate whether feelings of loneliness were affecting the mood of people during the COVID-19 lockdown, and whether pet ownership may have had a positive influence on both loneliness and general mood. As expected, higher loneliness scores were associated with higher negative and lower positive affective states. In addition, lower loneliness scores were associated with pet ownership and living with other people, but not with more frequent interactions with people from outside the household, suggesting that physical and close contact has an important role decreasing feelings of loneliness. Besides the effects on the loneliness score, pet ownership was not associated with positive or negative affective states. The strength of the attachment to animals, measured as the amount of comfort that people obtain from their pets, was stronger in people with potentially limited access to affiliative physical human contact and was associated with both higher positive and negative affective states. Additionally, people obtained significantly more comfort from dogs and horses compared with other pet species. The results suggest that during the confinement period, pets may have benefited people with smaller social networks by alleviating loneliness and offering comfort and embodied close contact.
Objective:
Childhood obesity is a public health concern that often worsens with age. Although several risk factors at the child and maternal levels have been identified in cross-sectional studies, less is known about their long-term contribution to racial/ethnic disparities in childhood obesity. This study examines child- and maternal-level factors associated with the growth trajectories of White, Black, and Latino children.
Methods:
Group-based trajectory models were used to identify BMI z score trajectories from birth to 9 years of age among White, Black, and Latino children. The associations of child- and maternal-level factors with the trajectory group identified as at risk for obesity were examined using adjusted logistic regression analysis, stratified by race/ethnicity.
Results:
Among White children, fast-food consumption (odds ratio [OR] = 1.66; 95% CI: 1.09-2.52) was associated with higher odds of following an at-risk trajectory. Among Black and Latino children, prepregnancy BMI was associated with following an at-risk trajectory (OR = 1.05; 95% CI: 1.03-1.08 for Black children, and OR = 1.12; 95% CI: 1.07-1.17 for Latino children).
Conclusions:
These findings showed racial/ethnic differences in the risk factors that influence the likelihood of obesity during childhood. Further research is needed to identify modifiable racial/ethnic specific risk factors to guide obesity-prevention interventions.
Historically, the prevalence of child growth failure (CGF) has been tracked dichotomously as the proportion of children more than 2 SDs below the median of the World Health Organization growth standards. However, this conventional "thresholding" approach fails to recognize child growth as a spectrum and obscures trends in populations with the highest rates of CGF. Our analysis presents the first ever estimates of entire distributions of HAZ, WHZ, and WAZ for each of 204 countries and territories from 1990 to 2020 for children less than 5 years old by age group and sex. This approach reflects the continuous nature of CGF, allows us to more comprehensively assess shrinking or widening disparities over time, and reveals otherwise hidden trends that disproportionately affect the most vulnerable populations.
Lack of a standardized method of identifying and defining pediatric malnutrition has led to an inability to fully understand the prevalence of and impact that malnutrition has on pediatric patients and the healthcare system. The Subjective Global Nutritional Assessment (SGNA) is an assessment tool meant to determine presence and severity of malnutrition in pediatric populations. However, the anthropometric section of the tool contains some out‐dated parameters. This has limited its clinical practicality. The aim of this paper is to propose updates to the anthropometrics section of the SGNA. A retrospective analysis of 153 SGNA's performed on children aged 1 month to 16 years was completed, comparing the original SGNA results to SGNA results incorporating updated anthropometric parameters for percentiles and ideal body weight. The category of length/height for age was updated to include z score cutoffs rather than percentiles, and ideal body weight was updated to z scores for weight for length or body mass index (BMI). Two serial growth questions were updated in wording only, to reflect z score trends. The results of the analysis showed these updates would have changed the rankings of eight patients (5%) for length/height for age, and 20 patients (13%) for ideal body weight to weight for length or BMI. Adjustments to these questions did not impact the overall SGNA rating. This study shows updates to the SGNA are not expected to have a significant impact on the validity of the tool and has the potential to improve its applicability to current day practice.
Developmental Dyscalculia (DD) signifies a failure in representing quantities, which impairs the performance of basic math operations and schooling achievement during childhood. The lack of specificity in assessment measures and respective cut-offs are the most challenging factors to identify children with DD, particularly in disadvantaged educational contexts. This research is focused on a numerical cognition battery for children, designed to diagnose DD through 12 subtests. The aims of the present study were twofold: to examine the prevalence of DD in a country with generally low educational attainment, by comparing z-scores and percentiles, and to test three neurodevelopmental models of numerical cognition based on performance in this battery. Participants were 304 Brazilian school children aged 7–12 years of both sexes (143 girls), assessed by the Zareki-R. Performances on subtests and the total score increase with age without gender differences. The prevalence of DD was 4.6% using the fifth percentile and increased to 7.4% via z-score (in total 22 out of 304 children were diagnosed with DD). We suggest that a minus 1.5 standard deviation in the total score of the Zareki-R is a useful criterion in the clinical or educational context. Nevertheless, a percentile ≤ 5 seems more suitable for research purposes, especially in developing countries because the socioeconomic environment or/and educational background are strong confounder factors to diagnosis. The four-factor structure, based on von Aster and Shalev’s model of numerical cognition (Number Sense, Number Comprehension, Number Production and Calculation), was the best model, with significant correlations ranging from 0.89 to 0.97 at the 0.001 level.
The study aimed to assess the prevalence of obesity and the related behavioral risk factors among children in Beijing.
Data were collected as part of a 2004 comprehensive study on obesity and metabolic syndrome among 21 198 children, aged 2-18 years old in Beijing. Four local and international references for the classification of childhood overweight and obesity were compared.
The combined prevalence of obesity and overweight among children, aged 2-18 years old, was 18.7%, 21.4%, and 20.1% based on the International Obesity Task Force (IOTF) reference, new World Health Organization (WHO) growth standard, and the US 2000 Center for Disease Control and Prevention Growth Charts, respectively; and it was 21.7%, according to the local Chinese body mass index (BMI) reference for school-age children (aged 7-18 years). Physical inactivity, less sleep duration, higher consumption of alcohol, snack food and Western fast food and more screen time were associated with overweight and obesity (p<0.05).
Over 20% of children and adolescents in Beijing are overweight or obese. Effort should be made to combat the growing obesity epidemic.
Body mass index (BMI) and triceps skinfold thickness (TSF) are commonly used measures of adiposity in clinical and epidemiologic studies. The 85th and 95th percentiles of BMI and TSF are often used operationally to define obesity and superobesity, respectively. Race-specific and population-based 85th and 95th percentiles of BMI and TSF for people aged 6-74 y were generated from anthropometric data gathered in the National Health and Nutrition Examination Survey 1 (NHANES I). The complex sample design of the survey is reflected in the reference values presented. Racial differences in these extremes of the distribution do not emerge until adulthood. Researchers may choose population-based, race-specific, or age-specific criteria for obesity on the basis of assumptions underlying their specific research questions.
To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points.
International survey of six large nationally representative cross sectional growth studies.
Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States.
97 876 males and 94 851 females from birth to 25 years of age.
Body mass index (weight/height(2)).
For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m(2) for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2-18 years.
The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
This report provides detailed information on how the 2000 Centers for Disease Control and Prevention (CDC) growth charts for the United States were developed, expanding upon the report that accompanied the initial release of the charts in 2000.
The growth charts were developed with data from five national health examination surveys and limited supplemental data. Smoothed percentile curves were developed in two stages. In the first stage, selected empirical percentiles were smoothed with a variety of parametric and nonparametric procedures. In the second stage, parameters were created to obtain the final curves, additional percentiles and z-scores. The revised charts were evaluated using statistical and graphical measures.
The 1977 National Center for Health Statistics (NCHS) growth charts were revised for infants (birth to 36 months) and older children (2 to 20 years). New body mass index-for-age (BMI-for-age) charts were created. Use of national data improved the transition from the infant charts to those for older children. The evaluation of the charts found no large or systematic differences between the smoothed percentiles and the empirical data.
The 2000 CDC growth charts were developed with improved data and statistical procedures. Health care providers now have an instrument for growth screening that better represents the racial-ethnic diversity and combination of breast- and formula-feeding in the United States. It is recommended that these charts replace the 1977 NCHS charts when assessing the size and growth patterns of infants, children, and adolescents.
In 2000, the Centers for Disease Control and Prevention (CDC) produced a revised growth reference. This has already been used in different settings outside the USA. Using data obtained during a nutritional survey in Madagascar, we compare results produced by using both the 2000 CDC and the 1978 National Center for Health Statistics (NCHS)/World Health Organization (WHO) growth references. We show that changing the reference has an important impact on nutritional diagnosis. In particular, the prevalence of wasting is greatly increased. This could generate substantial operational and clinical difficulties. We recommend continued use of the 1978 NCHS/WHO reference until release of the new WHO multi-country growth charts.
To compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes.
Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives.
Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe.
Respectively 4787, 10 381 and 226 infants and children.
Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%.
The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.
The cutoff points for creating anthropometric indicators of size and growth can be established by three distinct methods: statistical, risk-based, and prescriptive. The theoretical, philosophical, and technical bases for these are quite distinct, but the implications of each method for applications at population and individual levels can be explored by using a common conceptual model. This model posits that any observed anthropometric distribution is a mixed distribution of two (or more) subpopulations, representing some individuals who are or will remain healthy (the specificity distribution) and those who are or will become unhealthy (the sensitivity distribution). The performance and appropriateness of cutoff points based on statistical, risk-based, and prescriptive criteria depend upon the relative sizes of these two subpopulations in a given context, the distance between their means, and the strength and shape of the relationship between the anthropometric indicator and the health outcomes that define these two subpopulations. The risk-based and prescriptive methods both require substantial epidemiologic evidence if they are to fulfill their theoretical and public health expectations, and both face normative (ethical) trade-offs in establishing cutoff points. The prescriptive method faces even stronger normative challenges, especially in relation to overweight and obesity, because its explicit claim regarding the desirable size and growth of children and adolescents may understate the importance of individuality and overstate the strength of the relationship (and the evidence for the relationship) between size, growth, and future health. These concerns are most pronounced for applications at the individual level and for mild-to-moderate elevations of body-mass index and other indicators.
To determine cut offs to define thinness in children and adolescents, based on body mass index at age 18 years.
International survey of six large nationally representative cross sectional studies on growth.
Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States.
97 876 males and 94 851 females from birth to 25 years.
Body mass index (BMI, weight/height(2)).
The World Health Organization defines grade 2 thinness in adults as BMI <17. This same cut off, applied to the six datasets at age 18 years, gave mean BMI close to a z score of -2 and 80% of the median. Thus it matches existing criteria for wasting in children based on weight for height. For each dataset, centile curves were drawn to pass through the cut off of BMI 17 at 18 years. The resulting curves were averaged to provide age and sex specific cut-off points from 2-18 years. Similar cut offs were derived based on BMI 16 and 18.5 at 18 years, together providing definitions of thinness grades 1, 2, and 3 in children and adolescents consistent with the WHO adult definitions.
The proposed cut-off points should help to provide internationally comparable prevalence rates of thinness in children and adolescents.
To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults.
Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1-24 years) were merged with data from the under-fives growth standards' cross-sectional sample (18-71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0-5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample.
The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m(2) to 0.1 kg/m(2). At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m(2) for boys and 25.0 kg/m(2) for girls. These values are equivalent to the overweight cut-off for adults (> or = 25.0 kg/m(2)). Similarly, the +2 SD value (29.7 kg/m(2) for both sexes) compares closely with the cut-off for obesity (> or = 30.0 kg/m(2)).
The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group.
To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references.
Prospective birth cohort in Lambaréné, Gabon.
Two hundred and eighty-nine children from birth to 15 months of age.
Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below -2 SD of the corresponding reference median (Z score < or = -2) were classified as stunted or underweight-for-age, respectively.
With the new WHO 2006 standards a higher proportion (4.0%) of 3-month-old infants were underweight compared with the CDC (1.0%) or the NCHS (0.7%) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20%) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months.
The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.
To compare the prevalence of shortness, underweight, and overweight by using the Centers for Disease Control and Prevention (CDC) 2000 and the World Health Organization (WHO) 2006 growth charts. These comparisons are undertaken with 2 sets of cutoff values.
Data from the National Health and Nutrition Examination Survey 1999-2004 were used to calculate the prevalence estimates in US children aged 0 to 59 months (n = 3920). Cutoff values commonly used in the United States, on the basis of the 5th percentile of height-for-age to define shortness, the 5th percentile of weight-for-height or weight-for-age to define underweight, and the 95th percentile of weight-for-height or body mass index-for-age to define overweight were compared with the cutoff values recommended by WHO, which use <-2 z-score (equivalent to 2.3rd percentile) to define shortness and underweight and >or=2 z-score (equivalent to 97.7th percentile) to define overweight. A comparison with the same cutoff values (5th and 95th) in the 2 charts was also performed.
Applying the 5th or 95th percentile, we observed a higher prevalence of shortness and overweight for all the age groups when the WHO 2006 growth charts were used than when the CDC 2000 growth charts were used. Applying the 5th percentile to the WHO 2006 charts produced lower rates of underweight than did the CDC 2000 charts. However, applying the 5th or 95th percentiles to the CDC 2000 charts and the WHO-recommended cutoff values of -2 or +2 z-score to the WHO charts produced smaller differences in the prevalence of shortness and overweight than were seen when the 5th and 95th percentiles were applied to both the CDC and WHO charts.
Estimates of the prevalence of key descriptors of growth in children aged 0 to 59 months vary by the chart used and the cutoff values applied. The use of the 5th and 95th percentiles for the CDC growth charts and the 2.3rd and 97.7th percentiles for the WHO growth charts appear comparable in the prevalence of shortness and overweight, but not underweight. If practitioners were to use the WHO growth charts, it might be more appropriate to adopt the WHO recommended cutoff values as well, but this would be a change for office practice.
This article is a statement from the European Childhood Obesity Group after discussion with the participants at the 3rd ECOG Workshop in St Polten, Austria, 1993: W Burniat, M Caroli, C Catassi, ML Frelut, E Locard, E Malecka-Tendera, C Maffeis, D Molnar, EME Poskitt, IM Raetsch, MF Rolland-Cachera, C Van Aelst, L Vido, M Wabitsch, K Zwiauer.-
A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (⩾25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22kg/m2 to 25kg/m2 in different Asian populations; for high risk it varies from 26kg/m2 to 31kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23·0, 27·5, 32·5, and 37·5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
Objective
To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points.
Design
International survey of six large nationally representative cross sectional growth studies.
Setting
Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States
Subjects
97 876 males and 94 851 females from birth to 25 years of age
Main outcome measure
Body mass index (weight/height2).
Results
For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m2 for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2-18 years.
Conclusions
The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
Anthropometry is an effective and frequently performed child health and nutrition screening procedure. The value of physical growth data depends on their accuracy and reliability, how they are recorded and interpreted, and what follow-up efforts are made after identification of growth abnormality. The new National Center for Health Statistics percentiles can be used to improve identification of potential health and nutritional problems and to facilitate the epidemological comparison of one group of children with others.
Refence centile curves show the distribution of a measurement as it changes according to some covariate, often age. The LMS method summarizes the changing distribution by three curves representing the median, coefficient of variation and skewness, the latter expressed as a Box-Cox power. Using penalized likelihood the three curves can be fitted as cubic splines by non-linear regression, and the extent of smoothing required can be expressed in terms of smoothing parameters or equivalent degrees of freedom. The method is illustrated with data on triceps skinfold in Gambian girls and women, and body weight in U.S.A. girls.
• Weight-for-height indexes are often used in the clinical assessment of obesity in children and adolescents. The direct measurement of adiposity, using hydrostatic weighing and other techniques, is not feasible in studies involving young children or with large numbers of older subjects. Ratios of weight relative to height, such as the body-mass index (weight/height2), may be used as indirect measures of obesity and correlate with more direct measures of adiposity. Using data from the First National Health and Nutrition Examination Study, 1971 to 1974, standardized percentile curves of body-mass index for white children and adolescents were developed. These curves may be used to monitor the body-mass index of white children and adolescents longitudinally and for comparing an individual with others of the same sex and age.
(AJDC. 1991;145:259-263)
This report provides Body Mass Index (weight/height2) values for the French population from birth to the age of 87 years. BMI curves increase during the first year, decrease until the age of 6, increase again up to 65 years and decrease thereafter. These variations reflect the total changes of fat body mass during life. The 50th centile values of Wt/Ht2 at the ages of 20, 40, 60, 80 years are 21.5, 24.6, 25.4, 24.4 kg/m2 for men and 20.6, 22.6, 24.1, 23.4 kg/m2 for women. The values for the 3rd, 50th and 97th centiles in the middle years are approximately 18, 24 and 32 kg/m2. Graphs for these and four other percentiles are plotted against age, and two other graphs summarising the variation and skewness of the Wt/Ht2 distribution are provided to calculate exact percentiles and Z-scores for individuals.
The current international growth reference, the National Center for Health Statistics (NCHS) reference, is widely used to compare the nutritional status of populations and to assess the growth of individual children throughout the world. Recently, concerns were raised regarding the adequacy of this reference for assessing the growth of breast-fed infants. We used the NCHS reference to evaluate infant growth in one of the most developed areas of Brazil. Infants who were exclusively or predominantly breast-fed for the first 4-6 mo, and partially breast-fed thereafter, grew more rapidly than the NCHS reference in weight and length during the first 3 mo, but appeared to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS reference until approximately 6 mo, after which their growth became slower than that of the NCHS sample. To substantiate this finding, the NCHS growth curves were then compared with growth data of breast-fed infants in developed countries from pooled published studies, formula-fed North American and European infants and predominantly bottle-fed U.S. infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance System. In all three cases, weights showed the same pattern as the Brazilian infants-higher than NCHS in the early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breast-fed infants showed more pronounced declines than those who were predominantly bottle-fed. These findings suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breast-fed or artificially fed infants. This probably results from characteristics of the original sample and from inadequate curve-fitting procedures. The development of an improved international growth reference that reflects the normal infant growth pattern is indicated.
To evaluate the performance of the 2000 Centers for Disease Control and Prevention (CDC) growth charts in comparison with the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference as a tool for assessing growth in healthy breastfed infants.
Weight and length measurements were obtained from a pooled longitudinal sample of 226 healthy breastfed infants. Weight-for-age (WA), length-for-age (LA) and weight-for-length (WL) z-scores based on the CDC and NCHS/WHO references were computed for each child. Age-specific mean z-scores and proportions below and above specific cut-off points were calculated.
Breastfed infants grow more rapidly in the first 2 mo of life and less rapidly from 3 to 12 mo in relation to the CDC WA curves. Similarly, breastfed infants experience greater linear growth than the CDC median until age 4 mo. Thereafter, the mean LA z-score declines until month 9. Apart from a 1-mo difference in the time when linear growth begins to falter, the pattern of growth is remarkably similar when compared with the two references. The growth trajectories indicate that infants in the CDC reference are heavier and shorter than the NCHS/WHO reference population. Combining the two measurements as WL reveals that higher weight overrides lower length in the CDC versus the NCHS population, thus the estimated prevalence of wasting is higher by the CDC reference.
As was the case when compared with the NCHS/WHO reference, there are notable differences in the growth trajectory of breastfed infants examined against the CDC reference. A reference based on healthy breastfed infants is required if the growth patterns of infants following international feeding recommendations are to be correctly assessed.
It is still a matter of debate as to how to define obesity in young people, although a growing consensus is to use body mass index (BMI) cutoffs to classify obesity in children and adolescents.
This article provides a brief overview of issues related to the assessment of obesity in children and adolescents.
At present, BMI is probably the best choice among available measures. BMI can be easily assessed at low cost, and has a strong association with body fatness and health risks. However, as an indirect measure of adipose tissue, BMI has a number of limitations. Cole et al published a set of sex- and age-specific BMI cutoffs, which had been developed based on data collected in six countries, and the reference has been recommended for international use. Recently, several researchers have raised concerns regarding this international reference. It has been argued that population-specific standards should be used due to biological differences between populations.
BMI is a valid and feasible indirect measure of body fatness, but it suffers from a number of limitations. More efforts are needed to develop valid classifications of childhood obesity.
Since the 1970s, the World Health Organization (WHO) has recommended the use of the growth references developed by the United States National Center for Health Statistics (NCHS) based on national survey data collected in the 1960s and 1970s. These references are known as the WHO or NCHS/WHO growth references. Over the past three decades, the WHO or NCHS/WHO growth references have played an important role internationally in the assessment of child and adolescent growth and nutritional status. However, the references have a number of weaknesses. The limitations of the infant portion of the references were thoroughly assessed in WHO's effort to develop a new international growth reference for infants and preschool children. The present report discusses the limitations of the NCHS/WHO references for school-aged children and adolescents, including a number of conceptual, methodological, and practical problems. The global obesity epidemic poses another challenge that the NCHS/WHO reference cannot appropriately meet. There is a need for a single international reference to assess the nutritional status and growth of school-aged children and adolescents across different countries.
The Asia-Pacific perspective: redefining obesity and its treatment
- S Inoue
- P Zimmet
- I Caterson
- C Chen
- Y Ikeda
- A K Khalid
- Y S Kim
- J Bassett
Training course on child growth assessment: investigating causes of undernutrition and of overweight
- Who Training Course
Appropriate body-mass index for Asian populations and its implications for policy and intervention strategiesView Article
Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study
- WHO Multicentre Growth Reference Study Group
- National High Blood Pressure Education Program