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      Comparison of Slovak reference values for anthropometric parameters in children and adolescents with international growth standards: implications for the assessment of overweight and obesity

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          To compare the national reference percentile values for body height, weight, and body mass index (BMI) of children and adolescents in Slovakia with international standards and to analyze growth trends in this population.


          The study was designed as a repeated cross-sectional survey. Two nationwide anthropometric surveys (NAS) performed in 2001 and 2011 assessed body weight, height, and BMI of 38 692 children aged 7 to 18 years. Age- and sex-specifıc smoothed percentiles were generated with the lambda-mu-sigma method. Slovak standards were compared with World Health Organization (WHO) 2007 z-scores and International Obesity Task Force (IOTF) standards.


          Medians of body height corresponded to the 75th-85th percentile of the WHO 2007 standards. The secular trend of height increase was attenuated, and the final body height did not change between NAS 2001 and NAS 2011. The cut-off BMI values for obesity, set at the 97th percentile for age <14 years, were higher across age ranges than WHO 2007 standards but lower than IOTF standards. Obesity prevalence, relatively low in 2001 (<3%), doubled during the following decade ( P < 0.001), with the highest values (4.8%-7.6%) observed in children aged up to 13 years.


          NAS 2001 data were chosen as national growth standards, as these data were not influenced by the obesity rates increase in the period between the surveys. BMI cut-offs were lower than those in most European countries. Obesity proportions in prepubertal and pubertal boys might be overestimated when WHO 2007 cut-offs are used.

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          Most cited references 36

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          Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Development of a WHO growth reference for school-aged children and adolescents

            OBJECTIVE: 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. METHODS: 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. FINDINGS: 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/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). CONCLUSION: 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.
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              Establishing a standard definition for child overweight and obesity worldwide: international survey

               T. J. Cole (2000)

                Author and article information

                Croat Med J
                Croat. Med. J
                Croatian Medical Journal
                Croatian Medical Schools
                December 2018
                : 59
                : 6
                : 313-326
                [1 ]Slovak Academy of Sciences, Center of Experimental Medicine, Institute of Normal and Pathological Physiology, Bratislava, Slovakia
                [2 ]Department of Children and Youth Hygiene, Public Health Authority of the Slovak Republic, Bratislava, Slovakia
                [3 ]Faculty of Medicine, Comenius University, Institute of Hygiene, Bratislava, Slovakia
                Author notes
                Correspondence to:
Valéria Regecová
Institute of Normal and Pathological Physiology 
Center of Experimental Medicine
Slovak Academy of Sciences
Sienkiewiczova 1
81371 Bratislava, Slovakia 
                Copyright © 2018 by the Croatian Medical Journal. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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