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      Prevalence of thinness in children and adolescents in the Seychelles: comparison of two international growth references

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          Abstract

          Background

          Thinness in children and adolescents is largely under studied, a contrast with abundant literature on under-nutrition in infants and on overweight in children and adolescents. The aim of this study is to compare the prevalence of thinness using two recently developed growth references, among children and adolescents living in the Seychelles, an economically rapidly developing country in the African region.

          Methods

          Weight and height were measured every year in all children of 4 grades (age range: 5 to 16 years) of all schools in the Seychelles as part of a routine school-based surveillance program. In this study we used data collected in 16,672 boys and 16,668 girls examined from 1998 to 2004. Thinness was estimated according to two growth references: i) an international survey (IS), defining three grades of thinness corresponding to a BMI of 18.5, 17.0 and 16.0 kg/m 2 at age 18 and ii) the WHO reference, defined here as three categories of thinness (-1, -2 and -3 SD of BMI for age) with the second and third named "thinness" and "severe thinness", respectively.

          Results

          The prevalence of thinness was 21.4%, 6.4% and 2.0% based on the three IS cut-offs and 27.7%, 6.7% and 1.2% based on the WHO cut-offs. The prevalence of thinness categories tended to decrease according to age for both sexes for the IS reference and among girls for the WHO reference.

          Conclusion

          The prevalence of the first category of thinness was larger with the WHO cut-offs than with the IS cut-offs while the prevalence of thinness of "grade 2" and thinness of "grade 3" (IS cut-offs) was similar to the prevalence of "thinness" and "severe thinness" (WHO cut-offs), respectively.

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          Most cited references21

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          Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship.

          The objective was to study the relationship between body mass index (BMI) and body fat per cent (BF%) in different population groups of Asians. The study design was a literature overview with special attention to recent Asian data. Specific information is provided on Indonesians (Malays and Chinese ancestry), Singaporean Chinese, Malays and Indians, and Hong Kong Chinese. The BMI was calculated from weight and height and the BF% was determined by deuterium oxide dilution, a chemical-for-compartment model, or dual-energy X-ray absorptiometry. All Asian populations studied had a higher BF% at a lower BMI compared to Caucasians. Generally, for the same BMI their BF% was 3-5% points higher compared to Caucasians. For the same BF% their BMI was 3-4 units lower compared to Caucasians. The high BF% at low BMI can be partly explained by differences in body build, i.e. differences in trunk-to-leg-length ratio and differences in slenderness. Differences in muscularity may also contribute to the different BF%/BMI relationship. Hence, the relationship between BF% and BMI is ethnic-specific. For comparisons of obesity prevalence between ethnic groups, universal BMI cut-off points are not appropriate.
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            The nutritional status of school-aged children: why should we care?

            The nutritional status of school-aged children impacts their health, cognition, and subsequently their educational achievement. The school is an opportune setting to provide health and nutrition services to disadvantaged children. Yet, school-aged children are not commonly included in health and nutrition surveys. An up-to-date overview of their nutritional status across the world is not available. To provide a summary of the recent data on the nutritional status of school-aged children in developing countries and countries in transition and identify issues of public health concern. A review of literature published from 2002 to 2009 on the nutritional status of children aged 6 to 12 years from Latin America, Africa, Asia, and the Eastern Mediterranean region was performed. Eligible studies determined the prevalence of micronutrient deficiencies or child under- and overnutrition using biochemical markers and internationally accepted growth references. A total of 369 studies from 76 different countries were included. The available data indicate that the nutritional status of school-aged children in the reviewed regions is considerably inadequate. Underweight and thinness were most prominent in populations from South-East Asia and Africa, whereas in Latin America the prevalence of underweight or thinness was generally below 10%. More than half of the studies on anemia reported moderate (> 20%) or severe (> 40%) prevalence of anemia. Prevalences of 20% to 30% were commonly reported for deficiencies of iron, iodine, zinc, and vitamin A. The prevalence of overweight was highest in Latin American countries (20% to 35%). In Africa, Asia, and the Eastern Mediterranean, the prevalence of overweight was generally below 15%. The available data indicate that malnutrition is a public health issue in school-aged children in developing countries and countries in transition. However, the available data, especially data on micronutrient status, are limited. These findings emphasize the need for nutrition interventions in school-aged children and more high-quality research to assess nutritional status in this age group.
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              A comparison of international references for the assessment of child and adolescent overweight and obesity in different populations.

              To compare different references assessing child and adolescent overweight and obesity in different populations. Comparison cross-sectional study. The United States, Russia, China. A total of 6108 American, 6883 Russian and 3014 Chinese children aged 6-18 y. Using nationwide survey data from the USA (NHANES III, 1988-1994), Russia (1992), and China (1991), we compared three references: (1) the International Obesity Task Force (IOTF) reference, sex-age-specific body mass index (BMI) cut-offs that correspond to BMIs of 25 for overweight and 30 for obesity at age 18; (2) the World Health Organization (WHO) reference--BMI 85th percentiles for overweight in adolescents (10-19 y) and weight-for-height Z-scores for obesity in children under 10; (3) a USA reference--BMI 85th and 95th percentiles to classify overweight and obesity, respectively. Using the IOTF reference and 85th BMI percentiles, overweight prevalence was 6.4 and 6.5% in China, 15.7 and 15.0% in Russia, and 25.5 and 24.4% in the USA, respectively. Notable differences existed for several ages. Kappa (=0.84-0.98) indicated an excellent agreement between the two references in general, although they varied by sex-age groupings and countries. Overweight prevalence was twice as high in children (6-9 y) than in adolescents (10-18 y) in China and Russia, but was similar in the USA. Estimates of obesity prevalence using these three references varied substantially. The references examined produce similar estimates of overall overweight prevalence but different estimates for obesity. One should be cautious when comparing results based on different references. University of Illinois and University of North Carolina.
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                Author and article information

                Journal
                Nutr J
                Nutrition Journal
                BioMed Central
                1475-2891
                2011
                9 June 2011
                : 10
                : 65
                Affiliations
                [1 ]Section of Noncommunicable Diseases, Ministry of Health, Victoria, Republic of Seychelles
                [2 ]Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre and University of Lausanne, rue de la Corniche 2, 1066 Epalinges, Switzerland
                [3 ]Department of Nutrition for Health and Development, WHO, World Health Organization, Geneva, Switzerland
                Article
                1475-2891-10-65
                10.1186/1475-2891-10-65
                3121668
                21658236
                8471bb03-0c51-49d4-8016-43d0233ca8f4
                Copyright ©2011 Bovet et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 6 December 2010
                : 9 June 2011
                Categories
                Research

                Nutrition & Dietetics
                Nutrition & Dietetics

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