Prevalence of overweight and obesity among children six to ten years of age in the North-East Health region of Jamaica / Prevalencia del sobrepeso y la obesidad entre niños de seis a diez años de edad en la región Noreste de atención a la salud en Jamaica

OBJECTIVE: To estimate the prevalence and correlates of overweight and obesity among children six to ten years old in the NorthEast Health Region (NEHR) of Jamaica. METHODS: Weights and heights were measured in a representative sample of 5710 children between the ages of six and ten years in 34 schools between October 2008 and March 2009. Overweight and obesity were defined as body mass index (BMI) Zscore >1SD and >2SD, respectively based on the World Health Organization (WHO)endorsed age and genderspecific growth standards for children. Point prevalence estimates of overweight and obesity were calculated. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate associations between overweight and obesity and age, gender and school location. RESULTS: Overweight and obesity prevalence among children six to ten years old in NEHR, Jamaica, was 10.6% and 7.1%, respectively. Overweight (OR = 1.11, 95% CI: 1.04, 1.18) and obesity (OR = 1.17, 95% CI: 1.08, 1.26) prevalence increased significantly with age. Overweight (OR = 1.51, 95% CI: 1.27, 1.80) and obesity (OR = 1.36, 95% CI: 1.11, 1.67) prevalence was significantly higher among girls than boys. Children attending ruralpublic schools had less risk of being overweight (OR = 0.57, 95% CI: 0.46, 0.70) and obese (OR = 0.35, 95% CI: 0.28, 0.44) when compared with urbanpublic schools and private schools. Both overweight (OR = 2.11, 95% CI: 1.60, 2.78) and obesity (OR = 1.68, 95% CI: 1.24, 2.28) were significantly more common among children attending private schools. After adjusting for age and gender, the results still remained statistically significant. CONCLUSIONS: Overweight/obesity prevalence among children six to ten years old in NEHR of Jamaica is 17.7% with older children and girls having higher rates. Children attending urbanpublic and private schools have higher prevalence than those attending rural schools. Appropriately targeted interventions are needed to combat this problem.

OBJETIVO: Estimar la prevalencia y los correlatos de sobrepeso y obesidad entre niños de seis a diez años en la región noreste de atención a la salud (RNAS) de Jamaica. SUJETOS Y MÉTODOS: Se midió el peso y la altura en una muestra representativa de 5710 niños en edades entre seis y diez años, en 34 escuelas, entre octubre de 2008 y marzo de 2009. El sobrepeso y la obesidad se definieron como el índice de masa corporal (IMC) de puntuación Z > 1SD y > 2SD, respectivamente, tomando como base las normas específicas de crecimiento por género y edad para los niños, aprobadas por la Organización Mundial de la Salud (OMS). Se calcularon los estimados de prevalencia puntual del sobrepeso y la obesidad. Se utilizaron los cocientes de probabilidades relativas (OR) e intervalos de confianza (IC) del 95%, a fin de determinar las asociaciones entre el sobrepeso y la obesidad por un lado, y la edad, el género y lugar de la escuela, por otro lado. RESULTADOS: La prevalencia del sobrepeso y la obesidad entre los niños de seis a diez años en la RNAS, Jamaica, fue de 10.6% y 7.1%, respectivamente. La prevalencia del sobrepeso (OR = 1.11, IC de 95%: 1.04, 1.18) y de la obesidad (OR = 1.17, IC del 95%: 1.08, 1.26) aumentó significativamente con la edad. La prevalencia del sobrepeso (OR = 1.51, IC del 95%: 1.27, 1.80) y la obesidad (OR = 1,36, IC de 95%: 1.11, 1.67) fue significativamente mayor entre las hembras que entre los varones. Los niños que asistían a las escuelas públicas rurales tuvieron menos riesgo de tener sobrepeso (OR = 0.57, IC del 95%: 0.46, 0.70) y ser obesos (OR = 0.35, IC del 95%: 0.28, 0.44) en comparación con los de las escuelas urbanas públicas o privadas. Tanto el sobrepeso (OR = 2.11, IC del 95%: 1.60, 2.78) como la obesidad (OR = 1.68, IC del 95%: 1.24, 2.28) fueron significativamente más frecuentes entre los niños que asisten a escuelas privadas. Después de ajustar por edad y género, los resultados continuaban siendo todavía estadísticamente significativos. CONCLUSIONES: La prevalencia del sobrepeso/obesidad entre niños de seis a diez años en la RNAS en Jamaica es de 17.7%, correspondiendo las tasas más altas a las hembras, y a los niños o niñas de mayor edad. Los niños y niñas que asisten a escuelas urbanas públicas y privadas presentan una mayor prevalencia que los que asisten a escuelas rurales. Se necesitan intervenciones dirigidas adecuadamente a combatir este problema.

Prevalence of overweight and obesity among children six to ten years of age in the north-east health region of Jamaica.

OBJECTIVE: To estimate the prevalence and correlates of overweight and obesity among children six to ten years old in the North-East Health Region (NEHR) ofJamaica. METHODS: Weights and heights were measured in a representative sample of 5710 children between the ages of six and ten years in 34 schools between October 2008 and March 2009. Overweight and obesity were defined as body mass index (BMI) Z-score > 1SD and >2SD, respectively based on the World Health Organization (WHO)-endorsed age and gender-specific growth standards for children. Point prevalence estimates of overweight and obesity were calculated. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate associations between overweight and obesity and age, gender and school location. RESULTS: Overweight and obesity prevalence among children six to ten years old in NEHR, Jamaica, was 10.6% and 7.1%, respectively. Overweight (OR = 1.11, 95% CI: 1.04, 1.18) and obesity (OR = 1.17, 95% CI: 1.08, 1.26) prevalence increased significantly with age. Overweight (OR = 1.51, 95% CI: 1.27, 1.80) and obesity (OR = 1.36, 95% CI: 1.11, 1.67) prevalence was significantly higher among girls than boys. Children attending rural-public schools had less risk of being overweight (OR = 0.57, 95% CI: 0.46, 0.70) and obese (OR = 0.35, 95% CI: 0.28, 0.44) when compared with urban-public schools and private schools. Both overweight (OR = 2.11, 95% CI: 1.60, 2.78) and obesity (OR = 1.68, 95% CI: 1.24, 2.28) were significantly more common among children attending private schools. After adjusting for age and gender the results still remained statistically significant. CONCLUSIONS: Overweight/obesity prevalence among children six to ten years old in NEHR of Jamaica is 17.7% with older children and girls having higher rates. Children attending urban-public and private schools have higher prevalence than those attending rural schools. Appropriately targeted interventions are needed to combat this problem.

Progression from prehypertension to hypertension in a jamaican cohort: incident hypertension and its predictors / Progresión de la prehipertensión a la hipertensión en una cohorte jamaicana: la hipertensión incidente y sus predictores

OBJECTIVES: To estimate the incidence of hypertension in people with and without prehypertension and determine the factors that predict progression to hypertension. METHODS: Data from a cohort of 25-74-year old residents of Spanish Town , Jamaica, were analysed. All participants completed a structured questionnaire and had blood pressure (BP), anthropometric measurements and venous blood sampling performed by trained personnel. Blood Pressure was classified using the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) criteria. RESULTS: 708 persons who had the required data and were not hypertensive at baseline were included in this analysis. Mean follow-up time was 4.1 years; 28.7% of prehypertensive participants developed hypertension compared to 6.2% of normotensiveparticipants. The unadjusted incidence rate ratio (IRR [95% CI]) for progression among prehypertensive compared to normotensive participants was 4.62[2.96, 7.43]. Among males, the rate of progression to hypertension was significantly higher for those 45-64 years old and those who were current smokers. Among females, progression was higher for age groups 25-44 years, 45-64 years, those who were overweight (BMI > 25), obese (BMI > 30) and current smokers. In multivariate models, prehypertension, female gender, overweight status and older age remained significantly associated with progression to hypertension among the combined prehypertensive and normotensive groups. IRR [95% CI] were: prehypertension, 3.45 [2.18-5.45]; female gender, 1.81 [1.12, 2.94]; overweight, 1.87 [1.15, 2.94]; age 45-64 years, 1.73 [1.08, 2.76]; age > 65 years 2.39 #91;1.31, 4.34]. CONCLUSIONS: Prehypertension is associated with a three-fold increase in the incidence of hypertension. Higher BMI, age and female gender also independently predict the development of hypertension.

OBJETIVOS: Calcular la tasa de incidencia de hipertensión en las personas con y sin prehipertensión y determinar los factores que predicen la progresión a la hipertensión. MÉTODOS: Se analizaron los datos de una cohorte de residentes de 25-74 años de edad, de Spanish Town, Jamaica. Todos los participantes llenaron una encuesta estructurada. Asimismo se les midió la presión arterial (PA), se les realizó mediciones antropométricas, y se les recogió muestras de sangre por parte de un personal técnico calificado. La presión arterial fue clasificada usando criterios del Séptimo Informe del Comité Conjunto Nacional para la Prevención, Detección, Evaluación y Tratamiento de la Presión Arterial Alta (JNC-7). RESULTADOS: 708 personas que tenían los datos requeridos y no eran hipertensas según los datos de base, fueron incluidas en este análisis. El tiempo promedio de seguimiento fue de 4.1 años; 28.7% de los participantes prehipertensos desarrollaron hipertensión en comparación con 6.2% de participantes normotensos. La razón de tasas de incidencia sin ajustar (RTI [95% CI]) para la progresión entre prehipertensos en comparación con los participantes normotensos fue 4.62 [2.96, 7.43]. Entre los varones, la tasa de progresión a la hipertensión fue significativamente más alta para los de 45-64 años y los fumadores. Entre las hembras, la progresión fue más alta para los grupos etarios de 25-44 años, y 45-64 años, los que tenían sobrepeso (IMC = 25), los obesos (IMC = 30) y los fumadores. En los modelos multivariantes, la prehipertensión, el género femenino, la condición de sobrepeso, y un mayor número de años de edad, permanecieron significativamente asociados con la progresión a la hipertensión entre los grupos combinados de prehipertensos y normotensos. Las RTI [95% CI] fueron: la prehipertensión, 3.45 [2.18-5.45]; el género femenino, 1.81 [1.12,2.94]; el sobrepeso, 1.87 [1.15,2.94]; la edad 45-64 años, 1.73[1.08,2.76]; la edad > 65 años 2.39 [1.31,4.34]. CONCLUSIONES: La prehipertensión se halla asociada con un triple aumento de la incidencia de la hipertensión. El IMC más alto, la edad, y el género femenino predicen también independientemente el desarrollo de la hipertensión.

Prevalence of the metabolic syndrome in jamaican adults and its relationship to income and education levels / Prevalencia del síndrome metabólico en los adultos jamaicanos y relación del síndrome con los ingresos y el nivel de educación

OBJECTIVE: To estimate the prevalence of the metabolic syndrome in Jamaican adults and to evaluate its association with socio-economic status (SES). METHODS: A cross-sectional analysis was performed using data from a cohort study of persons, 25-74 years old, living in St Catherine, Jamaica, and who were evaluated between 1993 and 2001. Participants completed an interviewer administered questionnaire and had blood pressure and anthropometric measurements performed by trained observers. Venous blood was collected for measurement of fasting glucose and lipids. The metabolic syndrome was defined using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) criteria. Income and education were used as markers of SES. RESULTS: Data from 1870 participants (717 males 1153 females) were analysed. Prevalence of the metabolic syndrome was 21.1% (95% CI 19.2, 22.9%) using IDF criteria and 18.4% (95% CI 16.6, 20.2%) using the AHA/NHLBI criteria. Prevalence was higher among females (27.6% [IDF], 23.0% [AHA]) compared to males (10.6% [IDF], 11.0% [AHA]). The prevalence of the metabolic syndrome increased with age. Compared to males with primary/lower education, those with secondary and tertiary education had higher odds of having the metabolic syndrome after adjusting for age; odds ratio 3.12 (1.54, 6.34) and 2.61 (1.33, 5.11) respectively. High income was also associated with increased odds of having the metabolic syndrome among males, OR = 6.0 (2.22, 16.19) adjusting for age-group. There were no significant associations among women. CONCLUSION: The metabolic syndrome is common in Jamaica. Clinicians should look for this syndrome in their patients and take steps to treat the abnormalities identified.

OBJETIVO: Estimar la prevalencia del síndrome metabólico en los adultos jamaicanos, y evaluar su asociación con el nivel socioeconómico (NSE). MÉTODOS: Se realizó un análisis transversal usando datos de un estudio de cohorte de personas de 25-74 años de edad en Saint Catherine, Jamaica, evaluadas entre 1993 y 2001. Los participantes respondieron una encuesta administrada por el entrevistador. Asimismo, les fueron hechas mediciones antropométricas y mediciones de la presión arteria, por observadores entrenados. Se tomaron muestras de sangre venosa para medir la glucosa en ayunas y los lípidos. El síndrome metabólico fue definido usando criterios de la Federación Internacional de Diabetes (FID) y la Asociación Americana del Corazón y el Instituto Nacional del Corazón, los Pulmones y la Sangre (AHA/NHLBI, en inglés). Los ingresos y la educación se usaron como marcadores del NSE. RESULTADOS: Se analizaron los datos de 1870 participantes (717 varones y 1153 hembras). La prevalencia del síndrome metabólico fue 21.1% (95% CI 19.2, 22.9%) usando criterios de la FID y 18.4% (95% CI 16.6, 20.2%) usando los criterios de AHA/NHLBI. La prevalencia fue mayor entre las hembras (27.6% [FID], 23.0% [AHA]) en comparación con los varones (10.6% [FID], 11.0% [AHA]). La prevalencia del síndrome metabólico aumentó con la edad. En comparación con los varones con educación primaria/inferior, aquéllos con educación secundaria y terciaria tenían mayor probabilidad de presentar el síndrome metabólico después del ajuste por edad; el cociente de probabilidades (odds ratio) fue 3.12 (1.54, 6.34) y 2.61 (1.33, 5.11) respectivamente. El ingreso alto estuvo también asociado con mayores probabilidades de síndrome metabólico entre los varones, OR = 6.0 (2.22, 16.19) con ajuste por grupo etario. No hubo asociaciones significativas entre las mujeres. CONCLUSIÓN: El síndrome metabólico es común en Jamaica. Los clínicos deben buscar este síndrome en sus pacientes y dar pasos a fin de tratar las anormalidades identificadas.

[Assessment of personality and personality pathology in older persons]. / Diagnostiek van persoonlijkheid en persoonlijkheidspathologie bij ouderen.

Compared to other domains in personality research, research on personality and personality pathology in the elderly is still in its infancy. However, with the growing proportion of older people in the population, the interest in this topic has increased sharply in the past years. Nevertheless, our knowledge about this domain remains relatively limited. Researchers in this domain are facing several challenges. On the one hand, little is known about the course of personality and psychopathology in later life, because longitudinal studies are scarce or non-existent. On the other hand, both clinical practice and the research literature indicate a growing demand for reliable and valid instruments for the assessment of personality in the elderly. In this article we discuss the main conceptual and methodological issues, as well as recent evolutions concerning this research domain in the Netherlands and Flanders.

Progression from prehypertension to hypertension in a Jamaican cohort: incident hypertension and its predictors.

OBJECTIVES: To estimate the incidence of hypertension in people with and without prehypertension and determine the factors that predict progression to hypertension. METHODS: Data from a cohort of 25-74-year-old residents of Spanish Town, Jamaica, were analysed. All participants completed a structured questionnaire and had blood pressure (BP), anthropometric measurements and venous blood sampling performed by trained personnel. Blood Pressure was classified using the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) criteria. RESULTS: 708 persons who had the required data and were not hypertensive at baseline were included in this analysis. Mean follow-up time was 4.1 years; 28.7% of prehypertensive participants developed hypertension compared to 6.2% of normotensive participants. The unadjusted incidence rate ratio (IRR [95% CI]) for progression among prehypertensive compared to normotensive participants was 4.62 [2.96, 7.43]. Among males, the rate of progression to hypertension was significantly higher for those 45-64 years old and those who were current smokers. Among females, progression was higher for age groups 25-44 years, 45-64 years, those who were overweight (BMI > or =25), obese (BMI > or =30) and current smokers. In multivariate models, prehypertension, female gender overweight status and older age remained significantly associated with progression to hypertension among the combined prehypertensive and normotensive groups. IRR [95% CI] were: prehypertension, 3.45 [2.18-5.45]; female gender 1.81 [1.12, 2.94]; overweight, 1.87 [1.15, 2.94]; age 45-64 years, 1.73 [1.08, 2.76]; age > 65 years 2.39 [1.31, 4.34]. CONCLUSIONS: Prehypertension is associated with a three-fold increase in the incidence of hypertension. Higher BMI, age and female gender also independently predict the development of hypertension.

Prevalence of the metabolic syndrome in Jamaican adults and its relationship to income and education levels.

OBJECTIVE: To estimate the prevalence of the metabolic syndrome in Jamaican adults and to evaluate its association with socio-economic status (SES). METHODS: A cross-sectional analysis was performed using data from a cohort study of persons, 25-74 years old, living in St Catherine, Jamaica, and who were evaluated between 1993 and 2001. Participants completed an interviewer administered questionnaire and had blood pressure and anthropometric measurements performed by trained observers. Venous blood was collected for measurement of fasting glucose and lipids. The metabolic syndrome was defined using the International Diabetes Federation (IDF) and American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) criteria. Income and education were used as markers of SES. RESULTS: Data from 1870 participants (717 males 1153 females) were analysed. Prevalence of the metabolic syndrome was 21.1% (95% CI 19.2, 22.9%) using IDF criteria and 18.4% (95% CI 16.6, 20.2%) using the AHA/NHLBI criteria. Prevalence was higher among females (27.6% [IDF], 23.0% [AHA]) compared to males (10.6% [IDF], 11.0% [AHA]). The prevalence of the metabolic syndrome increased with age. Compared to males with primary/lower education, those with secondary and tertiary education had higher odds of having the metabolic syndrome after adjusting for age; odds ratio 3.12 (1.54, 6.34) and 2.61 (1.33, 5.11) respectively. High income was also associated with increased odds of having the metabolic syndrome among males, OR = 6.0 (2.22, 16.19) adjusting for age-group. There were no significant associations among women. CONCLUSION: The metabolic syndrome is common in Jamaica. Clinicians should look for this syndrome in their patients and take steps to treat the abnormalities identified.

Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa.

BACKGROUND/OBJECTIVE: The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children. METHODS: We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6-24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting. RESULTS: We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children. CONCLUSIONS: Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups.

The World Health Organization child growth standards: expected implications for clinical and epidemiological research.

In 2006 and 2007, the World Health Organization (WHO) released two sets of child growth standards (World Health Organization, WHO Child Growth Standards. Methods and development. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. WHO, Geneva, 2006; World Health Organization, WHO Child Growth Standards: Methods and Development. Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age. WHO, Geneva, 2007) to replace the National Center for Health Statistics references (Hamill et al., National Center for Health Statistics, Vital and Health Statistics Series 11, No 165, 1977) as an international tool for growth and nutritional assessment. This paper explores the scope of implications for future anthropometric research, highlighting foreseeable effects on the choice of research questions, choice of nutritional indices, training of measurers, and issues of internal and external validity of research results. The conclusion drawn is that the introduction of the WHO child growth standards is expected to have wide implications for growth and nutrition research. The full scope of this effect will gradually become clear while researchers, similar to health care workers, make the transition to using the new standards, re-evaluate results of past approaches, and explore the uses and functional validity of the standards, including those for indices that were not previously available.

The effect of nutritional support on weight gain of HIV-infected children with prolonged diarrhoea.

AIM: To examine the effect on growth and immunity of enhanced calorie and protein provision to HIV-infected children presenting with prolonged diarrhoea. METHODS: A total of 169 HIV-infected children aged 6-36 months with diarrhoea for 7 days or more were randomly assigned to either standard nutrition support for children with prolonged diarrhoea or an enhanced diet started during hospitalisation and continued after discharge. The change in weight between enrolment and 8, 14 and 26 weeks and changes in plasma HIV-RNA and CD4 cell count at 8 and 26 weeks were estimated. RESULTS: Children receiving enhanced nutrition achieved significantly more weight gain (p < 0.001) between enrolment and 8 weeks than children on the standard diet (median increase in weight-for-age standard deviation score +1.02 vs. +0.01). After 8 weeks median weight velocity was normal and similar in both groups. The change in median CD4 count was similar in both groups. The 26-week mortality rate was high in both groups (standard support: 22%, enhanced support: 29%). CONCLUSIONS: Nutrition support of children with advanced HIV infection and prolonged diarrhoea resulted in significant and sustained weight gain, but did not improve CD4 counts or survival. These results support integrated nutrition interventions for HIV-infected children.

Construction of the World Health Organization child growth standards: selection of methods for attained growth curves.

The World Health Organization (WHO), in collaboration with a number of research institutions worldwide, is developing new child growth standards. As part of a broad consultative process for selecting the best statistical methods, WHO convened a group of statisticians and child growth experts to review available methods, develop a strategy for assessing their strengths and weaknesses, and discuss methodological issues likely to be faced in the process of constructing the new growth curves. To select the method(s) to be used, the group proposed a two-stage decision-making process. First, to select a few relevant methods based on a list of set criteria and, second, to compare the methods using available tests or other established procedures. The group reviewed 30 methods for attained growth curves. Using the pre-defined criteria, a few were selected combining five distributions and two smoothing techniques. Because the number of selected methods was considered too large to be fully tested, a preliminary study was recommended to evaluate goodness of fit of the five distributions. Methods based on distributions with poor performance will be eliminated and the remaining methods fully tested and compared.

Maternal recall of exclusive breast feeding duration.

BACKGROUND: Both the pattern and duration of breast feeding are important determinants of health outcomes. In vertical HIV transmission research, reliable documentation of early breast feeding practices is important in order to correctly attribute postnatal transmission to feeding pattern. AIMS: To validate methods of collecting data on the duration of exclusive breast feeding (EBF) in an area of South Africa with a high HIV prevalence rate. METHODS: A total of 130 mothers were interviewed weekly, postnatally. At every interview a 48 hour and a seven day recall breast feeding history were taken. A subset of 70 mothers also received two intermediate visits per week during which additional 48 hour, non-overlapping, recall interviews were conducted. Ninety three infants were revisited at 6-9 months of age when mothers' recall of EBF duration from birth was documented. The different methods of recalling EBF status were compared against an a priori "best comparison" in each case. RESULTS: Reported breast feeding practices over the previous 48 hours did not reflect EBF practices since birth (specificity 65-89%; positive predictive value 31-48%). Six month EBF duration recall was equally poor (sensitivity at 2 weeks 79%; specificity 40%). Seven day recall accurately reflected EBF practices compared with thrice weekly recall over the same time period (sensitivity 96%, specificity 94%). CONCLUSIONS: 48 hour EBF status does not accurately reflect feeding practices since birth. Long term recall data on EBF are even more inaccurate. We recommend that data on duration of EBF be collected prospectively at intervals of no longer than one week.

Influence of knowledge, training and experience of observers on the reliability of anthropometric measurements in children.

OBJECTIVE: To elucidate the impact of the observer's level of technical knowledge, training and experience with measuring height and triceps skinfold thickness on the reliability of these measurements in children. Despite of instructions and encouraging careful measurements, these factors may significantly affect measurements and lead to interpretation difficulties, especially of short term growth data. SUBJECTS AND METHODS: A cross-sectional study was designed in which 18 children, aged 2-7 years, were measured in duplo by 12 observers with different backgrounds and levels of experience, protocol knowledge and protocol training. The main outcome measures, precision and accuracy, were expressed as technical error of measurement (TEM) and average bias (AB) in comparison with an expert anthropometrist. RESULTS: As expected, the best educated and most experienced observers scored the best precision and accuracy. By ranking analysis and multiple regressions we learned that precision and accuracy in measuring height and triceps skinfold thickness are mainly predicted by allround knowledge of the measurement protocol (p< 0.05) and the years of experience (p< 0.05). A practical training course of only a few hours does not seem to improve reliability significantly. CONCLUSION: To get a more reliable insight in growth of a child it is important to be aware of the influence on measurement outcome values of protocol knowledge and years of experience. Growth studies should use detailed anthropometric standardization protocols and train people to acquire better insight into these protocols.

Length velocity acceleration at 9 months of age in a representative birth cohort of Dutch infants.

According to the ICP (infancy-childhood-puberty) growth model, statural growth can be divided into three partially superimposed components assumed to represent different physiologic mechanisms. This model predicts a sudden acceleration of length velocity (LV) at the onset of the childhood component around 9 months. The existence of such an infancy-childhood growth spurt has not yet been firmly corroborated by epidemiological studies. In the present study length measurements were made at the target ages of 1, 3, 6, 9, 12, 15, 18 and 24 months in a birth cohort of 2034 infants. In order to check whether length growth showed a continuous smooth pattern, different mathematical models were fitted to the individual growth curves. The models included Count and Guo functions, 5th order polynomial and combinations of 5th order polynomial with the logarithmic term of the Count function and the square root term of the Guo function. We showed that in boys and girls there is a small but systematic lack of fit of the mathematical modeling, due to a sudden acceleration of LV around 9 months. In addition there was an increase in variation of attained length at this age. Comparison of unbalanced ANOVA models with and without addition of dummy variables for the target ages confirmed that there was an acceleration around 9 months that, if corrected for, leads to a significantly improved model fit (likelihood ratio test p < 0.0001). In absolute terms of LV, the misfit at 9 months was not greater than 0.5 cm/year on average. We conclude that the results of this study support the existence of a late infancy growth spurt. In our opinion, however, the magnitude of the phenomenon does not legitimate construction and use of discontinuous growth references such as the ICP reference.

Growth response to recombinant human growth hormone (GH) in children with idiopathic growth retardation by level of maximum GH peak during GH stimulation tests.

Due to their lack of reproducibility, it is unlikely that GH stimulation tests can provide reliable diagnostic information to distinguish partial isolated GH deficiency (GHD) from idiopathic short stature (ISS). We hypothesized that the classical distinction between these groups, essentially based on stimulatory GH peaks, is artificial and that, as a consequence, the average response to GH treatment will not be different between them. The hypothesized lack of prognostic validity of stimulatory GH peaks was studied in 435 prepubertal children with nonorganic growth retardation. Children were categorized as 'severe GHD', 'partial GHD' or 'ISS', if the maximum rise in their serum GH during two GH stimulation tests was 0--10 mU/l, 10--20 mU/l, or >20 mU/l, respectively. Children with 'partial GHD' had short-term (1- and 2-year) and long-term (till final adult height) growth responses similar to those of children with ISS, significantly lower than the response seen in children with 'severe GHD'. In children with stimulatory GH peaks >10 mU/l, including those currently considered partially GH deficient, the maximum GH peak was not a significant determinant of growth response in the short or the long term. In conclusion, 'partial GHD' is ill defined and cannot be distinguished from ISS based on the currently applied auxological or GH stimulation test criteria alone. More research is required for better identification of (all) children who will respond to GH treatment, whether or not GH deficient.

Final height of growth hormone-treated GH-deficient children and girls with Turner's syndrome: the Dutch experience. The Dutch Advisory Group on Growth Hormone.

In the Dutch growth hormone (GH) registration database there are currently 552 GH-deficient children being treated, subcutaneously, with recombinant human GH six to seven times per week. Of those, 112 who have been treated for at least 2 years have reached final height. Mean age at start of therapy was 11.70 years. Mean GH dose was 15.5 IU/m(2) body surface per week. Mean final height was 173.2 cm (boys) and 159.7 cm (girls) and -1.36 SD of the population mean. Of the patients, 73.2% and 63.4%, respectively, reached a final height above -2 SD of the population or within target limits. FH-SDS was higher compared with the results of earlier cohorts with different treatment regimens. Target height, GH peak value at diagnosis, age at start of GH therapy, height SDS (HSDS) at start of puberty, and duration of GH therapy were significantly correlated with final height. These results, combined with those of a prospective GH dose-response study, suggest that better long-term results can be obtained with early and prolonged treatment and if the GH dose is individually adapted to the short-term growth response. In an ongoing dose-response study, 68 girls with Turner's syndrome, aged 2-11 years, were randomized into three dosage groups with a daily GH dose of: (group A) 4 IU/m(2) body surface; (group B) 4 IU/m(2) in the first year of therapy and 6 IU/m(2) thereafter; (group C) 4 IU/m(2) in the first year, 6 IU/m(2) in the second year, and 8 IU/m(2) thereafter. After 4 years of GH therapy, girls aged 12 years or older started low-dose oestrogen therapy. After 7 years of GH therapy, mean HSDS in all three groups had increased to values above the third percentile for healthy girls. Mean final height and final height gain of 25 girls was 159.1 and 12.5 cm, 161.8 and 14.6 cm, and 162.7 and 16.0 cm in groups A, B and C respectively. These long-term and final height results are more favourable than the results of earlier Dutch Turner's syndrome studies. Possible explanations are the higher GH doses and/or the younger age at start of GH therapy.