Impact of Postnatal Head Circumference Growth in Normocephalic Infants Prenatally exposed to Zika Virus in Puerto Rico.

OBJECTIVE: We aimed to describe the head circumference (HC) growth trends for non-microcephalic infants exposed to the Zika virus (ZIKV) in utero. METHODS: This was a medical record review of non-microcephalic neonates exposed to ZIKV whose mothers received prenatal care at the fetal evaluation unit (2015-2017). The mean HC values of babies from prenatal age to 1 year old were compared with the standardized values on HC growth charts. RESULTS: Sixty-three mother-infant pairs were included, and 56 infants (boys, 30%; girls, 70%) were evaluated. The mothers tested positive for ZIKV; their babies had a mean gestational age of 38 weeks (32-42) and a mean birth weight of 3,150 grams (1,190-4,220). The mean HC growth of the fetuses (19-34 weeks gestational age) placed them in the 25th percentile, increasing to the 50th percentile (according to the World Health Organization [WHO]). Compared with other growth charts (INTERGROWTH- 21st [International Fetal and Newborn Growth Consortium for the 21st Century] and Puerto Rico reference values), the mean HC grew in the 50th percentile at 18 to 30 weeks of gestational age, indicating normal growth in children from Zika-positive women. According to the WHO chart, the postnatal HCs of both the girls and boys reached the 75th and 50th percentiles, respectively. CONCLUSION: Postnatal HC growth was normal. Results from this study suggest that infants exposed to ZIKV in utero can be normocephalic at birth. Therefore, the neurodevelopmental outcomes of such infants should be followed throughout childhood and adolescence, regardless of their HCs at birth.

Estándares de perímetro cefálico argentinos y de la Organización Mundial de la Salud: estudio comparativo / Argentine and World Health Organization head circumference standards: A comparison study

Introducción. Diversos estudios han evidenciado diferencias poblacionales en el tamaño cefálico que cuestionan la validez universal del estándar de la Organización Mundial de la Salud (OMS) para evaluar el crecimiento cefálico. Objetivos. Comparar las referencias argentinas de perímetro cefálico (PC) de 0 a 5 años con los estándares de la OMS. Población y métodos. Se compararon los percentiles 3 y 97 de PC de las referencias argentinas con los correspondientes del estándar de la OMS y se calcularon los porcentajes de niños clasificados como microcefálicos (PC < percentil 3 de la OMS) y macrocefálicos (PC > percentil 97 de la OMS) a edades específicas entre el nacimiento y los 5 años de edad. Resultados. La comparación de las referencias argentinas con los estándares de la OMS, muestra que ­en ambos sexos­ en el percentil 3, desde el primer mes y hasta los 6 meses, las referencias argentinas se encuentran por debajo de los estándares de la OMS, son similares entre los 9 y 18 meses, y luego se ubican por encima hasta los 60 meses. En relación con el percentil 97, las referencias argentinas se ubican por encima de los estándares de la OMS desde el nacimiento hasta los 60 meses en ambos sexos. Conclusiones. El tamaño cefálico de los niños y niñas argentinos difiere del de los estándares de la OMS. La adopción de los estándares de la OMS en nuestra población incrementa el porcentaje de diagnóstico de macrocefalia a todas las edades.

Introduction. Several studies have shown population differences in head circumference (HC) that question the universal validity of the World Health Organization (WHO) standard to assess head growth. Objectives. To compare the Argentine reference charts for HC from 0 to 5 years of age with the WHO standards. Population and methods. The 3rd and 97th percentiles for HC based on the Argentine reference charts were compared with the corresponding WHO standard and the percentage of children classified as having microcephaly (HC < 3rd percentile of the WHO) and macrocephaly (HC > 97th percentile of the WHO) at specific ages between 0 and 5 years were estimated. Results. The comparison of the Argentine reference charts with the WHO standards shows that, in both males and females, at the 3rd percentile, the Argentine reference charts are below the WHO standards from 1 to 6 months of age, similar from 9 to 18 months of age, and then above until 60 months old. In relation to the 97th percentile, the Argentine reference charts are above the WHO standards from birth to 60 months in both boys and girls. Conclusions. The head size of Argentine children is different from that established by the WHO standards. The adoption of the WHO standards for our population increases the percentage of macrocephaly diagnosis at all ages.

Referencias argentinas de perímetro cefálico desde el nacimiento hasta los 19 años / Argentine reference charts for head circumference from birth to 19 years of age

Introducción. El perímetro cefálico (PC) es un indicador del crecimiento cerebral y es necesario contar con referencias de crecimiento que permitan determinar variaciones normales o patológicas. Objetivos. Presentar las primeras referencias argentinas de perímetro cefálico entre el nacimiento y los 19 años, y compararlas con las referencias de Nellhaus, utilizadas en nuestro país hasta la actualidad. Población y métodos. Para la construcción de estas referencias, se combinaron datos de la Encuesta Nacional de Nutrición y Salud 2018 y estudios transversales realizados entre 2004 y 2007 en las provincias de Buenos Aires y La Pampa, que incluyeron 8326 niños, niñas y adolescentes sanos. Las curvas de crecimiento fueron ajustadas con el método LMS. Para evaluar la magnitud de las diferencias entre estas referencias y las de Nellhaus, a diferentes edades, se graficaron los centilos 2, 50 y 98. Resultados. El PC mostró un incremento de tamaño variable con la edad, de mayor magnitud en los primeros años de vida, y un ligero incremento en la pubertad. Los valores del centilo 98 de las referencias argentinas fueron mayores que los de Nellhaus en todas las edades. Los valores del centilo 2 de la referencia nacional fueron menores que los de Nellhaus durante los primeros 2 años de vida, similares entre los 3 y 7 años, y mayores a partir de esta edad. Conclusiones. Las curvas argentinas describen adecuadamente el patrón de crecimiento del PC. Las diferencias halladas con la referencia de Nellhaus pueden atribuirse a cambios seculares.

Introduction. Head circumference (HC) is an indicator of brain growth; growth charts are necessary to determine normal or pathological variations. Objectives. To present the first Argentine HC reference charts between birth and 19 years of age and to compare them with the Nellhaus charts, which have been used in our country to date. Population and methods. These references were developed based on combined data from the National Survey on Nutrition and Health of 2018 and cross-sectional studies conducted between 2004 and 2007 in the provinces of Buenos Aires and La Pampa, which included 8326 healthy children and adolescents. Growth curves were adjusted using the LMS method. To assess the differences between these reference charts and the Nellhaus charts, at different ages, the 2nd, 50th, and 98th percentiles were plotted. Results. HC showed a variable increase in size with age, which was greater in the first years of life, and a slight increase at puberty. The values for the 98th percentile of the Argentine reference charts were higher than those of the Nellhaus charts at all ages. The values for the 2 nd percentile of the national reference were lower than those of the Nellhaus charts during the first 2 years of life, similar between 3 and 7 years of age, and higher after this age. Conclusions. The Argentine curves adequately describe the growth pattern of HC. The differences found with the Nellhaus charts may be attributed to secular changes.

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

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

Risk Assessment of Cognitive Impairment at 2 Years of Age in Infants Born Extremely Preterm Using the INTERGROWTH-21st Growth Standards.

OBJECTIVE: To assess the risk of cognitive impairment among infants born extremely preterm using the INTERGROWTH-21st standards. STUDY DESIGN: We analyzed anthropometric data at birth and 36 weeks postmenstrual age (PMA) from infants born extremely preterm (24-26 weeks of gestation) admitted to US neonatal units between 2008 and 2018. To determine INTERGROWTH-21st z-score values that indicate an increased risk of cognitive impairment at 2 years of age (Bayley cognitive score <85), we employed classification and regression trees and redefined growth failure (weight, length, and head circumference z-scores at 36 weeks PMA) and growth faltering (weight, length, and head circumference z-score declines from birth to 36 weeks PMA). RESULTS: Among 5393 infants with a mean gestational age of 25 weeks, growth failure defined as a weight z-score of -1.8 or below at 36 weeks PMA and growth faltering defined as a weight z-score decline of 1.1 or greater from birth to 36 weeks PMA indicated a higher likelihood of cognitive impairment. A length z-score less than -1 at 36 weeks PMA had the highest sensitivity to detect cognitive impairment at 2 years (80%). A head circumference z-score decline of 2.43 or greater from birth to 36 weeks PMA had the highest specificity (86%). Standard definitions had fair to low sensitivity and specificity for risk detection of cognitive impairment. CONCLUSIONS: Length and head circumference z-scores had the highest sensitivity and specificity for risk detection of cognitive impairment. Monitoring these growth parameters could guide earlier individualized interventions with potential to reduce cognitive impairment. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID Generic Database: NCT00063063.

Argentine and World Health Organization head circumference standards: A comparison study. / Estándares de perímetro cefálico argentinos y de la Organización Mundial de la Salud: estudio comparativo.

Introduction. Several studies have shown population differences in head circumference (HC) that question the universal validity of the World Health Organization (WHO) standard to assess head growth. Objectives. To compare the Argentine reference charts for HC from 0 to 5 years of age with the WHO standards. Population and methods. The 3rd and 97th percentiles for HC based on the Argentine reference charts were compared with the corresponding WHO standard and the percentage of children classified as having microcephaly (HC < 3rd percentile of the WHO) and macrocephaly (HC > 97th percentile of the WHO) at specific ages between 0 and 5 years were estimated. Results. The comparison of the Argentine reference charts with the WHO standards shows that, in both males and females, at the 3rd percentile, the Argentine reference charts are below the WHO standards from 1 to 6 months of age, similar from 9 to 18 months of age, and then above until 60 months old. In relation to the 97th percentile, the Argentine reference charts are above the WHO standards from birth to 60 months in both boys and girls. Conclusions. The head size of Argentine children is different from that established by the WHO standards. The adoption of the WHO standards for our population increases the percentage of macrocephaly diagnosis at all ages.

Introducción. Diversos estudios han evidenciado diferencias poblacionales en el tamaño cefálico que cuestionan la validez universal del estándar de la Organización Mundial de la Salud (OMS) para evaluar el crecimiento cefálico. Objetivos. Comparar las referencias argentinas de perímetro cefálico (PC) de 0 a 5 años con los estándares de la OMS. Población y métodos. Se compararon los percentiles 3 y 97 de PC de las referencias argentinas con los correspondientes del estándar de la OMS y se calcularon los porcentajes de niños clasificados como microcefálicos (PC < percentil 3 de la OMS) y macrocefálicos (PC > percentil 97 de la OMS) a edades específicas entre el nacimiento y los 5 años de edad. Resultados. La comparación de las referencias argentinas con los estándares de la OMS, muestra que ­en ambos sexos­ en el percentil 3, desde el primer mes y hasta los 6 meses, las referencias argentinas se encuentran por debajo de los estándares de la OMS, son similares entre los 9 y 18 meses, y luego se ubican por encima hasta los 60 meses. En relación con el percentil 97, las referencias argentinas se ubican por encima de los estándares de la OMS desde el nacimiento hasta los 60 meses en ambos sexos. Conclusiones. El tamaño cefálico de los niños y niñas argentinos difiere del de los estándares de la OMS. La adopción de los estándares de la OMS en nuestra población incrementa el porcentaje de diagnóstico de macrocefalia a todas las edades.

Growth charts of Brazilian youngs: 20-years data of 95,000 children and adolescents from "Projeto Esporte Brasil".

This article aims to present growth curves for height, weight, and BMI of 95,000 Brazilian youths aged 6 to 17 years, including the five regions of the country, the Amazon region, and indigenous populations, and compare them with the World Health Organization (WHO) growth references. The final sample consisted of 52,729 boys and 42,731 girls from the "Projeto Esporte Brasil" database. Body mass and height information were used to derive the curves. The generalized additive model for location, scale, and shape was employed. In this study, we present smoothed weight-for-age, height-for-age, and BMI-for-age curves for boys and girls. Differences were observed between the results of the Brazilian curves and the WHO growth references. The developed curves will be valuable for professionals in medicine, public health, nutrition, physical education, and other related fields, regarding the assessment of physical growth in Brazilian children and adolescents and monitoring the nutritional status of this population. Additionally, these curves will facilitate the identification of individuals or subgroups at risk of diseases and delayed growth, with a greater focus on specific country-related factors.

Argentine reference charts for head circumference from birth to 19 years of age. / Referencias argentinas de perímetro cefálico desde el nacimiento hasta los 19 años.

Introduction. Head circumference (HC) is an indicator of brain growth; growth charts are necessary to determine normal or pathological variations. Objectives. To present the first Argentine HC reference charts between birth and 19 years of age and to compare them with the Nellhaus charts, which have been used in our country to date. Population and methods. These references were developed based on combined data from the National Survey on Nutrition and Health of 2018 and cross-sectional studies conducted between 2004 and 2007 in the provinces of Buenos Aires and La Pampa, which included 8326 healthy children and adolescents. Growth curves were adjusted using the LMS method. To assess the differences between these reference charts and the Nellhaus charts, at different ages, the 2nd, 50th, and 98th percentiles were plotted. Results. HC showed a variable increase in size with age, which was greater in the first years of life, and a slight increase at puberty. The values for the 98th percentile of the Argentine reference charts werehigher than those of the Nellhaus charts at all ages. The values for the 2nd percentile of the national reference were lower than those of the Nellhaus charts during the first 2 years of life, similar between 3 and 7 years of age, and higher after this age. Conclusions. The Argentine curves adequately describe the growth pattern of HC. The differences found with the Nellhaus charts may be attributed to secular changes.

Introducción. El perímetro cefálico (PC) es un indicador del crecimiento cerebral y es necesario contar con referencias de crecimiento que permitan determinar variaciones normales o patológicas. Objetivos. Presentar las primeras referencias argentinas de perímetro cefálico entre el nacimiento y los 19 años, y compararlas con las referencias de Nellhaus, utilizadas en nuestro país hasta la actualidad. Población y métodos. Para la construcción de estas referencias, se combinaron datos de la Encuesta Nacional de Nutrición y Salud 2018 y estudios transversales realizados entre 2004 y 2007 en las provincias de Buenos Aires y La Pampa, que incluyeron 8326 niños, niñas y adolescentes sanos. Las curvas de crecimiento fueron ajustadas con el método LMS. Para evaluar la magnitud de las diferencias entre estas referencias y las de Nellhaus, a diferentes edades, se graficaron los centilos 2, 50 y 98. Resultados. El PC mostró un incremento de tamaño variable con la edad, de mayor magnitud en los primeros años de vida, y un ligero incremento en la pubertad. Los valores del centilo 98 de las referencias argentinas fueron mayores que los de Nellhaus en todas las edades. Los valores del centilo 2 de la referencia nacional fueron menores que los de Nellhaus durante los primeros 2 años de vida, similares entre los 3 y 7 años, y mayores a partir de esta edad. Conclusiones. Las curvas argentinas describen adecuadamente el patrón de crecimiento del PC. Las diferencias halladas con la referencia de Nellhaus pueden atribuirse a cambios seculares.

Peso al nacer en el noroeste argentino. Comparación con una referencia nacional y un estándar internacional / Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard

Introducción. El tamaño al nacer se encuentra sujeto a influencias genéticas y ambientales; la altura geográfica es muy influyente. El peso al nacer (PN) es el indicador más utilizado para evaluarlo; existen diferentes estándares y referencias. Debido a la variabilidad de la distribución del PN en relación con la altura en la provincia de Jujuy (Argentina), este trabajo analiza la distribución percentilar del PN para tierras altas (TA) y tierras bajas (TB) jujeñas según edad gestacional (EG) y sexo, y su comparación con una referencia nacional y el estándar internacional INTERGROWTH-21st (IG-21). Población y métodos. Se analizaron los registros de 78 524 nacidos vivos en Jujuy en el período 20092014. Utilizando el método LMS, se estimaron los percentiles 3, 10, 50, 90 y 97 de PN/EG por sexo, para TA (≥2000 msnm), TB (<2000 msnm) y el total provincial, y se compararon gráficamente con la referencia poblacional argentina de Urquía y el estándar IG-21. La significación estadística se determinó mediante la prueba de Wilcoxon. Resultados. El PN en Jujuy presentó distribución heterogénea, con diferencias estadísticamente significativas (p <0,05) entre TB y TA. Al comparar con la referencia nacional y el estándar IG-21, se observaron diferencias por altitud, principalmente en los percentiles 90 y 97 para ambas regiones, y en los percentiles 3 y 10 en TA comparados con el estándar. Conclusiones. Se observó variabilidad de la distribución del PN asociada a la altura geográfica, por lo que, para evaluar el crecimiento intrauterino, resulta fundamental incluir la EG y el contexto donde transcurre la gestación.

Introduction. Size at birth is subject to genetic and environmental influences; altitude is highly influential. Birth weight (BW) is the most widely used indicator to assess size at birth; different standards and references are available. Due to the variability in BW distribution in relation to altitude in the province of Jujuy (Argentina), the purpose of this study is to analyze the percentile distribution of BW in the highlands (HL) and the lowlands (LL) of Jujuy based on gestational age (GA) and sex and compare it with a national reference and the INTERGROWTH-21 st (IG-21) international standard. Population and methods. The records of 78 524 live births in Jujuy in the 2009­2014 period were analyzed. Using the LMS method, the 3 rd, 10 th, 50 th, 90 th, and 97 th percentiles of BW/GA by sex were estimated for the HL (≥ 2000 MASL), the LL (< 2000 MASL), and the total for Jujuy, and compared with the Argentine population reference by Urquía and the IG-21 standard using growth charts. The statistical significance was established using the Wilcoxon test. Results. BW in Jujuy showed a heterogeneous distribution, with statistically significant differences (p < 0.05) between the LL and the HL. When compared with the national reference and the IG-21 standard, differences in terms of altitude were observed, mainly in the 90 th and 97 th percentiles for both regions and the 3 rd and 10 th percentiles in the HL compared with the international standard. Conclusions. BW distribution varied in association with altitude; therefore, to assess intrauterine growth, it is critical to include GA and the environment in which the pregnancy takes place.

Identifying biologically implausible values in big longitudinal data: an example applied to child growth data from the Brazilian food and nutrition surveillance system.

BACKGROUND: Several strategies for identifying biologically implausible values in longitudinal anthropometric data have recently been proposed, but the suitability of these strategies for large population datasets needs to be better understood. This study evaluated the impact of removing population outliers and the additional value of identifying and removing longitudinal outliers on the trajectories of length/height and weight and on the prevalence of child growth indicators in a large longitudinal dataset of child growth data. METHODS: Length/height and weight measurements of children aged 0 to 59 months from the Brazilian Food and Nutrition Surveillance System were analyzed. Population outliers were identified using z-scores from the World Health Organization (WHO) growth charts. After identifying and removing population outliers, residuals from linear mixed-effects models were used to flag longitudinal outliers. The following cutoffs for residuals were tested to flag those: -3/+3, -4/+4, -5/+5, -6/+6. The selected child growth indicators included length/height-for-age z-scores and weight-for-age z-scores, classified according to the WHO charts. RESULTS: The dataset included 50,154,738 records from 10,775,496 children. Boys and girls had 5.74% and 5.31% of length/height and 5.19% and 4.74% of weight values flagged as population outliers, respectively. After removing those, the percentage of longitudinal outliers varied from 0.02% (<-6/>+6) to 1.47% (<-3/>+3) for length/height and from 0.07 to 1.44% for weight in boys. In girls, the percentage of longitudinal outliers varied from 0.01 to 1.50% for length/height and from 0.08 to 1.45% for weight. The initial removal of population outliers played the most substantial role in the growth trajectories as it was the first step in the cleaning process, while the additional removal of longitudinal outliers had lower influence on those, regardless of the cutoff adopted. The prevalence of the selected indicators were also affected by both population and longitudinal (to a lesser extent) outliers. CONCLUSIONS: Although both population and longitudinal outliers can detect biologically implausible values in child growth data, removing population outliers seemed more relevant in this large administrative dataset, especially in calculating summary statistics. However, both types of outliers need to be identified and removed for the proper evaluation of trajectories.

Brazilian growth charts for Williams-Beuren Syndrome at ages 2 to 18 years.

OBJECTIVE: To develop growth charts for weight-for-age, height-for-age, and body mass index (BMI)-for-age for both genders aged 2 to 18 years for Brazilian patients with Williams-Beuren Syndrome (WBS). METHODS: This is a multicenter, retrospective, and longitudinal study, data were collected from the medical records of boys and girls with a confirmed diagnosis of WBS in three large university centers in the state of Sao Paulo, Brazil. Growth charts stratified by gender and age in years were developed using LMSchartmaker Pro software. The LMS (Lambda Mu Sigma) method was used to model the charts . The quality of the settings was checked by worm plots. RESULTS: The first Brazilian growth charts for weight-for-age, height-for-age, and BMI-for-age stratified by gender were constructed for WBS patients aged 2 to 18 years. CONCLUSION: The growth charts developed in this study can help to guide family members and to improve the health care offered by health professionals.

Birth weight in the Northwest region of Argentina. Comparison with a national reference and an international standard. / Peso al nacer en el noroeste argentino. Comparación conuna referencia nacional y un estándar internacional.

Introduction. Size at birth is subject to genetic and environmental influences; altitude is highly influential. Birth weight (BW) is the most widely used indicator to assess size at birth; different standards and references are available. Due to the variability in BW distribution in relation to altitude in the province of Jujuy (Argentina), the purpose of this study is to analyze the percentile distribution of BW in the highlands (HL) and the lowlands (LL) of Jujuy based on gestational age (GA) and sex and compare it with a national reference and the INTERGROWTH-21st (IG-21) international standard. Population and methods. The records of 78 524 live births in Jujuy in the 2009-2014 period were analyzed. Using the LMS method, the 3rd, 10th, 50th, 90th, and 97th percentiles of BW/GA by sex were estimated for the HL (≥ 2000 MASL), the LL (< 2000 MASL), and the total for Jujuy, and compared with the Argentine population reference by Urquía and the IG-21 standard using growth charts. The statistical significance was established using the Wilcoxon test. Results. BW in Jujuy showed a heterogeneous distribution, with statistically significant differences (p < 0.05) between the LL and the HL. When compared with the national reference and the IG-21 standard, differences in terms of altitude were observed, mainly in the 90th and 97th percentiles for both regions and the 3rd and 10th percentiles in the HL compared with the international standard. Conclusions. BW distribution varied in association with altitude; therefore, to assess intrauterine growth, it is critical to include GA and the environment in which the pregnancy takes place.

Introducción. El tamaño al nacer se encuentra sujeto a influencias genéticas y ambientales; la altura geográfica es muy influyente. El peso al nacer (PN) es el indicador más utilizado para evaluarlo; existen diferentes estándares y referencias. Debido a la variabilidad de la distribución del PN en relación con la altura en la provincia de Jujuy (Argentina), este trabajo analiza la distribución percentilar del PN para tierras altas (TA) y tierras bajas (TB) jujeñas según edad gestacional (EG) y sexo, y su comparación con una referencia nacional y el estándar internacional INTERGROWTH-21st (IG-21). Población y métodos. Se analizaron los registros de 78 524 nacidos vivos en Jujuy en el período 2009-2014. Utilizando el método LMS, se estimaron los percentiles 3, 10, 50, 90 y 97 de PN/EG por sexo, para TA (≥2000 msnm), TB (<2000 msnm) y el total provincial, y se compararon gráficamente con la referencia poblacional argentina de Urquía y el estándar IG-21. La significación estadística se determinó mediante la prueba de Wilcoxon. Resultados. El PN en Jujuy presentó distribución heterogénea, con diferencias estadísticamente significativas (p <0,05) entre TB y TA. Al comparar con la referencia nacional y el estándar IG-21, se observaron diferencias por altitud, principalmente en los percentiles 90 y 97 para ambas regiones, y en los percentiles 3 y 10 en TA comparados con el estándar. Conclusiones. Se observó variabilidad de la distribución del PN asociada a la altura geográfica, por lo que, para evaluar el crecimiento intrauterino, resulta fundamental incluir la EG y el contexto donde transcurre la gestación.

Fetal growth in Bogotá, Colombia: a comparison with international and latin american curves / Crecimiento fetal en Bogotá Colombia: una comparación con curvas internacionales y latinoamericanas

Abstract Objectives: to describe estimated fetal weight, biparietal diameter, head circumference, abdominal circumference, and femoral length in a sample of pregnant women and to compare them with the international curves. Methods: a retrospective cross-sectional study was conducted on ultrasonographic data of singleton pregnancies between 16 and 39 weeks in Bogotá, Colombia, from February 2015 to November 2018. Fetal parameters were evaluated. Descriptive analysis of each biometric parameter was performed, followed by comparison the curves provided by INTERGROWTH-21st and Lagos. Results: a total of 1133 sonographic reports were analysed. The means ± SDs of biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight measurements at 16and 39 weeks were 34.7 ± 1.5 and 92.2 ± 4.4 mm, 122.2 ± 6.6and 318.0 ± 17.0 mm, 107.2 ± 6.8 and329.3 ± 34.6mm, 20.6 ± 2.8 and 73.5 ± 3.3 mm, and257.8 ± 20.9 and 3,115 ± 663.7g, respectively. The data were presented in graphs. AC and FL were the parameters that showed more statistically significant differences with international curves. Conclusions: international reference charts analysed, show differences when fetal growth of this population was compared. The customized or local charts maybe are more useful to reach early detection of alterations offetal growth in each population.

Resumo Objetivos: describir el peso fetal estimado (PFE), el diâmetro biparietal (DBP), la circunferencia cefálica (CC), la circunferencia abdominal (CA) y la longitudfemoral (LF) en una muestra de gestantes y compararlos con curvas internacionales. Métodos: se realizó un estúdio transversal retrospectivo sobre datos ultrasonográficos de embarazos únicos entre 16y 39 semanas en Bogotá, Colombia, desde febrero del 2015 hasta noviembre del 2018. Se realizó un análisis descriptivo de cada parámetro biométrico, seguido de una comparación con las curvas proporcionados por INTERGROWTH-21sty Lagos. Resultados: se analizaron un total de 1133 informes ecográficos. Las medias ± DE de las mediciones del DBP, CC, CA, LFy PFE a las 16 y 39 semanasfueron 34,7 ± 1,5y 92,2 ± 4,4 mm, 122,2 ± 6,6y 318,0 ± 17,0 mm, 107,2 ± 6,8y 329,3 ± 34,6mm, 20,6 ± 2,8y 73,5 ± 3,3 mm, y 257,8 ± 20,9y 3115 ± 663,7g, respectivamente. La CAy LF fueron los parámetros que mostraron más diferencias estadísticamente significativas con las curvas internacionales. Conclusiones: los cuadros de referencia analizados muestran diferencias al comparar el crecimiento fetal de esta población. Las gráficas personalizadas o locales quizás sean más utiles para detectar tempranamente alteraciones del crecimiento fetal en cada población.

MULT: New height references and their efficiency in multi-ethnic populations.

OBJECTIVES: To develop new height references (MULT) based on longitudinal data of multi-ethnic populations and to compare them to the height references from the Dutch Growth Study, from the Centers for Disease Control and Prevention (CDC) and from the World Health Organization (WHO). METHODS: The MUL height references were developed through the LMS method and the Generalized Additive Models for Location Scale and Shape. They were constructed based on 2611 subjects (15 292 measurements) from the advantaged quintile of the Young Lives (Younger Cohort), Millennium Cohort Study, Adolescent Nutritional Assessment Longitudinal Study, and Epidemiological Health Investigation of Teenagers in Porto studies. The M, S curves were described to compare the growth trajectory of the MULT, DUTCH, CDC and WHO height references. For the population comparative analysis, we used the total sample of the studies (91 063 observations, 17 641 subjects). The Lin's concordance correlation coefficient (CCC) and Cohen's kappa coefficient (K) were used to verify the agreement between MULT, WHO and CDC height references. RESULTS: The MULT height references showed taller boys for the periods of 61-174 months and 196-240 months and taller girls for 61-147 and 181-240 months, when compared to CDC and WHO height references. There was an almost perfect agreement between WHO and MULT height references (CCC >0.99) for the subjects aged 2 to 5 years. CONCLUSIONS: MULT height references presented a taller population and a high agreement with WHO growth charts, especially for children under 5 years, indicating that it could be useful to assess nutritional status of multi-ethnic populations.

Reference growth curves to identify weight status (underweight, overweight or obesity) in children and adolescents: systematic review.

The identification of somatic growth, through reference curves, can be used to create strategies and public policies to reduce public health problems such as malnutrition and obesity and to identify underweight, overweight and obesity. The purpose of this systematic review was to identify studies providing reference growth curves for weight status in children and adolescents. A systematic search was conducted in eight databases and in gray literature (Google scholar). To assess the risk of bias/methodological quality of studies, the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-sectional Studies (NHLBI) was used. Overall, 86 studies that met the inclusion criteria were included. Through the values   of reference growth curves for the identification of underweight, overweight and obesity, it was possible to verify that there is great variability among percentiles for the identification of underweight, overweight and obesity. The most prevalent percentiles for underweight were P3 and P5; for overweight, the most prevalent was P85 and the most prevalent percentiles for obesity were P95 and P97. The most prevalent anthropometric indicators were Body Mass Index (BMI), Waist Circumference (WC), Body Mass (BM) for age and height for age. Conclusion: Such data can demonstrate that the optimal growth must be reached, through the standard growth curves, but that the reference curves demonstrate a cut of the population growth, raising possible variables that can influence the optimal growth, such as an increase in the practice of physical activities and an awareness of proper nutrition.

Performance of the INTERGROWTH-21st and World Health Organization fetal growth charts for the detection of small-for-gestational age neonates in Latin America.

OBJECTIVE: To evaluate the performance of INTERGROWTH-21st (IG-21st ) and World Health Organization (WHO) fetal growth charts to identify small-for-gestational-age (SGA) and fetal growth restriction (FGR) neonates, as well as their specific risks for adverse neonatal outcomes. METHODS: Multicenter cross-sectional study including 67 968 live births from 10 maternity units across four Latin American countries. According to each standard, neonates were classified as SGA and FGR (birth weight <10th and less than third centiles, respectively). The relative risk (RR) and diagnostic performance for a low APGAR score and low ponderal index were calculated for each standard. RESULTS: WHO charts identified more neonates as SGA than IG-21st (13.9% vs 7%, respectively). Neonates classified as having FGR by both standards had the highest RR for a low APGAR (RR, 5.57 [95% confidence interval (CI), 3.99-7.78]), followed by those who were SGA by both curves (RR, 3.27 [95% CI, 2.52-4.24]), while neonates with SGA identified by WHO alone did not have an additional risk (RR, 0.87 [95% CI, 0.55-1.39]). Furthermore, the diagnostic odds ratio for a low APGAR was higher when IG-21st was used. CONCLUSION: In a population from Latin America, the WHO charts seem to identify more SGA neonates, but the diagnostic performance of the IG-21st charts for low APGAR score and low ponderal index is better.

MULT - uma nova referência internacional para avaliação nutricional de crianças e adolescentes / MULT - a new international growth reference to assess the nutritional status of children and adolescents

Introdução: A disponibilidade de várias curvas de crescimento propostas por diversas instituições e modeladas com diferentes populações dificulta a adoção de uma referência internacional. Objetivo: Elaborar uma nova referência internacional e comparar seu desempenho com o de outras curvas de referências já existentes. Métodos: Dados sociodemográficos, antropométricos e de composição corporal de participantes com idades entre zero e 23 anos foram coletados dos inquéritos populacionais: National Health and Nutrition Examination Survey (NHANES), Porto Alegre, Santos, Young Lives: an International Study of Childhood Poverty (YL), Millennium Cohort Study (MCS), Geração XXI (G21), Epidemiological Health Investigation of Teenagers in Porto (EPITeen) e Estudo Longitudinal de Avaliação Nutricional de Adolescentes (ELANA). A nova referência internacional denominada MULT apresentou curvas de altura, índice de massa corporal (IMC) e índice alométrico de massa corporal (IAMC) para a idade construídas por meio do método LMS e o Generalized Additive Models for Location, Scale, and Shape (GAMLSS). A eficiência da referência MULT foi comparada com as das referências internacionais da World Health Organization (WHO), International Task Force Obesity (IOTF) e Centers for Disease Control and Prevention (CDC). A precisão diagnóstica das curvas foi realizada por meio da análise de adiposidade corporal e o risco de sobrepeso na pré-adolescência foi estimado a partir da análise da canalização de crescimento de IMC (CC-IMC). Ademais, uma ferramenta para avaliação nutricional baseada nos valores de referência MULT foi elaborada no Microsoft Excel e disponibilizada online. Resultados: Em comparação com as curvas da WHO, IOTF e CDC, as curvas de altura da MULT mostraram meninos mais altos nos períodos de 61-174 e 196-240 meses, e meninas mais altas nos períodos de 61-147 e 181-240 meses, com relação as de IMC, a MULT apresentou os valores médios mais baixos para as idades de 102-240 meses para os meninos e de 114-220 meses para meninas. Já as de IAMC apresentaram as maiores diferenças nas idades de 138-150 meses para meninos e de 114-132 meses para meninas, coincidindo com a puberdade. As curvas de IAMC apresentaram as melhores performances para diagnosticar obesidade a partir da análise da composição corporal (meninos=0,95;IC95%:0,94- 0,95/meninas=0,92; IC95%:0,92-093) e a análise de risco relativo (RR) apontou que crianças eutróficas durante a infância que aumentaram seu CC-IMC em ≥0,67 e <0,86 apresentaram maior probabilidade de estarem com excesso do peso aos 9,5-13,5 anos [IOTFRR= 2,31;IC95%:1,82-2,93/MULT-RR=2,49;IC95%:2,00-3,09/WHO-RR=2,47; IC95%:1,96- 3,12], em comparação com aquelas que permaneceram dentro do seu canal. Conclusão: Para diagnóstico da obesidade, a referência MULT teve um desempenho melhor entre as referências de IMC, enquanto que as curvas de IAMC da MULT apresentaram o melhor desempenho entre todas, sendo a única capaz de detectar que as meninas apresentavam, proporcionalmente, mais massa de gordura do que os meninos para os mesmos valores de índice. Além disso, a análise da canalização apontou que um aumento no CC-IMC ≥0,67DP durante a infância foi associado a um risco de excesso de peso aos 9,5-13,5 anos. Esses resultados apontam que a referência MULT pode ser uma excelente opção para avaliação nutricional de crianças e adolescentes.

Introduction: The availability of several growth references proposed by different institutions and modeled with different populations complicates the adoption of an international growth reference. Objective: To develop a new international reference and compare its performance with other existing growth references. Methods: Sociodemographic, anthropometric, and body composition data from birth to 23 years old were collected from the population surveys: National Health and Nutrition Examination Survey (NHANES), Porto Alegre, Santos, Young Lives: an International Study of Childhood Poverty (YL), Millennium Cohort Study (MCS), Generation XXI (G21), Epidemiological Health Investigation of Teenagers in Porto (EPITeen), and Longitudinal Study of Nutritional Assessment of Adolescents (ELANA). A new international reference called MULT was developed, which included height, BMI, and allometric body mass index (ABMI) growth charts. These curves were constructed using the LMS method and the generalized additive models for location, scale, and shape (GAMLSS). The efficiency of this reference was compared with the international growth references of the World Health Organization (WHO), International Task Force Obesity (IOTF), and Centers for Disease Control and Prevention (CDC). The diagnostic accuracy of the growth references was assessed through the analysis of body adiposity, and the risk of overweight in pre-adolescence was estimated from the analysis of the BMI growth channeling (BMI-GC). In addition, a nutritional assessment tool based on MULT reference values was developed in Microsoft Excel and made available online. Results: In comparison to the WHO, IOTF, and CDC, the MULT height reference showed taller boys during the periods of 61-174 and 196-240 months, and taller girls during the periods of 61-147 and 181-240 months. Regarding the BMI, the MULT presented the lowest mean values for the ages of 102-240 months for boys and for the ages of 114-220 months for girls. The ABMI reference presented the largest differences at ages 138- 150 months for boys and 114-132 months for girls, coinciding with the pubertal stage. The ABMI reference demonstrated the best performance in diagnosing obesity based on body composition analysis (boys=0.95;95%CI:0.94-0.95/girls=0.92;95%CI:0.92-0.93). The analysis of relative risk (RR) indicated that normal weight children who increased their BMI-GC during childhood by ≥0.67 and <0.86 were more likely to be overweight at 9.5-13.5 years [IOTFRR= 2.31; 95% CI: 1.82-2.93/MULT-RR=2.49; 95% CI: 2.00-3.09/WHO-RR=2.47; 95% CI: 1.96-3.12] compared to those who remained within their channel. Conclusion: For diagnosing obesity, the MULT reference performed better among the BMI references, while the ABMI reference showed the best performance overall, being the only one capable of detecting that girls had proportionally higher fat mass (FM) than boys for the same index values. Moreover, the canalization analysis indicated that an increase in BMI-GC ≥0.67 during childhood was associated with a significantly higher risk of overweight at 9.5-13.5 years. These results suggest that the MULT reference can be an excellent option to assess the nutritional status of children and adolescents.

Performances of birthweight charts to predict adverse perinatal outcomes related to SGA in a cohort of nulliparas.

BACKGROUND: Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes. METHODS: This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40th-60th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart. RESULTS: A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0-11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55-0.64, p < .05). The charts had poor performance (AUC 0.492 - 0.522) for the detection of neonatal morbidity related to SGA born at term. CONCLUSION: The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population.

Estudio comparativo de las curvas de crecimiento de la OMS y los aplicativos Anthro WHO e Intergrowth 21st utilizados para el diagnóstico de microcefalia en recién nacidos de término - Paraguay 2019 / Comparative study between the WHO growth curves, the Anthro WHO and Intergrowth 21st applications used for the diagnosis of microcephaly in term newborns -Paraguay 2019

RESUMEN Introducción. Los índices antropométricos son combinaciones de medidas utilizadas para evaluar el crecimiento normal del niño desde el nacimiento, entre ellos el perímetro cefálico (PC). Objetivo. Medir las concordancias entre las curvas de crecimiento de la OMS, los aplicativos Anthro WHO e Intergrowth 21st, en un grupo de recién nacidos (RN) diagnosticados con microcefalia. Metodología. estudio analítico transversal a 329 RN con microcefalia de un hospital regional. Se tomó como parámetro oro a las curvas de referencia de la OMS comparándolo con el puntaje Z obtenido con los aplicativos Anthro WHO e Intergrowth 21st. Se clasificó a la población según sexo; se calcularon los promedios con desviación estándar para edad gestacional, peso, talla, perímetro cefálico. Se estimó el coeficiente Kappa de Cohen y se utilizó la escala cualitativa Landis y Koch para medir la concordancia. Estadísticos con SPSS. Resultados. De 329 nacimientos, 195 (59%) fueron niñas. Sin diferencias significativas entre los promedios de edad gestacional, peso, talla y PC. Entre OMS/Anthro WHO Kappa=0,813 para las niñas y Kappa=0,804 para los niños (Landis-Koch= casi perfecto y considerable respectivamente). Entre OMS/Intergrowth 21st Kappa=0,030 para niñas y Kappa=0,305 para los niños (Landis-Koch= leve y aceptable respectivamente). Conclusión. El grado de acuerdo entre el parámetro oro OMS y Anthro WHO estuvieron entre considerable y casi perfecto por lo que ambos se pueden utilizar indistintamente. Se sugieren estudios adicionales para evaluar el impacto que pudiera tener las diferencias de acuerdos encontradas entre los parámetros de OMS e Intergrowth 21st.

ABSTRACT Introduction. Anthropometric indices are combinations of measures used to evaluate the normal growth of the child from birth; including head circumference (PC). Objetive. to measure the concordances between the WHO growth curves, the Anthro WHO and Intergrowth 21st applications, in a group of newborns (NB) diagnosed with microcephaly. Methodology. cross-sectional analytical study to 329 NBs with microcephaly from a regional hospital. The WHO reference curves were the gold parameter, comparing it with the Z score obtained with the Anthro WHO and Intergrowth 21st applications. Classified the population according to sex; the averages with standard deviation were calculated for gestational age, weight, height, head circunsfenere. The Cohen Kappa coefficient was estimated and Landis and Koch qualitative scale was used to measure the concordance. Statisticians with SPSS. Results. Of 329 births, 195 (59%) were girls. No significant differences between the means of gestational age, weight, size and CP. Between WHO / Anthro WHO Kappa = 0.813 for girls and Kappa = 0.804 for boys (Landis-Koch = almost perfect and considerable respectively). Between OMS / Intergrowth 21st Kappa = 0.030 for girls and Kappa = 0.305 for boys (Landis-Koch = mild and acceptable respectively). Conclusion. The degree of agreement between WHO gold parameter and the Anthro WHO parameter was between considerable and almost perfect, so both can be used interchangeably. Additional studies are suggested to assess the impact that the differences in agreement found between the WHO and Intergrowth 21st parameters could have.

Accuracy of international growth charts to assess nutritional status in children and adolescents: a systematic review.

OBJECTIVE: To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012). DATA SOURCE: We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: "Child", "Adolescent", "Nutritional Assessment", "Growth Chart", "Ethnic Groups", "Stature by age", "Body Mass Index", "Comparison", "CDC", "WHO", and "IOTF". The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH. DATA SYNTHESIS: Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations. CONCLUSIONS: There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.