Novel growth reference ImaGrow differed from existing charts for preterm children aged 0-2 years.

AIM: This study aimed to address the critical need for more accurate growth reference charts for preterm infants, with a particular focus on low- and very low-birth-weight infants. METHODS: The subjects were recruited at a single tertiary centre. The cohort comprised singleton and twin infants born before 37 weeks of gestation, with data collected from 2000 to 2016. Standardised measurements of body parameters were recorded in this mixed longitudinal survey. LMS method was utilised for data analysis. Statistical analysis was performed using SPSS Statistics Version 21. The validation with another new cohort was executed. RESULTS: A total of 1781 infants (52.5% boys) met the inclusion criteria. The median gestational age at birth was 30 weeks, with a median birth weight of 1350 grams. The main findings included the construction of ImaGrow charts for low- and very low-birth-weight infants and significant differences in growth trajectories compared to Fenton+WHO charts. CONCLUSION: Our comprehensive growth references, ImaGrow, are based on a long-term auxological assessment of preterm infants and differ from charts derived from size-at-birth standards or charts for term babies. These charts have significant implications for clinical practice in monitoring and assessing the growth of preterm infants.

Syrian national growth references for children and adolescents aged 2-20 years.

BACKGROUND: During the past three decades, growth charts have become one of the principal tools for monitoring anthropometric development in individuals and populations as well. Growth references by the CDC and other countries have been widely used in our hospitals and healthcare units for clinical assessment of children's development. The apparent overestimation and underestimation of many children's anthropometrics indicated the need to construct our own references. The objective of this study is to establish the national growth references for the Syrian population 2-20-year-old. METHODS: A multicenter cross-sectional sample of 13,548 subjects, aged 2-20 years, were recruited from various kindergartens, schools, and universities across the Syrian Arab Republic between February and May-2019. Response variables (stature, weight, and BMI) were fitted against age using P-splines and three empirical distributions: Box-Cox T, Box-Cox Power Exponential, and Box-Cox Cole and Green. Residuals diagnostic Q-tests and worm plots were used to check the validity of fitted models. RESULTS: Box-Cox T provided the best fit for stature-for-age, whereas Box-Cox Power Exponential provided the best fit for weight-for-age and BMI-for-age. Residuals diagnostics revealed adequate models fitting. BMI cutoffs revealed an increased prevalence of obesity (4.5% and 3.66%) and overweight (20.1% and 19.54%), for boys and girls respectively, in our population. CONCLUSIONS: Growth charts are available for use now in our hospitals and healthcare units. For 0-2-year-old children, we recommend using the World Health Organization's standards.

The prevalence of malnutrition and growth percentiles for urban South African children.

BACKGROUND: Low- and middle-income countries (LMIC) are experiencing a double-burden of malnutrition characterised by high prevalence of both under- and over-nutrition. We set out using data from the mixed-longitudinal Birth-to-Twenty Plus (Bt20+) birth cohort, to evaluate the patterns of malnutrition and growth in a large South African (SA) city by; (i) assessing the prevalence of undernutrition from birth to 5 years of age and overweight and obesity from ages 2 to 21 years in black and white, male and female children, and (ii) determining percentiles for height, weight, BMI, waist and hip circumferences and comparing the centiles to American and Dutch references. METHODS: Height, weight, waist and hip circumferences were measured on urban black and white SA children from the Bt20+. A total of 3273 children born between April and June 1990 in the Greater Johannesburg Metropolitan area were included in the cohort. Z-scores were derived using the WHO 2006 child growth standards (0-5 years), for defining stunting, underweight and wasting. The International Obesity Task Force (IOTF) references were used to define overweight and obesity. Percentiles were developed using the lambda mu sigma (LMS) method and compared to American and Dutch references. RESULTS: Black children were consistently shorter and black males lighter than white children and American references. The prevalence of stunting peaked at 2 years and was significantly higher in males than females and in black than white children. Black females had a greater prevalence of overweight and obesity than black males from 10 to 17 years. The percentiles for black females for weight and BMI were similar to those of South African white and American references but both black and white South African females had lower waist circumferences than American references. CONCLUSION: The growth percentiles show that young South African urban black females are experiencing general but not central obesity due to a secular change which is faster in weight than height. High levels of undernutrition persist alongside high levels of over-nutrition with adolescence being a critical period for the upsurge in obesity in females. Early intervention is needed to combat the rise in obesity.

Contemporary height, weight and body mass index references for children aged 0 to adulthood in Switzerland compared to the Prader reference, WHO and neighbouring countries.

Background: In 2011, WHO growth curves replaced those of Prader and colleagues (First Zurich longitudinal study) in Switzerland.Aim: To present contemporary height-, weight- and body mass index (BMI)-for-age references reflecting children's growth in modern Switzerland.Subjects and methods: Cross-sectional sample comprising 30,141 boys and girls aged 0-20 years measured between 2012 and 2019. Height, weight and BMI reference curves were created using the LMS method. Derived percentiles were compared with those of Prader, WHO and neighbouring countries.Results: Growth in the first 5 years is almost identical with Prader curves. Thereafter children are taller, yet their final height is only about 1 cm higher. Today's children, in particular boys, are considerably heavier. In comparison with WHO growth references, Swiss children are taller from the second year until adulthood; the WHO 3rd percentiles lie about 4 cm below those of our updated references. Weight and BMI median percentiles from our sample are similar to those of WHO and higher than the Prader curves. However, the course of the 97th BMI percentile WHO curves extends well below the 97th percentile of the updated Swiss curves.Conclusion: This study provides contemporary reference data for assessing individual growth based on height, weight and BMI of Swiss children.

The first Seriatum study of growth by R. E. Scammon.

Richard E. Scammon's article, "The First Seriatim Study of Human Growth," provided one of the best-known visuals in the field of human biology. Scammon resurrected longitudinal height data of one child from Buffon's Histoire Naturelle, converted them to metric, and plotted these measurements as a function of age. The result was the first graph of one individual's growth curve from birth to 18 years of age. This image was subsequently reproduced in numerous texts on human growth and biology. Published in 1927, Scammon's article provides a snapshot of the state of growth research at the time and gives a (literal) picture of the future of human biology. The graph of the growth of one child symbolizes the importance of process and variation in biological anthropology.

Growth curves and the international standard: How children's growth reflects challenging conditions in rural Timor-Leste.

OBJECTIVES: Population-specific growth references are important in understanding local growth variation, especially in developing countries where child growth is poor and the need for effective health interventions is high. In this article, we use mixed longitudinal data to calculate the first growth curves for rural East Timorese children to identify where, during development, deviation from the international standards occurs. MATERIALS AND METHODS: Over an eight-year period, 1,245 children from two ecologically distinct rural areas of Timor-Leste were measured a total of 4,904 times. We compared growth to the World Health Organization (WHO) standards using z-scores, and modeled height and weight velocity using the SuperImposition by Translation And Rotation (SITAR) method. Using the Generalized Additive Model for Location, Scale and Shape (GAMLSS) method, we created the first growth curves for rural Timorese children for height, weight and body mass index (BMI). RESULTS: Relative to the WHO standards, children show early-life growth faltering, and stunting throughout childhood and adolescence. The median height and weight for this population tracks below the WHO fifth centile. Males have poorer growth than females in both z-BMI (p = .001) and z-height-for-age (p = .018) and, unlike females, continue to grow into adulthood. DISCUSSION: This is the most comprehensive investigation to date of rural Timorese children's growth, and the growth curves created may potentially be used to identify future secular trends in growth as the country develops. We show significant deviation from the international standard that becomes most pronounced at adolescence, similar to the growth of other Asian populations. Males and females show different growth responses to challenging conditions in this population.

Growth of children in Greenland exceeds the World Health Organization growth charts.

AIM: Previous studies have found high rates of stunted linear growth in Greenlandic children. We measured growth patterns in Greenland and compared them with international growth charts. METHODS: The study cohort comprised 279 healthy children aged 6-10 years in 2012. They participated in two pregnancy and birth cohorts in Greenland and longitudinal growth data as birth was extracted from their medical records. Growth reference ranges were estimated with the lambda-mu-sigma (LMS) method and compared with growth charts from Denmark and the World Health Organization (WHO). RESULTS: The children's mean length, weight and head circumference were significantly larger than the WHO growth charts (p < 0.001). We found that 21-28% of the children aged zero to one years exceeded the WHO growth chart for length by more than two standard deviations. For weight and head circumference, 9-16% of the children aged 0-10 years and 9-11% of the children from zero to two years exceeded the WHO charts by more than two standard deviations. The Danish references were exceeded to a lesser degree. CONCLUSION: This study showed that the growth of Greenlandic children up to 10 years was no longer stunted. Major determining factors suggested are genetic admixture, maternal overweight, changes in nutrition and improved health.

Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants.

AIM: This study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references. METHODS: We generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's foetal growth model, using national data on birthweights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-2012, to estimate the prevalence of infants with SGA birthweights, namely those below the 10th percentile. RESULTS: The SGA prevalence was 31.8% with country-specific references and 34.0% with common European references. The European references yielded a 10-point difference in the SGA prevalence between countries with lower term birthweights (39.9%) - Portugal, Italy and France - and higher term birthweights, namely Denmark, the Netherlands, Sweden (28.9%; p < 0.001). This was not observed with country-specific references, where the respective figures were 32.4% and 33.9% (p = 0.34), respectively. CONCLUSION: One-third of VPT infants were SGA according to intrauterine references. Common European references showed significant differences in SGA prevalence between countries with high and low-term birthweights.

The height-, weight- and BMI-for-age of preschool children from Nizhny Novgorod city, Russia, relative to the international growth references.

BACKGROUND: Monitoring a child's growth status helps to diagnose diseases and implement curative and preventive measures. The aim of this study was to assess how well preschool children of Russian city (Nizhny Novgorod) match with, or diverge from, international growth charts (WHO2006,2007; USCDC2000). METHODS: Cross-sectional study included 3,130 children aged 3-7 years attending municipal preschools of Nizhny Novgorod, the city in the European part of Russia. The study was held from February 2012 to October 2013. The international WHO2006,2007 and USCDC2000 growth references were used to calculate the height, weight and BMI z-scores. The distributions of z-scores were analysed with descriptive and inferential statistical methods. Z-score equal 0.25 was considered as a benchmark for clinically significant differences. RESULTS: Means height z-scores calculated with the use of WHO2006, 2007 and USCDC2000 references were above the 50th centile (0.13 - 0.47) for both boys and girls. The means height z-scores was less than 0.25 SD above the 50th centile only for WHO2006. Stunting prevalence (the height-for-age z-score less than -2) was slightly higher under WHO2006 (3-4%) than under USCDC 2000 (2-3%). Stunting prevalence among children aged 5-7 years was similar under WHO2007 and USCDC2000 references (1%). For boys and girls aged 3-4 years the thinness prevalence, using WHO2006 was 2%, using USCDC2000 was 6% (p < 0.05). At the age 5-7 years this proportion under WHO2007 was 3% in both sex groups, under USCDC2000 was 8% for boys and 6% for girls (p < 0.05). A proportion of preschoolers aged 3-4 years with overweight was slightly higher under WHO2006 reference (13-15%) than under USCDC2000 (12-14%). In the case of age 5-7 years the overweight prevalence under WHO2007 (13-12 %) was lower than under USCDC2000 (14%). Obesity prevalence under WHO2006,2007 (3-4%) was slightly higher than that under USCDC2000 reference (2-3%). Preschoolers' distribution by groups of normal weight, overweight, obesity didn't significantly differ among the references (chi-square). CONCLUSIONS: The growth assessment of children aged 3-7 years attending municipal preschools of the Russian city Nizhny Novgorod under the international references (WHO2006,2007; USCDC 2000), demonstrated that the height fit to the WHO2006 standard for the children aged 3 and 4 was generally fine, since all the mean values were within 0.25 of the standard deviations of the mean. Beyond the age of 5 the fit to the WHO2007 was poor while the fit to the USCDC2000 was poor throughout.

Weight and height centiles of Argentinian children and adolescents: a comparison with WHO and national growth references.

BACKGROUND: Studies in several countries comparing the performance of WHO references and their own national growth standards reported differences that could affect screening and growth monitoring. AIM: To estimate weight and height centiles on a sample of Argentinian children and adolescents and compare selected centiles with WHO and national growth references. SUBJECTS AND METHODS: A cross-sectional school survey was conducted on 6239 boys and girls aged 5-18. Data were collected between 2005-2009 in Santa Rosa, Argentina. Smoothed weight and height centiles were estimated by the LMS method and compared with WHO 2007 and Argentinian (ARG) growth references. RESULTS: Weight centiles were higher than those of WHO and ARG. Height centiles were above the ARG and below the WHO ones. The greatest differences with ARG were seen before puberty and then declined up to age 18. In contrast, differences with WHO increased from puberty onwards. CONCLUSION: Compared with the ARG reference, linear growth of these schoolchildren shows a secular acceleration without substantial improvements in the adult height. In relation to WHO, the results suggest that around the adolescent growth spurt differences in linear growth between populations became larger, limiting the clinical usefulness of international growth references in adolescents.

The prevalence of rapid weight gain in infancy differs by the growth reference and age interval used for evaluation.

BACKGROUND: Infant rapid weight gain (RWG) may predict subsequent obesity, but there are inconsistencies in the growth references and age intervals used for assessment. METHODS: This study evaluated whether the prevalence of RWG (an increase of >0.67 in weight-for-age z-score) differed by growth reference (2006 WHO standards vs 2000 CDC references) and age interval of assessment (0-3, 0-6, 6-12 and 0-12 months). Pooled data from singleton term infants from two observational studies on maternal mood disorders during pregnancy were used (n = 161). Differences in RWG prevalence by growth reference and age interval were tested using Cochran's Q and McNemar's tests. RESULTS: The CDC reference produced a higher RWG prevalence (14% of infants additionally categorized as RWG, p < 0.0001) within the 0-3 month age interval compared to the WHO standards; this pattern was reversed for the 6-12 and 0-12 month intervals. RWG prevalence did not differ across age interval within the WHO standards, but did differ with the CDC references (range: 22% for 0-3 months to 4.2% for 6-12 months, p < 0.0001). CONCLUSIONS: Caution is advised when comparing studies with different criteria for RWG. Future studies should use the 2006 WHO standards and a consistent age interval of evaluation.

Reference growth curves of anthropometric markers in Brazilian children and adolescents aged 7-14 years from southern Brazil.

Reference growth curves are viable tools for monitoring somatic growth. Therefore, the objective of this study was to develop reference growth curves for body mass, height, body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in Brazilian children and adolescents aged 7-14 years. The reference growth curves were constructed from a cross-sectional panel study using data from four surveys conducted in 2002, 2007, 2012/2013 and 2018/2019, with 9675 children and adolescents aged 7-14 years, of both sexes from Florianopolis, Southern Brazil. Growth curves were constructed using the LMS method, based on anthropometric indicators and indices (body mass, height, BMI, WC and WHtR), measured according to standardised norms. There was an increase in body mass, height, BMI and WC values with increasing age in both sexes and percentiles (P5, P10, P25, P50, P75, P85 and P95). The girls presented higher values of body mass, BMI and WC in the analysed percentiles, compared to the boys. Regarding height, there was a higher value from 10 to 11 years old in girls and from 12 to 14 years old in boys. WHtR decreased with increasing age in both sexes and analysed percentiles. Region-specific reference growth curves can enable the monitoring of somatic growth of particular paediatric populations, expanding discussions in different regions of the world.

Comparison of Nutritional Status of Healthy Under-Five Indian Children Using Composite Index of Anthropometric Failure on WHO 2006 versus 2019 Indian Synthetic Growth Charts.

OBJECTIVES: To assess nutritional status of apparently-healthy under-five Indian children using Composite Index of Anthropometric Failure (CIAF) and to compare anthropometric failure prevalence using conventional indices and CIAF on World Health Organization (WHO) vs. synthetic Indian growth charts. METHODS: This observational study was conducted over 2 y. The inclusion criteria was apparently-healthy children (0-60 mo) and the exclusion criteria were acute/chronic illness and small for gestational age. RESULTS: A total of 1557 children (762 girls) were included in the study. The mean age of the subjects was 21 mo. The Z-scores for height, weight, body mass index (BMI) for age and weight for height in children were lower on WHO vs. synthetic charts (p = 0.0001). Significantly higher proportion of children were moderately and severely underweight, stunted and wasted on WHO charts. Synthetic charts identified significantly higher proportion as normal for weight, height, BMI for age, weight for height, overweight (overall), and a higher prevalence of severe stunting, and severe acute malnutrition (SAM) was noted among girls compared to boys. Using CIAF, 54.1% children were normal on WHO charts vs. 78.0% on synthetic (p = 0.0001). Larger proportion of girls (8.8%) were stunted+underweight (category-E) vs. boys (4.3%) on synthetic charts (p = 0.0003). Significantly higher proportion of children demonstrated failure (single/dual/multiple) on WHO charts except category-Y (higher proportion of underweight on synthetic charts). Maximum difference in CIAF (WHO vs. synthetic) was observed between 0-24 mo age. Of 1215 children normal on synthetic charts, 837 (68.9%) were normal on WHO charts. Of 116 underweight children (category-Y) on synthetic charts, 20 (17.2%) were underweight on WHO charts; remaining had compound failure (wasting+underweight = 49.1%, wasting+stunting+underweight = 14.7%, stunting+underweight = 12.1%) on WHO charts. Among those stunted+underweight (category-E) on synthetic charts, WHO charts classified 1/4th as wasted+stunted+underweight (category-D). CONCLUSIONS: Synthetic references are more representative of Indian growth patterns, and seem more appropriate for monitoring growth of Indian children to avoid mislabelling as malnourished.

Validation of growth standards and growth references: A review of literature.

The World Health Organization (WHO) growth standards provide the most recognized and widely accepted way of assessing child growth. To ensure its applicability, accuracy, and reliability, studies have validated WHO growth standards against local populations and other internationally recognized growth references. We reviewed outcomes of evaluations done on WHO growth standards and assess the appropriateness of using these growth standards on a global level. We undertook a systematic quantitative review of studies published from 2011 to 2020 from multiple databases. Studies were included if they considered children aged 59 months and below and reported on validation of growth standards. There was an agreement in studies that validated WHO growth standards against international growth references of its superiority in identifying stunted, overweight, and obese children. However, they were less likely to identify underweight children. None of the studies reviewed reported similar growth trajectories to WHO standards in all indicators considered. Regional differences in child growth were observed in comparison to WHO growth standards. Adoption of regional-specific standards increases the sensitivity of identifying children with adverse nutrition outcomes.

Socioeconomic impacts on Andean adolescents' growth: Variation between households, between communities and over time.

Background/Objectives: We evaluated potential socioeconomic contributors to variation in Andean adolescents' growth between households within a peri-urban community undergoing rapid demographic and economic change, between different community types (rural, peri-urban, urban) and over time. Because growth monitoring is widely used for assessing community needs and progress, we compared the prevalences of stunting, underweight, and overweight estimated by three different growth references. Methods: Anthropometrics of 101 El Alto, Bolivia, adolescents (Alteños), 11.0-14.9 years old in 2003, were compared between households (economic status assessed by parental occupations); to one urban and two rural samples collected in 1983/1998/1977, respectively; and to the WHO growth reference, a representative sample of Bolivian children (MESA), and a region-wide sample of high-altitude Peruvian children (Puno). Results: Female Alteños' growth was positively associated with household and maternal income indices. Alteños' height averaged ∼0.8SD/∼0.6SD/∼2SDs greater than adolescents' height in urban and rural communities measured in 1983/1998/1977, respectively. Overweight prevalence was comparable to the WHO, and lower than MESA and Puno, references. Stunting was 8.5/2.5/0.5 times WHO/MESA/Puno samples, respectively. Conclusions/Implications: Both peri-urban conditions and temporal trends contributed to gains in Alteños' growth. Rural out-migration can alleviate migrants' poverty, partly because of more diverse economic options in urbanized communities, especially for women. Nonetheless, Alteños averaged below WHO and MESA height and weight medians. Evolved biological adaptations to environmental challenges, and the consequent variability in growth trajectories, favor using multiple growth references. Growth monitoring should be informed by community- and household-level studies to detect and understand local factors causing or alleviating health disparities.

Choice of standards for sonographic fetal abdominal circumference percentile.

BACKGROUND: The diagnosis of abnormal fetal abdominal circumference is based on values >90th or <10th percentile. There are dozens of established norms that can be used to determine the percentile of a given abdominal circumference measurement, but there is no established method to determine which norms should be used. OBJECTIVE: This study aimed to evaluate the applicability of 5 established abdominal circumference norms to our measurements and to determine which, if any, should be used for the diagnosis of abnormal fetal abdominal circumference. STUDY DESIGN: Data were pooled from 6 maternal-fetal medicine practices to conduct a cross-sectional study. The inclusion criteria were a singleton fetus at 22.0 to 39.9 weeks of gestation with cardiac activity present, complete fetal biometry measured, and examination from 2019 or 2020. For patients with >1 eligible examination during the study period, a single examination was chosen at random for inclusion. Five norms of abdominal circumference were studied: the Hadlock formula, the World Health Organization Fetal Growth Curves, the International Fetal and Newborn Growth Consortium for the 21st-Century Project; and the National Institutes of Child Health and Human Development Fetal Growth Studies (fetuses of White patients and unified standard). Using formulas relating abdominal circumference to gestational age, we calculated the z scores of abdominal circumference (standard deviations from the mean), standard deviation of the z score, Kolmogorov-Smirnov D statistic, and relative mean squared error. The 5 norms were assessed for fit to our data based on 6 criteria: mean z score close to 0, standard deviation of the z score close to 1, low D statistic, low mean squared error, fraction of values >90th percentile close to 10%, and fraction of values <10th percentile close to 10%. RESULTS: The inclusion criteria were met in 40,684 ultrasound examinations in 15,042 patients. Considering the 6 evaluation criteria, observed abdominal circumferences had the best fit to the World Health Organization standard (mean z score of 0.11±1.05, D statistic of 0.041, mean squared error of 0.84±1.46, 13% of examinations >90th percentile, and 7% of examinations <10th percentile). The Hadlock reference had an anomaly in its assumption of a constant standard deviation, resulting in the underdiagnosis of abnormal values at early gestational ages and overdiagnosis at late gestational ages. The International Fetal and Newborn Growth Consortium for the 21st-Century Project standard had a mean circumference smaller than all the other norms, resulting in the underdiagnosis of small circumferences and the overdiagnosis of large circumferences. Similar results were observed when restricting the analyses to a low-risk subgroup of 5487 examinations without identified risk factors for large for gestational age or small for gestational age. CONCLUSION: The diagnosis of abnormal abdominal circumference depends on the norms used to define abdominal circumference percentiles. The World Health Organization standard had the best fit for our data.

World Health Organization's Growth Reference Overestimates the Prevalence of Severe Malnutrition in Children with Sickle Cell Anemia in Africa.

Anthropometric indices are widely used to assess the health and nutritional status of children. We tested the hypothesis that the 2007 World Health Organization (WHO) reference for assessment of malnutrition in children with sickle cell anemia (SCA) overestimates the prevalence of severe malnutrition when compared to a previously constructed SCA-specific reference. We applied the WHO and SCA-specific references to children with SCA aged 5-12 years living in northern Nigeria (Primary Prevention of Stroke in Children with SCA in sub-Saharan Africa (SPRING) trial) to determine the difference in prevalence of severe malnutrition defined as body mass index (BMI) Z-score <-3 and whether severe malnutrition was associated with lower mean hemoglobin levels or abnormal transcranial Doppler measurements (>200 cm/s). A total of 799 children were included in the final analysis (median age 8.2 years (interquartile range (IQR) 6.4-10.4)). The application of the WHO reference resulted in lower mean BMI than the SCA-specific reference (-2.3 versus -1.2; p < 0.001, respectively). The use of the WHO reference when compared to the SCA-specific reference population also resulted in a higher prevalence of severe malnutrition (28.6% vs. 6.4%; p < 0.001). The WHO reference significantly overestimates the prevalence of severe malnutrition in children with SCA when compared to an SCA-specific reference. Regardless of the reference population, severe malnutrition was not associated with lower mean hemoglobin levels or abnormal transcranial Doppler (TCD) measurements.

Indian Growth References from 0-18-Year-Old children and Adolescents - A Comparison of Two Methods.

BACKGROUND AND AIMS: For updating growth references, large datasets are usually required; collection of these data are expensive and cumbersome. Using a combination of regression equations, Preece Baines model and global LMS values, synthetic growth references for the target population can be generated. The objective of this study is to compare growth references created from continuous anthropometric data using LMS method versus those created synthetically from anthropometric means at key ages. METHODS: De-identified data on 46421 children (26037 boys) from 0-18 years of age from several multicentric studies conducted by the authors' group (2007 to 2017) were included in this study; growth references were constructed using the LMS method. For the production of synthetic references, arithmetic means of heights and weights at key ages were used and global LMS values were used from literature. RESULTS: There was no difference in the medians for height, weight and BMI between the references created by the two methods. The extreme percentile values for height were similar (P < 0.05). However, the spread of values for weight and BMI was narrower in the synthetic references. CONCLUSION: Growth references produced from continuous data differ from those produced synthetically using anthropometric means mainly at the extreme centiles for weight and body mass index; synthetic references take into consideration global trends over several decades.

Perspective: Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition.

Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food Security and Nutrition in Bangladesh report as an example to demonstrate that determining the true prevalence of undernutrition, overweight, and obesity is complicated by racial/ethnic variation across populations in timing of the adolescent growth spurt, growth potential, and body build. Further challenging the task are inherent limitations of the body mass index as an indicator of thinness and adiposity, and cutoffs that poorly distinguish a well-nourished population from a malnourished one. We provide recommendations for adolescent nutrition policy and program decision-making, emphasizing the importance of 1) critically interpreting indicators and distributions by age when using the 2007 WHO Growth Reference; 2) examining what is happening before and after adolescence, when interpretation of anthropometry is more straightforward, as well as trends over time; and 3) complementing anthropometry with other information, particularly dietary intake. Finally, we advocate that nutrition researchers prioritize exploration of better methods to predict peak height velocity, for development of standardized indicators to measure dietary quality among adolescents, and for studies that will illuminate causal paths so that we can effectively improve adolescent dietary intake and nutritional status.

Growth References of Preschool Children Based on the Taiwan Birth Cohort Study and Compared to World Health Organization Growth Standards.

BACKGROUND: To develop new growth references for height, weight, and body mass index (BMI) for children aged 0-5 years in the Taiwan Birth Cohort Study (TBCS) and to compare these references with both 1997 Taiwan references and World Health Organization (WHO) standards. METHODS: Data were obtained from the TBCS of a nationally representative sample of 24,200 children. A total of 18,466 children completed the baseline survey at 6 months of age and three follow-up surveys at 18 months, 3 years, and 5.5 years of age. The modified LMS method was used to construct percentile curves by sex, including length/height for age, weight for age, and BMI for age. RESULTS: TBCS children of both sexes were shorter and lighter at birth compared with 1997 Taiwan references and WHO standards. The growth patterns of TBCS children were close to those of the 1997 Taiwan references after 6 months of age. Compared with WHO standards, however, TBCS children were heavier after 6 months of age. CONCLUSION: This study has developed TBCS references to monitor the growth of children in Taiwan, whose weight growth patterns differed from those "prescribed" by WHO standards.