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Development of a WHO growth reference for school-aged children and adolescents Translated title: Mise au point d'une référence de croissance pour les enfants d'âge scolaire et les adolescents Translated title: Elaboración de valores de referencia de la OMS para el crecimiento de escolares y adolescentes

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      Abstract

      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.

      Translated abstract

      OBJECTIF: Construire des courbes de croissance pour les enfants d'âge scolaire et les adolescents concordant avec la Norme OMS de croissance de l'enfant pour les enfants d'âge préscolaire et avec les points de coupure pour l'indice de masse corporelle (IMC) s'appliquant aux adultes. MÉTHODES: Les données de référence NCHS/OMS pour la croissance (de 1 à 24 ans) de 1977 ont été regroupées avec celles de l'échantillon transversal d'enfants de moins de 5 ans (18 à 71 mois) utilisé pour la norme de croissance de manière à lisser la transition entre les deux échantillons. Les méthodes statistiques correspondant à l'état de la technique [méthode Box-Cox-power-exponential (BCPE), complétée par des outils permettant de sélectionner les meilleurs modèles], ayant servi à construire la norme OMS de croissance de l'enfant (0 à 5 ans), ont été appliquées à cet échantillon combiné. RÉSULTATS: La fusion des jeux de données a permis d'obtenir une transition plus douce au niveau de 5 ans pour les courbes de taille, de poids et d'IMC en fonction de l'âge. S'agissant de l'IMC en fonction de l'âge, sur l'ensemble des centiles, l'ampleur de la différence entre les deux courbes à l'âge de 5 ans se situe principalement entre 0,0 kg/m² et 0,1 kg/m². A 19 ans, les nouvelles valeurs d'IMC correspondant à un écart type de +1 sont de 25,4 kg/m² pour les garçons et de 25,0 kg/m² pour les filles. Ces valeurs concordent avec le point de coupure pour l'excès pondéral chez l'adulte (> 25,0 kg/m²). De même, les valeurs correspondant à plus de 2 écarts types (29,7 kg/m² pour les deux sexes) sont très proches du point de coupure pour l'obésité (> 30,0 kg/m²). CONCLUSION: Les nouvelles courbes coïncident étroitement à 5 ans avec la norme OMS de croissance de l'enfant et à 19 ans avec les points de coupure recommandés chez l'adulte pour l'excès pondéral et l'obésité. Elles comblent les lacunes en matière de courbes de croissance et fournissent une référence appropriée pour la tranche d'âges 5 -19 ans.

      Translated abstract

      OBJETIVO: Elaborar curvas de crecimiento para escolares y adolescentes que concuerden con los Patrones de Crecimiento Infantil de la OMS para preescolares y los valores de corte del índice de masa corporal (IMC) para adultos. MÉTODOS: Se fusionaron los datos del patrón internacional de crecimiento del National Center for Health Statistics/OMS de 1977 (1-24 años) con los datos de la muestra transversal de los patrones de crecimiento para menores de 5 años (18-71 meses), con el fin de suavizar la transición entre ambas muestras. A esta muestra combinada se le aplicaron los métodos estadísticos de vanguardia utilizados en la elaboración de los Patrones de Crecimiento Infantil de la OMS (0-5 años), es decir, la transformación de potencia de Box-Cox exponencial, junto con instrumentos diagnósticos apropiados para seleccionar los mejores modelos. RESULTADOS: La fusión de los dos conjuntos de datos proporcionó una transición suave de la talla para la edad, el peso para la edad y el IMC para la edad a los 5 años. Con respecto al IMC para la edad, la magnitud de la diferencia entre ambas curvas a los 5 años fue generalmente de 0,0 kg/m² a 0,1 kg/m² en todos los centiles. A los 19 años, los nuevos valores del IMC para +1 desviación estándar (DE) fueron de 25,4 kg/m² para el sexo masculino y de 25,0 kg/m² para el sexo femenino, es decir, equivalentes al valor de corte del sobrepeso en adultos (> 25,0 kg/m²). A su vez, el valor correspondiente a +2 DE (29,7 kg/m² en ambos sexos) fue muy similar al valor de corte de la obesidad (> 30,0 kg/m²). CONCLUSIÓN: Las nuevas curvas se ajustan bien a los Patrones de Crecimiento Infantil de la OMS a los 5 años y a los valores de corte del sobrepeso y de la obesidad recomendados para los adultos a los 19 años, colman la laguna existente en las curvas de crecimiento y constituyen una referencia apropiada para el grupo de 5 a 19 años de edad.

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      Most cited references 29

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      Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally. The Consultation also concluded that the fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles. A reduction in fat intake to around 20-25% of energy is necessary to minimize energy imbalance and weight gain in sedentary individuals. While there is strong evidence that certain genes have an influence on body mass and body fat, most do not qualify as necessary genes, i.e. genes that cause obesity whenever two copies of the defective allele are present; it is likely to be many years before the results of genetic research can be applied to the problem. Methods for the treatment of obesity are described, including dietary management, physical activity and exercise, and antiobesity drugs, with gastrointestinal surgery being reserved for extreme cases.
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        Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee.

        Anthropometry provides the single most portable, universally applicable, inexpensive and non-invasive technique for assessing the size, proportions, and composition of the human body. It reflects both health and nutritional status and predicts performance, health, and survival. As such, it is a valuable, but currently underused, tool for guiding public health policy and clinical decisions. This report presents the conclusions and comprehensive recommendations of a WHO Expert Committee for the present and future uses and interpretation of anthropometry. In a section that sets the technical framework for the report, the significance of anthropometric indicators and indices is explained and the principles of applied biostatistics and epidemiology that underlie their various uses are discussed. Subsequent sections provide detailed guidance on the use and interpretation of anthropometric measurements in pregnant and lactating women, newborn infants, infants and children, adolescents, overweight and thin adults, and adults aged 60 years and over. With a similar format for each section, the report assesses specific applications of anthropometry in individuals and populations for purposes of screening and for targeting and evaluating interventions. Advice on data management and analysis is offered, and methods of taking particular measurements are described. Each section also includes a discussion of the extent, reliability and universal relevance of existing reference data. An extensive series of reference data recommended by the Expert Committee and not widely distributed by WHO hitherto is included in an annex.
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          WHO Child Growth Standards based on length/height, weight and age.

            (2006)
          To describe the methods used to construct the WHO Child Growth Standards based on length/height, weight and age, and to present resulting growth charts. The WHO Child Growth Standards were derived from an international sample of healthy breastfed infants and young children raised in environments that do not constrain growth. Rigorous methods of data collection and standardized procedures across study sites yielded very high-quality data. The generation of the standards followed methodical, state-of-the-art statistical methodologies. The Box-Cox power exponential (BCPE) method, with curve smoothing by cubic splines, was used to construct the curves. The BCPE accommodates various kinds of distributions, from normal to skewed or kurtotic, as necessary. A set of diagnostic tools was used to detect possible biases in estimated percentiles or z-score curves. There was wide variability in the degrees of freedom required for the cubic splines to achieve the best model. Except for length/height-for-age, which followed a normal distribution, all other standards needed to model skewness but not kurtosis. Length-for-age and height-for-age standards were constructed by fitting a unique model that reflected the 0.7-cm average difference between these two measurements. The concordance between smoothed percentile curves and empirical percentiles was excellent and free of bias. Percentiles and z-score curves for boys and girls aged 0-60 mo were generated for weight-for-age, length/height-for-age, weight-for-length/height (45 to 110 cm and 65 to 120 cm, respectively) and body mass index-for-age. The WHO Child Growth Standards depict normal growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socio-economic status and type of feeding.
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            Author and article information

            Affiliations
            [1 ] World Health Organization Switzerland
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            bwho
            Bulletin of the World Health Organization
            Bull World Health Organ
            World Health Organization (Genebra )
            0042-9686
            September 2007
            : 85
            : 9
            : 660-667
            S0042-96862007000900010

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Public Health
            Categories
            Health Policy & Services

            Public health

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