The Pediatric Yorkhill Malnutrition Score Is a Reliable Malnutrition Screening Tool.

Children often experience malnutrition while they are hospitalized. Therefore, the prevention of malnutrition and nutritional management need to be done properly using malnutrition screening tools. This study aimed to determine the sensitivity and specificity of the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Risk of Impaired Nutritional Status and Growth (STRONGkids) when compared to the Subjective Global Nutritional Assessment for Children (SGNA). This study involved 81 pediatric patients with ages ranging from 1 to 16 years old. The two screening tools and the SGNA were examined in each subject. The results of this study determined that the sensitivity and specificity of the PYMS were 95.7% and 66.7%, respectively, while in the STRONGkids they were 52.2% and 41.7%, respectively. This indicates that the PYMS is the most appropriate malnutrition screening tool to be used for a malnutrition screening policy.

Forensic aspects of starvation.

Fatal starvation is a rare cause of death in industrialized countries. However, it may have major medicolegal importance if death results from the deliberate withholding of food, especially from infants. In such cases, the task of the forensic pathologist and the medical examiner, respectively, is to clarify the cause of death and give an expert opinion on the degree and duration of starvation. Several classification systems have been developed to estimate protein-energy malnutrition in developing countries. Simpler classifications, such as the Gomez classification, use the weight expected for the respective age group as the standard. However, smaller infants will be lighter, and therefore the classification may not be accurate in this case. Following the Waterlow classification, the extent of stunted growth (referring to growth retardation in cases of chronic malnutrition) is calculated using the ratio of the measured body height to that expected for the age. Using such classification systems, grading of stunting and wasting can be achieved and may greatly help in the assessment of a given child's nutritional status in legal cases. The application of the Waterlow classification to the authors' case material and previously published cases in the literature is herein demonstrated. The Waterlow classification is not only of importance for grading the final stage of fatal starvation, but also for the chronological development of the nutritional status if anthropometrical data have been repeatedly recorded from the affected individual in vivo.

Zinc y desnutrición / Zinc and undernutrition

Son cuatro los nutrientes en que su deficiencia es importante en niños: hierro, yodo, vitamina A y zinc. Más o menos se calcula que hay 2 billones de personas en el mundo con algún grado de déficit de zinc. Los pacientes que están en riesgo de presentar deficiencias de zinc son los recién nacidos con bajo peso al nacimiento, bien sea prematuros, desnutridos in útero o hijos de madres desnutridas, en los cuales sus depósitos están reducidos. A diferencia de otros oligoelementos o micronutrientes, determinar el estado de déficit no es fácil. Los niveles séricos de zinc, están influenciados por factores no dietarios como infección, estrés o actividad física extenuante; al igual que por el ciclo circadiano.

Four nutrient deficiency that is important in children, iron, iodine, vitamin A and zinc. More or less it is estimated that 2 billion people in the world with some degree of zinc deficiency. Patients who are at risk for zinc deficiency are infants with low birth weight, either premature or malnourished in utero, undernourished mothers, in which their deposits are reduced. Unlike other trace elements or micronutrients, determine the deficit is not easy. Serum levels of zinc are not influenced by dietary factors such as infection, stress or strenuous physical activity, as well as by the circadian cycle.

Compra, almacenamiento, preparación y consumo de alimentos en la alimentación del niño con cáncer / Purchase, storage, food preparation and consumption power in children with cancer

Durante el tratamiento del niño con cáncer las dificultades que se presentan en la alimentación son variadas. El cáncer en niños, puede acompañarse de desnutrición que puede ser asociada a la naturaleza de la enfermedad y/o como consecuencia de su tratamiento. Dentro de los objetivos en la manipulación de los alimentos se incluye varios aspectos como son los de evitar la contaminación y el control en el consumo. Se deben hacer algunas recomendaciones en cuanto a la compra, almacenamiento, preparación y consumo de los alimentos.

During the treatment of children with cáncer are varied difficulties that arise in their diet. Cancer in children, is a group of diseases that are different from one another, may be associated with manlnutrition associated with the nature of the disease and/or following treatment. The targets in the food handling of children with cáncer include avoiding food contamination and control its management. It should make recommendations regarding the purchase, storage, preparation and consumption of food.

Exceso de peso y preguntas frecuentes sobre la alimentación del niño con cáncer / Overweight and frequently asked questions about feeding the child with cancer

Durante el tratamiento del niño con cáncer, es posible requerir el uso de corticoides, los cuales como efecto adverso tienen el aumento en el apetito, que unido al sedentarismo de estos niños, incrementan de peso y pueden concurrir en sobrepeso y obesidad, malnutrición que es tan dañina como la desnutrición. Es necesario un control y seguimiento estricto por parte del pediatra y nutricionista infantil en estos niños con malnutrición.

During the treatment of children with cancer, may require the use of corticosteroids, which have the adverse effect of increased appetite, which together with the inactivity of theses children, increased weight and may attend overweight and obesity, malnutrition that is as harmful as malnutrition. It is necessary to control and closely monitored by the pediatrician and infant nutritionist in these children with malnutrition.

Nutrición parenteral intrahemodialítica / Intrahemodialytic parenteral nutrition

Los estudios demuestran grandes ventajas al manejar nutrición parenteral intrahemodialítica (NPID). La ventaja más trascendente es respecto a la condición clínico metabólica del paciente. Las desventajas puedenser metabólicas, mecánicas, y económicas. La valoración del estado nutricional considera aspectos antropométricos y bioquímicos. Los carbohidratos se indican a 5mg/kg/min de dextrosa; los aminoácidosdeben proveer 1.3g de proteínas kg/día; los lípidos se administran a 0.5ml/min al inicio de la infusión; elvolumen se realizará en función a cada uno de los nutrimentos; los oligoelementos y vitaminas no estánindicadas en la NPID.

Studies show great advantages in handling intrahemodialytic parenteral nutrition (NPID). The most significant advantage is to the metabolic clinical condition of the patient. The disadvantages may be metabolic, mechanical, and economic. The assessment of nutritional status must considered anthropometricand biochemical aspects. Carbohydrates are listed 5 mg/kg/min dextrose, amino acids should provideprotein 1.3 g/kg/ day, lipids must be administered 0.5 ml/min at the start of the infusión, the volumen is madeaccording to each nutrients, trace elements and vitamins are not listed in the NPID.

Antropometría en niños de la consulta externa del Hospital Universitario del Valle de Cali, Colombia, según la OMS / Anthropometry in children ambulatory from Hospital Universitario del Valle

Objetivo: Valorar por medio de antropometría, a los niños que asisten a la Consulta Externa del Hospital Universitario del Valle “Evaristo García” (HUV) de Cali, Colombia por medio de los patrones de crecimiento infantil de la OMS entre el 1 de julio y el 31 de diciembre de 2010. Materiales y Métodos: Estudio descriptivo observacional no experimental (N=214 niños), edad (E) entre los 0 meses y 17 años, que asistieron al HUV. Se dividieron en 3 grupos: 0 meses a 2 años; >2 años a 4 años y 11 meses, y 5 a 18 años. Se le realizó una historia clínica completa, peso (P), talla (T) y perímetro cefálico (PC) y diagnóstico de primera vez según sistema comprometido. Se aplicó el software Nutritional Statistical System (NSS)®, el cual utiliza como guía de referencia los patrones de crecimiento infantil de la OMS, teniendo como indicadores antropométricos para cada grupo de edad el P/E, el P/T, la T/E, el Índice de masa corporal (IMC), y el PC/E y PC/T. Se realizó su análisis estadístico como porcentajes, promedios, moda, me d i a , me diana y desviación estándar. Conclusiones: Todos los indicadores antropométricos utilizados estuvieron afectados con algún tipo de déficit nutricional, siendo el IMC el menos afectado con un 24,5% y el más afectado es el P/E con un 58,1%. En cuanto a los excesos nutricionales, se encontró que el sobrepeso y la obesidad presentan porcentajes de 17,3% y 3,1% respectivamente. Según los diagnósticos de primera vez, la anomalía con mayor porcentaje de tipo respiratorio con el 18,2%. El indicador PC se utilizó para correlacionarlo con la E, pero es aconsejable utilizarlo igualmente para la talla, lo que podría dar un mejor criterio de diagnóstico.

Objective: To assess through anthropometry, children attending the outpatient clinic of the Hospital Universitario del Valle "Evaristo Garcia" (HUV) Cali, Colombia through the Child Growth Standards WHO between July 1 and on December 31, 2010. Materials and Methods: Descriptive observational nonexperimental (N = 214 children), aged (A) 0 months to 17 years, who attended the HUV. They were divided into 3 groups: 0 months to 2 years; > 2 years to 4 years and 11 months, and 5 to 18 years. They underwent a complete medical history, weight (W), height (H) and head circumference (HC) and the first time as diagnosis of compromised system. Nutritional software was applied, which uses as a reference guide to childhood growth patterns by WHO, with the anthropometric indicators for each age group the W/A, W/H, H/A, BMI, and HC/A and HC/H. Statistical analysis was performed as percentages, averages, mode, mean, median and standard deviation. Conclusions: All anthropometric indicators used were affected with some type of nutritional deficiency, with a BMI less affected with 24.5% and the most affected is the W/A 58.1%. In terms of nutritional excesses, it was found that overweight and obesity have percentages of 17.3% and 3.1% respectively. According to the first diagnosis of the anomaly with the greatest percentage of respiratory type with 18.2%. The indicator HC was used to correlate with A, but it is advisable to use also for H, which could give a better diagnostic criteria.

Enfermedad inflamatoria intestinal: primera parte / Inflammatory bowel disease: first part

La enfermedad inflamatoria intestinal (EII), se caracteriza por tener un proceso clínico impredecible. Se puede definir como la inflamación de la mucosa gastrointestinal de etiología desconocida. Se ha propuesto que resulta de una respuesta inmunitaria aberrante del huésped a los antígenos normales del tracto gastrointestinal. El diagnóstico se apoya en la evaluación integral de criterios clínicos, radiológicos, endoscópicos e histológicos. Pueden encontrarse síntomas digestivos y manifestaciones extraintestinales. El déficit de vitaminas y oligoelementos, juegan un papel importante en el estado nutricio de los pacientes con EII, afectando más a los pacientes con EC.

Inflammatory bowel disease (IBD) is characterized by an unpredictable clinical process. It can be defined as inflammation of the gastrointestinal mucosa of unknown etiology. It is proposed that results from an aberrant immune response to antigens of the host's normal gastrointestinal tract. The diagnosis is based on the comprehensive assessment of clinical, radiological, endoscopic and histologic findings. You can find digestive symptoms and extraintestinal manifestations. The deficit of vitamins and trace elements play an important role in the nutritional status of patients withIBD, affecting more patients with CD.

Perceptions of childhood obesity on the Texas-Mexico border.

OBJECTIVES: We sought to determine the extent of intracultural consensus in perceptions of childhood obesity among Mexican American mothers living on the Texas-Mexico border. DESIGN AND SAMPLE: A descriptive, cross-sectional study examined women's judgments about the parameters of childhood obesity. The convenience sample consisted of 61 Mexican American women who were mothers of at least 1 child under age 18. MEASURES: Participants underwent an anthropometric assessment and were surveyed regarding self-perceived weight and household food security. They were then shown photographs of 36 Mexican American boys ages 6 and 7 and asked to sort them into categories by weight status; they also selected 3 children they believed represented the healthiest, most appropriate weight for age. Accuracy scores were computed and examined for bivariate relationships with women's own body mass index (BMI) and survey responses. RESULTS: We found considerable intracultural variation in women's judgments, which could not be explained by the anthropometric and survey variables tested. Women selected a wide range of percentiles as representative of a healthy child. On average, about half of the truly overweight children (BMI>or=95th percentile), however, were considered normal or even underweight. CONCLUSIONS: Local perceptions and language may not correspond to CDC/WHO clinical standards. Larger studies are needed to confirm these preliminary findings.

Proposed recommended nutrient densities for moderately malnourished children.

Recommended Nutrient Intakes (RNIs) are set for healthy individuals living in clean environments. There are no generally accepted RNIs for those with moderate malnutrition, wasting, and stunting, who live in poor environments. Two sets of recommendations are made for the dietary intake of 30 essential nutrients in children with moderate malnutrition who require accelerated growth to regain normality: first, for those moderately malnourished children who will receive specially formulated foods and diets; and second, for those who are to take mixtures of locally available foods over a longer-term to treat or prevent moderate stunting and wasting. Because of the change in definition of severe malnutrition, much of the older literature is pertinent to the moderately wasted or stunted child. A factorial approach has been used in deriving the recommendations for both functional, protective nutrients (type I) and growth nutrients (type II).

Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger.

OBJECTIVE: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death. DESIGN: Retrospective data analysis. SETTING: A Médecins Sans Frontières (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children. PARTICIPANTS: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included. INTERVENTIONS: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children. OUTCOME MEASURES: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program. RESULTS: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program. CONCLUSIONS: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs.

Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor.

BACKGROUND: Severe malnutrition contributes up to 50% of childhood mortality in developing countries is frequently characterised by electrolyte depletion, including low total body phosphate. During therapeutic re-feeding, electrolyte shift from extracellular to intra-cellular compartments may induce hypo-phosphataemia (hypo-P) with resultant increased morbidity and mortality. This biochemical imbalance is under-recognised, and the frequency of this problem among African malnourished children is unclear. OBJECTIVES: To determine the magnitude of hypo-phosphataemia in children under five years of age presenting to Kenyatta National Hospital with kwashiorkor and marasmic kwashiorkor and to evaluate the relationship between hypo-phosphataemia and nutritional intervention during the first five days of treatment. DESIGN: Short longitudinal survey. SETTING: The General Paediatric wards of the Kenyatta National Hospital (KNH), Nairobi. SUBJECTS: Children under five years of age presenting with kwashiorkor or marasmic kwashiorkor at KNH were recruited into the study. MAIN OUTCOME MEASURES: Low serum phosphate level (< 1.20 mmol/l) and patient outcome (survival or death) during the first five days of treatment. RESULTS: One hundred and sixty five children were enrolled between June 2005 and February 2006 of which 107 (64%) had kwashiorkor and 58 (36%) had marasmic kwashiorkor. They were of mean age 20 months (range 3-60), and 95 (58%) were male. The prevalence of hypo-phosphataemia was 86% on admission, increased to 90% and 93% on day one and two respectively, and then declined to 90% by the fourth day. At admission 6% were hypo-phosphataemic, increasing to 18% and 22% on day one and two respectively, and declining to 11% by day four. On admission mean serum phosphate was below normal at 0.91 mmol/l, declined significantly to 0.67 mmol/l and to a nadir of 0.63 mmol/l after the first and second day of treatment respectively, then rose slightly to 0.75 mmol/l on the fourth day (p < 0.001 comparing each follow-up mean level with the admission level). There was a positive association between severity of nadir serum phosphate level and mortality (p = 0.028). There were no deaths among children with normal nadir serum phosphate levels. However, among children with mild, moderate and severe nadir hypo-phosphataemia, 8,14 and 21% died respectively. Children with dermatosis and hypomagnesaemia showed a trend for association with mortality (p = 0.082 and 0.099 respectively). CONCLUSION: Hypo-phosphataemia is frequent among children with kwashiorkor and marasmic kwashiorkor presenting at KNH. Serum phosphate levels decline significantly during the first two days of nutritional intervention, and severity of

Prevalence of malnutrition in human immunodeficiency virus/acquired immunodeficiency syndrome orphans in the Nyanza province of Kenya: a comparison of conventional indexes with a composite index of anthropometric failure.

The prevalence of undernutrition in children is commonly reported using a conventional index, which identifies three conventional categories: stunting, underweight, and wasting. Recently, a composite index of anthropometric failure was developed to categorize undernutrition into seven mutually exclusive categories, including single failures (stunting, underweight, or wasting) and multiple failures (stunting and underweight, stunting and wasting, underweight and wasting, and stunting and underweight and wasting). This cross-sectional study used baseline data gathered during a feeding program targeting orphans and vulnerable children impacted by human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS) in Kenya to compare the conventional index with the composite index of anthropometric failure. Children younger than 5 years of age who participated in the feeding trial were included in the analysis (n=170). The conventional index found that the prevalence of undernutrition included 31.2% stunted, 14.1% underweight, and 5.9% wasted children, whereas the composite index of anthropometric failure estimated a more severe overall prevalence rate (38.2%); thus, the conventional index did not uncover the complexity of malnutrition experienced. Of the 53 children classified as stunted by the conventional index, the composite index of anthropometric failure identified 36 (67.9%) as stunted and 17 (32.1%) as stunted and underweight. Thus, the composite index of anthropometric failure was able to distinguish children with multiple anthropometric failures. In total, multiple anthropometric failures were found in 22 of the 65 children with anthropometric failure. These data suggest that the complexity and prevalence of undernutrition may be underestimated using the conventional index because it does not identify children experiencing multiple anthropometric failures. The ability of the composite index of anthropometric failure to identify children with multiple anthropometric failures may have profound implications for prioritizing, designing, and targeting nutritional interventions.

Nutritional status and risk factors of chronic malnutrition in children under five years of age in Aydin, a western city of Turkey.

We aimed to assess the prevalence and risk factors of chronic malnutrition in children under five years old in Aydin province, Turkey. A cross-sectional design was used to study a group of 1,400 children. Multistage sampling, including cluster and random sampling, respectively, was used in the selection of the study group. Stunting, wasting and underweight were used as indicators of nutritional status for children. The prevalence of malnutrition in children under five years was found as 10.9% for stunting, 4.8% for underweight and 8.2% for wasted. Increased risk was found in families without social security by 2.071, with low birth weight by 2.516 and with giving no colostrum by 2.787 in stunted children. Improving social security coverage is essential. Mothers should be informed on the usefulness of breast-feeding at antenatal care services during their pregnancies and taught appropriate breast-feeding practices, including the importance of giving colostrum, at baby-friendly institutions after birth.

Recognition of childhood overweight during health supervision visits: Does BMI help pediatricians?

OBJECTIVE: To assess, in diverse pediatric practices, the frequency of overweight/obesity (OW/OB) identification during health supervision visits and its association with BMI curve use. RESEARCH METHODS AND PROCEDURES: Pediatricians in public and private practice in St. Louis, MO, participated in a study of the care of chronic conditions during health supervision visits. Requested information from 30 visits per pediatrician of children 6 to 17 years of age included the visit note, the growth chart, and a one-page questionnaire about patient demographics and visit content. Pediatricians indicated the presence and discussion of common chronic conditions, including OW/OB. Identification was compared with patient BMI category, and associations between identification and patient and visit characteristics, including BMI curve use, were examined. RESULTS: Twenty-one (40%) of contacted pediatricians returned information from 557 visits. Pediatricians identified OW/OB in 27% of children with a BMI at the 85th to 94th percentile and 86% of children with a BMI at or above the 95th percentile. Identification was higher in adolescents but was not associated with patient sex or race, practice setting, insurance type, or visit length. Only 41% of growth charts were current, and 6.1% had BMI plotted. BMI plotting was associated with OW/OB identification when the BMI was at the 85th to 94th percentile but not when the BMI was at or above the 95th percentile. After controlling for BMI percentile, OW/OB identification was significantly associated with diet counseling (odds ratio, 7.46; 95% confidence interval, 3.42 to 16.24) and exercise counseling (odds ratio, 5.57; 95% confidence interval, 2.61 to 11.90). DISCUSSION: Despite low BMI curve use, pediatricians recognized most overweight/obese children with a BMI at or above the 95th percentile. BMI plotting may increase recognition in mildly overweight children.

A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs.

BACKGROUND: The complexity and cost of measuring weight-for-height make it unsuitable for use by community-based volunteers. This has led community therapeutic care programs to adopt a two-stage screening and admission procedure in which mid-upper-arm circumference (MUAC) is used for referral and weight-for-height is used for admission. Such a procedure results in many individuals being referred for care on the basis of MUAC but subsequently being refused treatment because they do not meet the weight-for-height admission criterion. This "problem of rejected referrals" has proved to be a major barrier to program uptake. OBJECTIVE: To systematically review methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. METHODS: Clinical and anthropometric methods for case detection of severely malnourished children in the community were reviewed with regard to their ability to reflect both mortality risk and nutritional status. RESULTS: MUAC, with the addition of the presence of bipedal edema, was found to be the indicator best suited to screening and case detection of malnutrition in the community. The case definition "MUAC < 110 mm OR the presence of bipedal edema," with MUAC measured by a color-banded strap, is suitable for screening and case detection of malnutrition in the community for children aged between 6 and 59 months. Monitoring and discharge criteria were also reviewed. CONCLUSIONS: There is no compelling evidence to support a move away from using weight in combination with clinical criteria for monitoring and discharge.

Nutritional status of underfive children in a pastoral community in Simanjiro district, Tanzania.

A study was conducted in Simanjiro district in northern Tanzania to determine the nutritional status of underfive children in a pastoral community. Weight and height measurements were carried out on 250 children and that of mean upper arm circumference (MUAC) on 226 children. The z-scores of weight-for-age, weight-for-height and height-for-age indicated that 31.2% of the children were underweight and 6.0% were severely underweight. Wasting was observed in 17.2% children of whom 3.2% were severely wasted. Severely stunted children were 3.2% while 14% were moderately stunted. Measurements of MUAC indicated that 35% and 3.5% of the children were moderately and severely undernourished, respectively. The nutritional status of the children under study was slightly lower than the national average. In conclusion, malnutrition in Simanjiro district is prevalent, and therefore, appropriate multidisciplinary approach on nutrition education, environmental sanitation and hygienic practices at family and community level need to be promoted to reduce childhood illnesses thereby increasing child health and nutritional status.

Body mass index cutoff points for evaluation of nutritional status in Brazilian children and adolescents

OBJETIVO: Delinear sistema de classificação, composto de curva de referência e valores críticos, baseado na distribuição do índice de massa corporal (IMC) em população de referência nacional e destinado à avaliação do estado nutricional de crianças e adolescentes brasileiros. MÉTODO: Dados de 13.279 homens e 12.823 mulheres com idade de 2 a 19 anos, extraídos da Pesquisa Nacional Nutrição e Saúde (1989), foram utilizados para construir a curva de referência. Utilizou-se o método LMS para o cálculo dos parâmetros da curva do IMC e a função polinomial para modelar esses parâmetros ao longo das idades. Os valores críticos para classificação do estado nutricional em déficit de peso, excesso de peso e obesidade foram expressos de acordo com centis e valores do IMC equivalentes a 17,5, 25 e 30 kg/m² , respectivamente, aos 20 anos. RESULTADOS: Os valores dos parâmetros L, M e S foram tabulados em intervalos semestrais para cada sexo. A partir desses valores, foi construído o gráfico com nove centis da distribuição de referência do IMC. Foram apresentados os valores críticos equivalentes aos valores de 17,5, 25 e 30 kg/m² no início da idade adulta. CONCLUSÃO: O sistema classificatório apresentado pode ser utilizado em avaliações clínicas e epidemiológicas, é similar metodologicamente à grande parte das curvas nacionais já apresentadas e oferece, ainda, a definição de baixo peso.

OBJECTIVE: To delineate a classification system, comprising reference curves and cutoff points, based on the distribution of body mass index (BMI) across a national reference population and designed for the assessment of the nutritional status of Brazilian children and adolescents. METHODS: Data from 13,279 males and 12,823 females aged from 2 to 19 years, extracted from the National Nutrition and Health Survey dataset (1989), were used to construct a reference curve. The LMS method was employed to calculate the BMI curve parameters and polynomial functions were used to model these parameters against age. The cutoff values for classifying nutritional status as underweight, overweight and obese were expressed as centiles and BMI values equivalent to 17.5, 25 and 30 kg/m² at 20 years, respectively. RESULTS: Values for the L, M and S parameters were tabulated at 6-month intervals for each sex. Using these values, a graph was plotted with nine BMI distribution reference centiles. Cutoff values were presented that are equivalent to BMIs of 17.5, 25 and 30 kg/m² at the start of adulthood. CONCLUSIONS: The classification system presented here can be used for clinical and epidemiological assessments, it is methodologically similar to the majority of national curves that have been presented to date and, furthermore, it offers a definition of underweight.

Body mass index cutoff points for evaluation of nutritional status in Brazilian children and adolescents.

OBJECTIVE: To delineate a classification system, comprising reference curves and cutoff points, based on the distribution of body mass index (BMI) across a national reference population and designed for the assessment of the nutritional status of Brazilian children and adolescents. METHODS: Data from 13,279 males and 12,823 females aged from 2 to 19 years, extracted from the National Nutrition and Health Survey dataset (1989), were used to construct a reference curve. The LMS method was employed to calculate the BMI curve parameters and polynomial functions were used to model these parameters against age. The cutoff values for classifying nutritional status as underweight, overweight and obese were expressed as centiles and BMI values equivalent to 17.5, 25 and 30 kg/m(2) at 20 years, respectively. RESULTS: Values for the L, M and S parameters were tabulated at 6-month intervals for each sex. Using these values, a graph was plotted with nine BMI distribution reference centiles. Cutoff values were presented that are equivalent to BMIs of 17.5, 25 and 30 kg/m(2) at the start of adulthood. CONCLUSIONS: The classification system presented here can be used for clinical and epidemiological assessments, it is methodologically similar to the majority of national curves that have been presented to date and, furthermore, it offers a definition of underweight.