Long-term health and quality-of-life consequences of mass screening for childhood celiac disease: a 10-year follow-up study.

OBJECTIVE: Mass screening for celiac disease is controversial. The objective of this study was to determine whether detection of childhood celiac disease by mass screening improves long-term health status and health-related quality of life. METHODS: We conducted a prospective 10-year follow-up study of 32 children who were aged 2 to 4 years, had celiac disease identified by mass screening, and had a gluten-free diet (19) or a normal gluten-containing diet (13). The follow-up included assessments of general health status, celiac disease-associated symptoms, celiac disease-associated serum antibodies, and health-related quality of life. RESULTS: Ten years after mass screening, 81% of the children were adhering to a gluten-free diet. The health status improved in 66% of the treated children: in 41% by early treatment and in 25% by prevention of the gluten-dependent symptoms that they developed after diagnosis. For 19% of the children, treatment after screening would not have improved their health status, because they had no symptoms at screening and have remained symptom-free while consuming gluten. The health-related quality of life of the children with symptoms improved significantly after 1 year of gluten-free diet. Ten years after screening, the health-related quality of life of the children with celiac disease was similar to that of the reference population. CONCLUSION: Identification by mass screening led 10 years later to health improvement in 66% of children without deterioration of generic health-related quality of life. There is a good compliance after mass screening. In a research setting, delaying treatment for children without symptoms seems to be an option after a positive screening test. Long-term follow-up studies are needed to assess possible long-term complications in untreated, nonsymptomatic celiac disease.

Health-related quality of life for extremely low birth weight adolescents in Canada, Germany, and the Netherlands.

OBJECTIVE: The goal was to compare health-related quality of life of 12- to 16-year-old adolescents born at an extremely low birth weight in regional cohorts from Ontario (Canada), Bavaria (Germany), and the Netherlands. METHODS: Patients were extremely low birth weight survivors from Canada, Germany, and the Netherlands. Health-related quality of life was assessed with Health Utilities Index 3. Missing data were substituted by proxy reports. Differences in mean Health Utilities Index 3 scores were tested by using analysis of variance. Differences in the numbers of children with affected attributes were tested by using logistic regression analyses. RESULTS: Survival rates were similar; response rates varied between 71% and 90%. Significant differences in health-related quality of life were found between the cohorts, with Dutch children scoring highest on Health Utilities Index 3 and German children scoring lowest, independent of birth weight, gestational age, and cerebral palsy. Differences in mean utility scores were mainly attributable to differences in the cognition health attribute. Most of the results were corroborated by logistic regression analyses. CONCLUSIONS: There were significant differences between the 3 cohorts in health-related quality of life, not related to differences in birth weight, gestational age, or cerebral palsy. Survival and response rates alone cannot explain these differences.

Social lifestyle, risk-taking behavior, and psychopathology in young adults born very preterm or with a very low birthweight.

OBJECTIVE: To assess social lifestyle, risk-taking behavior, and psychopathology in young adults born very preterm or with a very low birthweight. STUDY DESIGN: This study was part of the 19-year follow-up in a large ongoing collaborative study in The Netherlands (the POPS study) on the long-term outcome of prematurity and dysmaturity. 656 adolescents from the POPS study without serious handicap were compared with peers in the general population in lifestyle, risk-taking behavior, psychopathology, and social participation. RESULTS: Adolescents from the POPS study smoked significantly less than their peers. Compared with their peers, boys from the POPS study consumed alcohol less often, and girls from the POPS study consumed alcohol approximately as often. Lifetime drug-use was significantly lower than in the reference group. With the exception of fare-dodging, criminal behavior in POPS adolescents was significantly lower than in control subjects. Boys had more trouble in establishing a relationship. The clinical psychopathology reported by POPS subjects was not significantly higher than in control subjects. CONCLUSION: Adolescents born very preterm or with a very low birthweight without serious disabilities engaged less in risk-taking behavior, did not show more psychopathology, but had more difficulties in establishing social contacts. The latter might be attributable to a more prominent internalizing behavior.

Pre-conception counselling in primary care: prevalence of risk factors among couples contemplating pregnancy.

The outcome of pregnancy can be influenced by several risk factors. Women who are informed about these risks during pre-conception counselling (PCC) have an opportunity to take preventive measures in time. Several studies have shown that high-risk populations have a high prevalence of such risk factors. However, prevalence in the general population, which is assumed to be low risk, is largely unknown. We therefore provided a systematic programme of PCC for the general population and studied the prevalence of risk factors using the risk-assessment questionnaire which was part of the PCC. None of the couples reported no risk factors at all and only 2% of the couples reported risk factors for which written information was considered to be sufficient. Therefore, 98% of all couples reported one or more risk factors for which at least personal counselling by a general practitioner (GP) was indicated. Many of these factors were related to an unhealthy lifestyle. Women with a low level of education reported more risk factors than women with a high level of education. There is a great need for PCC as shown by the fact that almost all couples reported risk factors for which personal counselling was indicated. Pre-conception counselling may reduce the risk of adverse pregnancy outcome by enabling couples to avoid these risks. PCC can be provided by GPs, who have the necessary medical knowledge and background information to counsel couples who wish to have a baby.

Functional outcomes and participation in young adulthood for very preterm and very low birth weight infants: the Dutch Project on Preterm and Small for Gestational Age Infants at 19 years of age.

OBJECTIVE: Young adults who were born very preterm or with a very low birth weight remain at risk for physical and neurodevelopmental problems and lower academic achievement scores. Data, however, are scarce, hospital based, mostly done in small populations, and need additional confirmation. METHODS: Infants who were born at < 32 weeks of gestation and/or with a birth weight of < 1500 g in The Netherlands in 1983 (Project on Preterm and Small for Gestational Age Infants) were reexamined at age 19. Outcomes were adjusted for nonrespondents using multiple imputation and categorized into none, mild, moderate, or severe problems. RESULTS: Of 959 surviving young adults, 74% were assessed and/or completed the questionnaires. Moderate or severe problems were present in 4.3% for cognition, 1.8% for hearing, 1.9% for vision, and 8.1% for neuromotor functioning. Using the Health Utility Index and the London Handicap Scale, we found 2.0% and 4.5%, respectively, of the young adults to have > or = 3 affected areas in activities and participation. Special education or lesser level was completed by 24%, and 7.6% neither had a paid job nor followed any education. Overall, 31.7% had > or = 1 moderate or severe problems in the assessed areas. CONCLUSIONS: A total of 12.6% of young adults who were born very preterm and/or with a very low birth weight had moderate or severe problems in cognitive or neurosensory functioning. Compared with the general Dutch population, twice as many young adults who were born very preterm and/or with a very low birth weight were poorly educated, and 3 times as many were neither employed nor in school at age 19.

Lower mortality but higher neonatal morbidity over a decade in very preterm infants.

Better perinatal care has led to better survival of very preterm children, but may or may not have increased the number of children with cerebral and pulmonary morbidity. We therefore investigated the relationship between changes in perinatal care during one decade, and short-term outcome in very preterm infants. Perinatal risk factors and their effects on 28-day and in-hospital mortality, and on intraventricular haemorrhage and bronchopulmonary dysplasia (BPD) in survivors, were compared in two surveys of very preterm singleton infants in the Netherlands. Between 1983 and 1993, 28-day mortality decreased from 52.1% to 31.8% in infants of 25-27 weeks' gestation and from 15.2% to 11.3% in infants of 28-31 weeks' gestation. The incidence of intraventricular haemorrhage in survivors did not change (44.4% and 43.3% in infants of 25-27 weeks' gestation, and 29.0% and 24.0% in infants of 28-31 weeks' gestation). The incidence of BPD in survivors increased from 40.3% to 60.0% in infants of 25-27 weeks' gestation and remained similar in infants of 28-31 weeks' gestation (8.5% and 9.8% respectively). In multivariable analysis, higher mortality was associated with congenital malformation, low gestational age, low birthweight, no administration of steroids before birth, low Apgar scores and intraventricular haemorrhage, in 1983 as well in 1993, and with male gender in 1993. The effect of maternal age on mortality diminished significantly between 1983 and 1993. Intraventricular haemorrhage in surviving children was associated with low gestational age and artificial ventilation, both in 1983 and in 1993. The effect of artificial ventilation on the incidence of intraventricular haemorrhage diminished significantly between 1983 and 1993. BPD was associated with low gestational age and artificial ventilation, both in 1983 and in 1993, and with low birthweight and caesarean section in 1993. We conclude that the better survival of very preterm infants, especially of those of 25-27 weeks' gestation, has been accompanied by a similar incidence (and thus with an increased absolute number) of children with intraventricular haemorrhage and by an increased incidence of children with BPD.

Outcome of perinatal care for very preterm infants at 5 years of age: a comparison between 1983 and 1993.

Perinatal mortality in very preterm infants has decreased by up to 50% during the last decades. Studies of changes of long-term outcome are inconclusive. We studied the visual, auditory, neuromotor, cognitive and behavioural development of two geographically defined populations of very preterm, singleton infants, born in 1983 and in 1993, and analysed the relationship between perinatal risk factors and outcomes. The incidence of disabling cerebral palsy increased from 6.0% to 11.1% (OR 2.45 [95% CI 1.11, 5.38]). Impaired vision and strabismus decreased significantly, presumably by continuous monitoring of pO(2). Hearing problems, the need for special education and the incidence of behavioural problems did not change over time. The proportion of children who showed optimal performance in every developmental domain increased from 29.5% in 1983 to 43.2% in 1993. Cerebral palsy was associated with male gender in 1983, with low Apgar score and intraventricular haemorrhage in 1993, and with seizures both in 1983 and in 1993. The intensiveness of neonatal treatment has increased, leading to the survival of many more healthy infants, but at the cost of more infants with cerebral damage. Modern perinatal care is no longer limited by the devastating effects of pulmonary problems as it was in the past, but fails to safeguard cerebral integrity in very preterm infants.

Effects of antibullying school program on bullying and health complaints.

OBJECTIVE: To evaluate the effects of an antibullying school intervention in elementary schools. DESIGN: Two-year follow-up randomized intervention group-control group. SETTING: Forty-seven elementary schools in the Netherlands. PARTICIPANTS: Three thousand eight hundred sixteen children aged 9 to 12 years. INTERVENTION: During the first study year, an antibullying school program was implemented in the schools in the intervention group. MAIN OUTCOME MEASURES: A questionnaire measuring bullying behavior, depression, psychosomatic complaints, delinquent behavior, and satisfaction with school life and peer relationships was filled out by the students at 3 times to obtain the following data: a baseline measurement, a first-effect measurement at the end of the first year, and a second-effect measurement at the end of the second year. RESULTS: The number of bullied children decreased by 25% in the intervention group compared with the control group (relative risk, 0.75; 95% confidence interval, 0.57-0.98). The intervention group also showed a decline in the scale scores of victimization (-1.06 vs 0.28; P< .01) and active bullying behaviors (-0.47 vs 0.12, P< .05). Self-reported peer relationships also improved in the intervention schools (0.48 vs 0.11; P< .05), and there was a trend for a decrease in reported depression in the intervention schools (-0.33 vs -0.10; P< .10). At follow-up, there were no differences between the intervention and control groups for the outcome measures. Schools had also lowered their antibullying activities during the second study year. CONCLUSIONS: An antibullying school policy can reduce bullying behavior. To keep bullying at a consistently low level, schools must continue antibullying measures every year. Continued counseling may help schools in their efforts to establish a lasting antibullying policy.

Continuous admission to primary school and mental health problems.

BACKGROUND: Younger children in a school class have higher rates of mental health problems if admission to primary school occurs once a year. This study examines whether this relative age effect also occurs if children are admitted to school continuously throughout the year. METHODS: We assessed mental health problems based on parent-reports (using the Child Behavior Checklist, CBCL) and on professional assessments, among two Dutch national samples of in total 12,221 children aged 5-15 years (response rate: 86.9%). RESULTS: At ages 5-6, we found a higher occurrence of mental health problems in relatively young children, both for mean CBCL scores (p = 0.017) and for problems assessed by child health professionals (p < 0.0001). At ages 7-15, differences by relative age did not reach statistical significance. CONCLUSION: Continuous admission to primary school does not prevent mental health problems among young children, but may do so at older ages. Its potential for the prevention of mental problems deserves further study.

Do bullied children get ill, or do ill children get bullied? A prospective cohort study on the relationship between bullying and health-related symptoms.

OBJECTIVES: A number of studies have shown that victimization from bullying behavior is associated with substantial adverse effects on physical and psychological health, but it is unclear which comes first, the victimization or the health-related symptoms. In our present study, we investigated whether victimization precedes psychosomatic and psychosocial symptoms or whether these symptoms precede victimization. DESIGN: Six-month cohort study with baseline measurements taken in the fall of 1999 and follow-up measurements in the spring of 2000. SETTING: Eighteen elementary schools in the Netherlands. PARTICIPANTS: The study included 1118 children aged 9 to 11 years, who participated by filling out a questionnaire on both occasions of data collection. OUTCOME MEASURES: A self-administered questionnaire measured victimization from bullying, as well as a wide variety of psychosocial and psychosomatic symptoms, including depression, anxiety, bedwetting, headaches, sleeping problems, abdominal pain, poor appetite, and feelings of tension or tiredness. RESULTS: Victims of bullying had significantly higher chances of developing new psychosomatic and psychosocial problems compared with children who were not bullied. In contrast, some psychosocial, but not physical, health symptoms preceded bullying victimization. Children with depressive symptoms had a significantly higher chance of being newly victimized, as did children with anxiety. CONCLUSIONS: Many psychosomatic and psychosocial health problems follow an episode of bullying victimization. These findings stress the importance for doctors and health practitioners to establish whether bullying plays a contributing role in the etiology of such symptoms. Furthermore, our results indicate that children with depressive symptoms and anxiety are at increased risk of being victimized. Because victimization could have an adverse effect on children's attempts to cope with depression or anxiety, it is important to consider teaching these children skills that could make them less vulnerable to bullying behavior.

Alarming prevalences of overweight and obesity for children of Turkish, Moroccan and Dutch origin in The Netherlands according to international standards.

AIM: Prevalences of overweight in The Netherlands, defined by international cut-off points, are presented in 14 500 children of Dutch origin, 2904 of Turkish and 2855 of Moroccan origin, aged 0-21 y. RESULTS: The mean prevalence for Turkish boys and girls was 23.4% and 30.2%, for Moroccans 15.8% and 24.5%, for Dutch youths in large cities 12.6% and 16.5%, and for other Dutch participants 8.7% and 11.3%, respectively. CONCLUSION: The development of adequate prevention strategies is urgently needed.

Catch-up growth up to ten years of age in children born very preterm or with very low birth weight.

BACKGROUND: Improved survival due to advances in neonatal care has brought issues such as postnatal growth and development more to the focus of our attention. Most studies report stunting in children born very preterm and/or small for gestational age. In this article we study the growth pattern of these children and aim to identify factors associated with postnatal catch-up growth. METHODS: 1338 children born with a gestational age <32 weeks and/or a birth weight of <1500 grams were followed during a Dutch nationwide prospective study (POPS). Subgroups were classified as appropriate for gestational age and <32 weeks (AGA) or small for gestational age (<32 wks SGA and > or =32 wks SGA). Data were collected at different intervals from birth until 10 years for the 962 survivors and compared to reference values. The correlation between several factors and growth was analysed. RESULTS: At 10 years the AGA children had attained normal height, whereas the SGA group demonstrated stunting, even after correction for target height (AGA: 0.0 SDS; SGA <32 wks: -0.29SDS and > or =32 wks: -0.13SDS). Catch-up growth was especially seen in the SGA children with a fast initial weight gain. BMI was approximately 1 SD below the population reference mean. CONCLUSION: At 10 years of age, children born very preterm AGA show no stunting. However, many children born SGA, especially the very preterm, show persistent stunting. Early weight gain seems an important prognostic factor in predicting childhood growth.

The changing impact of a severe disaster on the mental health and substance misuse of adolescents: follow-up of a controlled study.

BACKGROUND: Disasters are believed to have large effects on the mental health of adolescents but the lack of prospective pre- and post-disaster data on affected and control populations have limited our knowledge on the validity of these claims. We examined the medium-term, 12 months' effects of a severe disaster on the mental health of adolescents, and compared them to effects after 5 months. METHOD: A café fire in The Netherlands injured 250 adolescents and killed 14. We obtained data 15 months before and 12 months after the disaster about behavioural and emotional problems (using the Youth Self-Report) and substance misuse, in 124 students of an affected school of whom 31 were present at the fire (response 77.5%) and 830 other students (56.4%); mean age at baseline, 13.8 years. RESULTS: We found differences between students from the affected school and others for excessive use of alcohol (odds ratio 3.42, 95% confidence interval 2.00-5.85, p < 0.0001), but not for behavioural and emotional problems and use of other substances. Effects had decreased compared to those after 5 months. CONCLUSIONS: In the long run, the effects of disaster decrease regarding self-reported behavioural and emotional problems, but they remain regarding alcohol misuse among those present at the disaster, and their peers.

Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice?

UNLABELLED: The aim of this study was to present age references for waist circumference (WC), hip circumference (HC), and waist/hip ratio (WHR) in Dutch children. Cross-sectional data were obtained from 14,500 children of Dutch origin in the age range 0-21 years. National references were constructed with the LMS method. This method summarises the distribution by three smooth curves representing skewness (L curve), the median (M curve), and coefficient of variation (S curve). The correlations between body mass index-standard deviation score (BMI-SDS), the circumferences and their ratio, and demographic variables were assessed by (multiple) regression analysis for three age groups: 0-<5 years (1), 5-<12.5 years (2), and 12.5-<21 years (3). A cut-off for clinical use was suggested based on the International Obesity Task Force criteria for BMI. Mean WC and HC values increased with age. Mean WC was slightly higher in boys than in girls, and this difference was statistically significant from 11 years of age onwards. In contrast, HC was significantly higher in girls than in boys from 9 years onwards. The correlation between WC-SDS and BMI-SDS ( r =0.73, P <0.01) and between HC and BMI-SDS ( r =0.67, P <0.01) increased with age. With regard to WHR-SDS, a low correlation was found for 12.5-20 years of age ( r =0.2, P <0.01). WC-SDS correlated positively with height SDS ( r =0.35, P <0.01). CONCLUSION: Waist circumferences can be used to screen for increased abdominal fat mass in children, whereby a cut-off point of 1.3 standard deviation score seems most suitable.

Area deprivation and child psychosocial problems--a national cross-sectional study among school-aged children.

BACKGROUND: We examined the association of area deprivation with the occurrence of psychosocial problems among children aged 4-16 in a representative national sample of children based on standardised measures of parent-reported problems and diagnoses made by doctors and nurses working in child healthcare (child health professionals, CHPs). METHODS: The study comprised 4480 children aged 4-16 years, eligible for a routine health assessment (response: 90.1 %), in 19 Child Healthcare Services across the Netherlands that routinely provided preventive child healthcare to nearly all school-aged children. Parents completed the Child Behaviour Checklist (CBCL). CHPs examined the child and interviewed parents and child during their routine health assessments. Main outcome measures concerned psychosocial problems as reported by parents (i. e. a clinical score on the CBCL) and as identified by CHPs. RESULTS: Prevalence rates of psychosocial problems were 8.6% for parent-reported problems and 10.1 % for CHP-identified problems. They were much higher in the most deprived third of the areas. Odds ratios (95 % confidence intervals) compared with the least deprived third were 1.93 (1.41-2.64) regarding parent-reported problems and 1.76 (1.30-2.38) regarding CHP-identified problems. Regarding parent reports, associations were slightly stronger for behavioural problems than for emotional problems. Less than a quarter of the area differences could be explained by individual and family characteristics. CONCLUSIONS: Child psychosocial problems occur more frequently in deprived areas. Both preventive and curative health services should be better equipped for this concentration of child and adolescent morbidity in deprived areas.

Infant crying and abuse.

Child abuse and neglect are important causes of child morbidity and death. We assessed potentially detrimental parental actions induced by infant crying in 3259 infants aged 1-6 months, in the Netherlands. In infants aged 6 months, 5.6% (95% CI 4.2-7.0) of parents reported having smothered, slapped, or shaken their baby at least once because of its crying. The risks of detrimental actions were highest for parents from non-industrialised countries, those with either no job or a job with short working hours, and those who judged their infant's crying to be excessive. Clinicians should be aware of the risks of abuse in children known to cry a lot and should target interventions at parents to help them cope with this crying.

Identification and management of psychosocial problems among toddlers in Dutch preventive child health care.

OBJECTIVES: To assess the degree to which preventive child health professionals (CHPs) identify and manage psychosocial problems among preschool children in the general population and to determine the association with parent-reported behavioral and emotional problems, sociodemographic factors, and mental health history of children. DESIGN: The CHPs examined the child and interviewed the parents and child during their routine health assessments. The Child Behavior Checklist (CBCL) was completed by the parents. SETTING: Sixteen child health care services across the Netherlands that routinely provided well-child care to nearly all preschool children. PATIENTS: Of 2354 children aged 21 months to 4 years who were eligible for a routine health assessment, 2229 (94.7%) participated. MAIN OUTCOME MEASURES: Identification and management of psychosocial problems by CHPs. RESULTS: In 9.4% of all children, CHPs identified psychosocial problems. Two in 5 of the CHP-identified children were referred for additional diagnosis and treatment. Identification of psychosocial problems and subsequent referral were much more likely in children with a clinical CBCL total problems score than in others (identification: 29% vs 7%; odds ratio [95% confidence interval], 5.40 [3.45-8.47]; referral: 15% vs 3%; odds ratio [95% confidence interval], 6.50 [3.69-11.46]). CONCLUSIONS: The CHPs frequently identify psychosocial problems in preschool children, although less than among school-aged children, but they miss many cases of parent-reported problems as measured by a clinical CBCL score. This general population study shows substantial room for improvement in the early identification of psychosocial problems.

Bullying behavior and associations with psychosomatic complaints and depression in victims.

OBJECTIVES: To assess the association between bullying behavior and a wide variety of psychosomatic health complaints and depression. Study design In a cross-sectional study, 2766 elementary school children age 9 to 12 years filled out a questionnaire on bullying behavior and health complaints. Three groups-bullied children, active bullies, and children who both bully and are bullied-were compared with the group of children not involved in bullying behavior. Subsequently, risks for psychosomatic symptoms and depression were calculated by means of odds ratios. RESULTS: Bully victims had significantly higher chances for depression and psychosomatic symptoms compared with children not involved in bullying behavior. Odds ratios were as follows: headache, 3.0; sleeping problems, 2.4; abdominal pain, 3.2; bed-wetting, 2.9; feeling tired, 3.4; and depression, 7.7. Children who actively bullied did not have a higher chance for most of the investigated health symptoms. CONCLUSIONS: Being bullied is strongly associated with a wide range of psychosomatic symptoms and depression. These associations are similar to the complaints known to be associated with child abuse. Therefore, when such health complaints are presented, pediatricians and other health care workers should also be aware of the possibility that a child is being bullied to take preventive measures.

The effect of a severe disaster on the mental health of adolescents: a controlled study.

BACKGROUND: Disasters greatly affect the mental health of children and adolescents, but quantification of such effects is difficult. Using prospective predisaster and postdisaster data for affected and control populations, we aimed to assess the effects of a severe disaster on the mental health and substance use of adolescents. METHODS: In January, 2001, a fire in a café in Volendam, Netherlands, wounded 250 adolescents and killed 14. In the 15 months before the disaster, all grade 2 students (aged 12-15 years) from a school in Volendam (of whom 31 were in the café during the fire), and from two other schools, had been selected as controls for a study. 124 Volendam students and 830 from the other two schools had provided data for substance use, and completed the youth self-report (YSR) questionnaire about behavioural and emotional problems. 5 months after the disaster, we obtained follow-up data from 91 (response rate 73.4%) Volendam adolescents and 643 (77.5%) controls from the other two schools. The primary outcome measures were changes in score in YSR categories of total problems, alcohol misuse, smoking, and substance use. We compared changes in scores between groups using logistic regression. FINDINGS: Volendam adolescents had larger increases in clinical scores than controls for total problems (odds ratio 1.82, 95% CI 1.01-3.29, p=0.045) and excessive use of alcohol (4.57, 2.73-7.64, p<0.0001), but not for smoking or use of marijuana, MDMA (ecstasy), and sedatives. Increases in YSR scores were largest for being anxious or depressed (2.85, 1.23-6.61), incoherent thinking (2.16, 1.09-4.30), and aggressive behaviour (3.30, 1.30-8.36). Intention-to-treat analyses showed significantly larger for increases in rates of excessive drinking and YSR symptom subscales in Volendam adolescents than controls. Effects were mostly similar in victims and their classmates. INTERPRETATION: Mental health interventions after disasters should address anxiety, depression, thought problems, aggression, and alcohol abuse of directly affected adolescents and their peer group.

Height, weight, body mass index and pubertal development reference values for children of Turkish origin in the Netherlands.

UNLABELLED: The aim of this study was to provide growth and sexual maturation reference data for Turkish children living in The Netherlands. We also compared these references with the reference data of children of Dutch origin and with Turkish reference data collected in Turkey and elsewhere in Europe. Cross-sectional growth and demographic data were collected from 2,904 children of Turkish origin and 14,500 children of Dutch origin living in the Netherlands in the age range 0-20 years. Growth references for length, height, weight for height, body mass index (BMI) and head circumference were constructed with the LMS method. Reference curves for sexual maturation and menarche were estimated by a generalised additive model. Predictive variables for height and BMI were assessed by univariate and multivariate regression analyses. Young Turkish adults were 10 cm shorter than their Dutch contemporaries. Mean height was 174.0 cm for males and 160.7 cm for females. Height differences in comparison with Dutch children started at 3 years. Height SDS was predominantly associated with target height. The height of Turkish children living in the Netherlands was similar to Turkish children in Germany and to children from high socio-economic classes in Istanbul. Compared to Dutch children, maturation stages started 0.5-0.7 years later for both sexes. In girls, median age at menarche was 12.8 years, 5 months earlier than in Dutch girls. BMI of Turkish children was higher than that of Dutch children at all ages. BMI SDS was associated with birth weight and the duration of stay of the mother in the Netherlands. CONCLUSION: Turkish children are considerably shorter and more overweight than Dutch children. Separate growth charts for Turkish children in The Netherlands are useful for growth monitoring.