LMS-based continuous pediatric reference values for soluble receptor activator of nuclear factor kappa B ligand (sRANKL) and osteoprotegerin (OPG) in the HARP cohort.

Soluble RANKL (sRANKL) and osteoprotegerin (OPG) are regulators of osteoclast differentiation and activation, but adequate pediatric reference values are lacking. Here we provide LMS (Lambda-Mu-Sigma)-based continuous pediatric reference percentiles for sRANKL, OPG and sRANKL/OPG ratio that will allow calculation of standardized patient z-scores to assess bone modeling in children. PURPOSE: Soluble receptor activator of nuclear factor kappa B ligand (sRANKL) and osteoprotegerin (OPG) are regulators of osteoclast differentiation and activation and thus bone metabolic turnover in children. Adequate pediatric reference values for their serum/plasma concentrations are lacking. The development of Lambda-Mu-Sigma (LMS)-based continuous reference percentiles for laboratory parameters allow improved data interpretation in clinical practice. METHODS: A total of 300 children aged 0.1-18 years (166 boys) were enrolled in the HAnnover Reference values for Pediatrics (HARP) study. sRANKL and OPG were assessed by ELISA. LMS-based continuous reference percentiles were generated using RefCurv software. RESULTS: LMS-based percentiles were established for sRANKL, OPG and sRANKL/OPG ratio, which were all found to be age-dependent. sRANKL and sRANKL/OPG associated with sex. In boys, sRANKL percentiles were highest during infancy, followed by a continuous decline until the age of 7 years and a second peak around age 12-13 years. In girls, a continuous, slow decline of sRANKL percentiles was noticed from infancy onwards until the age of 13 years, followed by a rapid decline until adulthood. OPG percentiles continuously declined from infancy to adulthood. The percentiles for sRANKL/OPG ratio paralleled those of sRANKL. Serum concentrations of sRANKL correlated with OPG and serum phosphate z-scores, while OPG concentrations inversely associated with standardized body weight, BMI, and urinary phosphate to creatinine ratio (each p < 0.05). CONCLUSION: This is the first report of LMS-based continuous pediatric reference percentiles for sRANKL, OPG and sRANKL/OPG ratio that allows calculation of standardized patient z-scores to assess bone metabolic turnover in children.

Percentile curves for the knee injury and osteoarthritis outcome score in the middle-aged Dutch population.

OBJECTIVE: To improve the interpretation of the Knee injury and Osteoarthritis Outcome Score (KOOS) in individual patients, we explored associations with age, sex, BMI, history of knee injury and presence of clinical knee osteoarthritis, and developed percentile curves. METHODS: We used cross-sectional data of middle-aged individuals from the population-based Netherlands Epidemiology of Obesity (NEO) study. Clinical knee osteoarthritis was defined using the ACR classification criteria. KOOS scores were handled according to the manual (zero = extreme problems, 100 = no problems). Patient characteristics associated with KOOS were explored using ordered logistic regression, and sex and body mass index (BMI)-specific percentile curves were developed using quantile regression with fractional polynomials. The curves were applied as a benchmark for comparison of KOOS scores of participants with knee osteoarthritis and comorbidities. RESULTS: The population consisted of 6,643 participants (56% women, mean (SD) age 56(6) years). Population-based KOOS subscale scores (median; interquartile range) near optimum: pain (100;94-100), symptoms (96;86-100), ADL function (100;96-100), sport/recreation function (100;80-100), quality of life (100;75-100). Worse KOOS scores were observed in women and in participants with higher BMI. Clinical knee osteoarthritis was defined in 15% of participants, and was, in comparison to other patient characteristics, associated with the highest odds of worse KOOS scores. Furthermore, presence of any comorbidity and cardiovascular disease specifically, was associated with worse KOOS scores, particularly in women. CONCLUSIONS: In the middle-aged Dutch population KOOS scores were generally good, but worse in women and with higher BMI. These percentile curves may be used as benchmarks in research and clinical practice.

A spatio-temporal reference model of the aging brain.

Both normal aging and neurodegenerative disorders such as Alzheimer's disease (AD) cause morphological changes of the brain. It is generally difficult to distinguish these two causes of morphological change by visual inspection of magnetic resonance (MR) images. To facilitate making this distinction and thus aid the diagnosis of neurodegenerative disorders, we propose a method for developing a spatio-temporal model of morphological differences in the brain due to normal aging. The method utilizes groupwise image registration to characterize morphological variation across brain scans of people with different ages. To extract the deformations that are due to normal aging we use partial least squares regression, which yields modes of deformations highly correlated with age, and corresponding scores for each input subject. Subsequently, we determine a distribution of morphologies as a function of age by fitting smooth percentile curves to these scores. This distribution is used as a reference to which a person's morphology score can be compared. We validate our method on two different datasets, using images from both cognitively normal subjects and patients with Alzheimer disease (AD). Results show that the proposed framework extracts the expected atrophy patterns. Moreover, the morphology scores of cognitively normal subjects are on average lower than the scores of AD subjects, indicating that morphology differences between AD subjects and healthy subjects can be partly explained by accelerated aging. With our methods we are able to assess accelerated brain aging on both population and individual level. A spatio-temporal aging brain model derived from 988 T1-weighted MR brain scans from a large population imaging study (age range 45.9-91.7y, mean age 68.3y) is made publicly available at www.agingbrain.nl.

Sex- and age-specific percentiles of body composition indices for Chinese adults using dual-energy X-ray absorptiometry.

PURPOSE: The aims of the study were to develop sex- and age-specific percentiles for lean mass index (LMI), appendicular LMI (aLMI), fat mass index (FMI), and body fat distribution indices in Chinese adults using dual-energy X-ray absorptiometry (DXA), and to compare those indices with those of other ethnicities using the US NHANES data. METHODS: Whole-body and regional lean mass and fat mass (FM) were measured using DXA in 5688 healthy males (n = 1693) and females (n = 3995) aged 20-90 years. Body fat distribution indices were expressed as % fat trunk/% fat legs, trunk/appendicular FM ratio (FMR), and android/gynoid FMR. Percentile curves of LMI, aLMI, FMI, and body fat distribution indices were obtained by the Lambda-Mu-Sigma method. RESULTS: The aLMI and LMI were negatively associated with age, decreasing from the fifth decade for males, but were not associated with age in females. Females had more total FM than males, whereas males had greater central adiposity (% fat trunk/% fat legs ratio, trunk/appendicular FMR, and android/gynoid FMR) than females. Moreover, FMI and body fat distribution indices consistently increased with age in both sexes, especially in women. In comparison with white, black, and Mexican populations in the USA, Chinese adults had lower total FM, but had greater central adiposity (% fat trunk/% fat legs ratio and trunk/appendicular FMR). Additionally, older white and Mexican populations showed greater decreases for aLMI and LMI than their Chinese counterparts. CONCLUSIONS: We present the sex- and age-specific percentiles for aLMI, LMI, FMI, and body fat distribution indices by DXA in Chinese adults, which may refine the individual assessment of the nutritional status of Chinese adults.

Reference charts of sitting height, leg length and body proportions for Chinese children aged 0-18 years.

BACKGROUND: The reference charts of sitting height (SH), subischial leg length (LL) and the sitting height/leg length ratio (SH/LL) are useful tools in assessing body proportion for clinicians and researchers in related areas. However, reference charts of body proportions for Chinese children and adolescents are limited. AIM: To construct reference charts of SH, LL and SH/LL for Chinese children and adolescents. SUBJECTS AND METHODS: Stature and sitting height of 92 494 (46 240 boys and 46 254 girls) healthy Han nationality children, aged 0-18 years, were measured in two national large-scale cross-sectional surveys in 2005 in China. SH/LL was selected as the indicator of body proportion. References of SH, LL and SH/LL were constructed using the LMS method. RESULTS: The reference charts demonstrated that SH and LL increased with age. Growth in SH slowed by the age of 17 years in boys and 15 years in girls. Similarly, growth in LL slowed at 16 years in boys and 14 years in girls. The SH/LL ratio declined from birth (2.00 in boys and 2.03 in girls) to 13 years in boys (1.11) and to 11 years in girls (1.13), then increased slightly to the age of 18 (1.16 in boys and 1.18 in girls). The gender difference of SH/LL was not significantly different before the age of 11 years. After the age of 11, SH/LL appeared elevated in girls compared to boys. CONCLUSIONS: The reference charts of SH, LL and SH/LL are useful tools for assessing body proportions for Chinese children and adolescent individuals.

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.

The life-course changes in muscle mass using dual-energy X-ray absorptiometry: The China BCL study and the US NHANES study.

BACKGROUND: Sarcopenia is an important indicator of ill health and is linked to increased mortality and a reduced quality of life. Age-associated muscle mass indices provide a critical tool to help understand the development of sarcopenia. This study aimed to develop sex- and age-specific percentiles for muscle mass indices in a Chinese population and to compare those indices with those from other ethnicities using the National Health and Nutrition Examination Survey (NHANES) data. METHODS: Whole-body and regional muscle mass was measured by dual-energy X-ray absorptiometry (DXA) in participants of the China Body Composition Life-course (BCL) study (17 203 healthy Chinese aged 3-60 years, male 48.9%) and NHANES (12 663 healthy Americans aged 8-59 years, male 50.4%). Age- and sex-specific percentile curves were generated for whole-body muscle mass and appendicular skeletal muscle mass using the Generalized Additive Model for Location Scale and Shape statistical method. RESULTS: Values of upper and lower muscle mass across ages had three periods: an increase from age 3 to a peak at age 25 in males (with the 5th and 95th values of 41.5 and 66.4 kg, respectively) and age 23 in females (with the 5th and 95th values of 28.4 and 45.1 kg, respectively), a plateau through midlife (30s-50s) and then a decline after their early 50s. The age at which muscle mass began to decline was 52 years in men with the 5th and 95th percentile values of 43.5 and 64.6 kg, and 51 years in women with the 5th and 95th percentile values of 31.6 and 46.9 kg. Appendicular skeletal muscle mass decreased earlier than whole body muscle mass, especially leg skeletal muscle mass, which decreased slightly after age 49 years in both sexes. In comparison with their US counterparts in the NHANES, the Chinese participants had lower muscle mass indices (all P < 0.001) and reached a muscle mass peak earlier with a lower muscle mass, with the exception of similar values compared with adult Mexican and White participants. The muscle mass growth rate of Chinese children decreased faster than that of other races after the age of 13. CONCLUSIONS: We present the sex- and age-specific percentiles for muscle mass and appendicular skeletal muscle mass by DXA in participants aged 3-60 from China and compare them with those of different ethnic groups in NHANES. The rich data characterize the trajectories of key muscle mass indices that may facilitate the clinical appraisal of muscle mass and improve the early diagnosis of sarcopenia in the Chinese population.

Developing normative values and predictive models for the 6-minute walk test across diverse adolescent developmental stages.

The six-minute walking test (6MWT) is commonly used to measure functional capacity in field settings, primarily through the distance covered. This study aims to establish reference curves for the six-minute walking distance (6MWD) and peak heart rate (PHR) and develop a predictive equation for cardiovascular capacity in Tunisian children and adolescents. A total of 1501 participants (706 boys and 795 girls), aged 10-18 years, were recruited from schools in Tunisia. The Lambda (L), Mu (M), and Sigma (S) methods (LMS method) were employed to develop smoothed percentile curves for 6MWD and PHR. Multivariate linear regression was utilized to formulate a prediction equation for 6MWD. Smoothed percentiles (3rd, 10th, 25th, 50th, 75th, 90th, and 97th) for 6MWD and PHR were presented with age. All variables showed a strong positive correlation (p < 0.001) with a six-minute walking distance (r ranged from 0.227 to 0.558 for girls and from 0.309 to 0.610 for boys), except resting heart rate, which showed a strong negative correlation (girls: r = -0.136; boys: r = -0.201; p < 0.001). Additionally, PHR showed a weak correlation (p > 0.05). The prediction equations, based on age as the primary variable, were established for both genders. For boys: 6MWD = 66.181 + 38.142 × Age (years) (R2 = 0.372; Standard Error of Estimate (SEE) = 122.13), and for girls: 6MWD = 105.535 + 28.390 × Age (years) (R2 = 0.312; SEE = 103.66). The study provides normative values and predictive equations for 6MWD and PHR in Tunisian children and adolescents. These findings offer essential tools for identifying, monitoring, and interpreting cardiovascular functional deficits in clinical and research settings.

Normative data in resting and maximum heart rates and a prediction equation for young Tunisian soccer players: a cross-sectional study.

Heart rate (HR) is an important indicator of work intensity during physical activity. Maximum heart rate (MHR) is a physiological measure that is frequently used as a benchmark for maximal exercise intensity. The aim of this study was to establish reference curves for maximum heart rate (MHR) and resting heart rate (RHR) and to develop an estimated equation for Tunisian adolescent footballers. The study involved 801 adolescent players, aged 11 to 18, who belonged to five Tunisian first-division soccer teams. The LMS method was used for smoothing the curves and the multivariate linear regression to develop a prediction equation of MHR. Our results showed that MHR and RHR reference curves decrease with age. The values of the median curves of MHR and RHR ranged from 208.64 bpm (11 years) to 196.93 (18 years) and 73.86 (11 years) to 63.64 (18 years), respectively. The prediction equation obtained from the model was MHR= 225.08 - 1.55 X Age (years) (R2 = 0.317; P < 0.001; standard error of the estimate (SEE) = 5.22). The comparisons between the estimated values and the measured values have found that our model (- 0.004 ±5.22 bpm) was to be more accurate than two other widely known models. BOX's equation underestimates the measured MHR values by -3.17 ± 5.37 bpm and TANAKA's equation overestimates by + 4.33 ±5.5 bpm. The reference curves can be used by coaches and physical trainers to classify the resting heart rate (RHR) and maximum heart rate (MHR) of each adolescent player, track their evolution over time, and design tailored training programs with specific intensities for Tunisian soccer players.

Normative reference and cut-offs values of maximal aerobic speed-20 m shuttle run test and maximal oxygen uptake for Tunisian adolescent (elite) soccer players.

This study aimed to develop reference curves of aerobic parameters of 20 m shuttle run test for Tunisian soccer players. The study was conducted in the 2022/2023 pre-season. The reference curves of the maximal aerobic speed (MAS) and the maximal oxygen uptake (VO2max) were developed according to the Lambda, Mu and Sigma (LMS) method, using data from 742 Tunisian premier league soccer players aged 11-18 years. Measured variables included: weight, height, body mass index and maximal heart rate (HRmax). HRmax was measured when the participants completed the maximal aerobic speed. VO2max was estimated using the 20 m shuttle run test protocol (speed increment every minute). Our results presented the smoothed percentiles (3rd, 10th, 25th, 50th, 75th, 90th and 97th) of MAS (km/h) and VO2max (ml/kg•min⁻1) according to age. In addition, raw data showed that VO2 max was positively correlated with age (r = 0.333; P < 0.001), height (cm) (r = 0.279; P < 0.001), weight (kg) (r = 0.266; P < 0.001), practice period (years) (r = 0.324; P < 0.001) and BMI (kg/m2) (r = 0.10; P < 0.05). However, it was negatively correlated to HRmax (bpm) (r = -0.247; P < 0.001). Only the measurements within the age group [12-12.99] are significantly higher (p < 0.001; ES = 0.63) compared with the previous age group [11-11.99]. Finally, regarding prevalence, our findings showed that 15.5 % of the players in our sample had VO2max values above the 87.7th percentile cut-off, while only 0.3 % exceeded the 99.18th percentile. The development of normative curves could help coaches and physical trainers to more accurately detect weaknesses in the aerobic performance of their players in order to sustain high-intensity repetitive actions during a soccer match.

Body fat accrual trajectories for a sample of Asian-Canadian and Caucasian-Canadian children and youth: A longitudinal DXA-based study.

BACKGROUND: Body fat accrual trajectories can be used to monitor trends in body fat mass and identify potential health risks. Currently, no body fat percent (BF%) centile distance and velocity curves exist for Canadian youth. OBJECTIVES: To develop sex-specific and ethnic-specific BF% centile distance and velocity curves for White and Asian-Canadian youth. METHODS: We utilized 4734 observations from 944 participants (female = 487; Asian = 532) to create sex-specific BF% velocity curves for age 10 to 18 years and sex-specific and ethnic-specific BF% percentile distance curves for ages 9 to 18 years for White and Asian children. BF% was derived from whole body DXA scans. RESULTS: BF% centile distance curves for Asian and White girls were similar. BF% at most centiles plateaued around age 16 for Asian but not for White boys. Velocity curves for boys declined from age 11 to 13 years and then increased until age 18 years. For girls from 10 to 15 years, velocity curves converged towards the 50th centile then remained flat from 16 to 18 years. CONCLUSIONS: BF% distance and velocity centiles can be used to identify when an individual veers from an average BF% accrual trajectory. In future, these curves may be used to investigate differences in fat mass and accrual across Canada.

The adaptation of Demirjian's dental age estimation method on North German children.

The aim of this study was to test the accuracy of Demirjian's method for dental age (DA) estimation on north German children, to adapt the method used in case of inaccuracy in this sample and to construct dental maturity percentile curves for this population. Orthopantomograms (OPGs) of 1260 north German children (566 males and 694 females) aged 5-17 years were used from patients' records of the Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Germany. Demirjian's dental maturity scale for the seven left mandibular teeth was applied to the first sample (951 OPGs) to estimate the DA and compare it to the chronological age (CA) of each child. For the adaptation of Demirjian's method on this sample of radiographs, new weighted maturity scores were created by the use of linear regression. Polynomial percentile curves of the total dental maturity in comparison to the CA are presented. The second sample (309 OPGs) was used to evaluate the adapted method and compare it to Demirjian's method. Demirjian's method overestimated the mean CA of boys by 0.46±0.86 years (mean difference±standard deviation) and of girls by 0.55±0.95 years. The new adapted weighted scores estimated the CA of boys (0.07±0.82 years) and girls (-0.04±0.82 years) more accurately. The adapted method showed no significant difference between DA and CA. The method by Demirjian et al., when applied to north German children, significantly overestimated most age cohorts for both sexes. The adapted north German weighted scores and percentile curves showed a notable improvement in age estimation and were more reliable for CA estimation and DA assessment.

Percentile reference curves for normal pancreatic dimensions in Indian children.

OBJECTIVES: This study aims at determining the normal pancreatic dimensions in pediatric age groups considering demographic parameters and thus developing percentile reference curves for normal pancreatic dimensions in Indian children. SETTING AND DESIGN: It is a cross-sectional study. MATERIALS AND METHODS: A hospital-based cross-sectional study was planned at a children hospital during July 2016-December 2017, in which the pancreatic dimensions of 1078 normal children in the age range of 1 month to 19 years were obtained through abdominal ultrasonography (USG). The demographic details like age and gender were obtained for each child. STATISTICAL ANALYSIS USED: Percentile reference curves were obtained with reference to age for each gender type independently. Generalized additive models for location, scale, and shape were used to obtain percentile plots for each pancreatic part. RESULTS: The mean age of children was 6.65 ± 4.43 years and the male-to-female ratio was 1.63:1. The head, body, and tail dimensions increased with the age. For head, up to 25th percentile, the curves were similar for both genders, while subsequent curves were higher in males as compared to females. Similar was the observation for body of pancreas. For tail, up to 75th percentile, the curves were similar for both genders. CONCLUSION: The normal ranges can be supportive in diagnosis of illness related to pancreas. The dimensions within 5-95th percentile along with iso-echogenicity can be regarded as normal, while the dimensions beyond these limits along with change of echogenicity can be suspected for pancreatic disorders.

Development of the Drooling Infants and Preschoolers Scale (DRIPS) and reference charts for monitoring saliva control in children aged 0-4 years.

OBJECTIVES: To develop and validate a parent questionnaire to quantify drooling severity and frequency in young children (the Drooling Infants and Preschoolers Scale - the DRIPS). To investigate development of saliva control in typically developing young children in the age of 0-4 years. To construct sex-specific reference charts presenting percentile curves for drooling plotted for age to monitor the development of saliva control in infancy and preschool age. STUDY DESIGN: The DRIPS was developed consisting of 20 items to identify severity and frequency of drooling during meaningful daily activities. Factor analysis was performed to test construct validity. A piecewise logistic regression was followed by a piecewise linear regression to construct sex-specific reference charts. RESULTS: We obtained 652 completed questionnaires from parents of typically developing children. The factor analysis revealed four discriminating components: drooling during Activities, Feeding, Non nutritive sucking, and Sleep. To illustrate the development of saliva control, eight sex-specific reference curves were constructed to plot the scores of the DRIPS by age group, at the 15th, 50th, 85th and 97th percentile. About 3-15% of the preschoolers in our cohort did not acquire full saliva control at the age of 4 years. CONCLUSIONS: With the DRIPS it is possible to validly compare and visualize the development of saliva control in an individual infant or preschooler and allow clinicians to timely initiate individually targeted interventions if children outperform.

[Percentile curves on growth among breastfed 1-4 year olds in 8 urban areas].

Objective: To construct the growth percentile curves of weight-, length/height-, head circumference and BMI for 1 to 4 year-olds who had been breastfed in urban areas. Methods: Data was from the longitudinal study on 1 025 breastfed children aged 1 to 4 years, in 8 urban areas during 2008-2012. MLwiN2.25 was selected to construct the multi-level models of weight-for-age,length for-age, head circumference-for-age and BMI-for-age. The models included many growth relevant factors including gender, age, family and social demographic characteristics, perinatal factors, parent biological characteristics, dietary patterns and diseases of childen. Based on these models, predicted values (P(3), P(15), P(50), P(85), P(97)) were estimated to fit the percentiles reference curves. Results: The percentiles reference curves of weight-, length/height, head circumferenceand BMI-for-age for the 1-4 year-olds who had been breastfed in the urban areas were developed. Differences of all the indicators between boys and girls were statistically significant (P<0.001). Weight, length/height, head circumference and BMI were higher in boys than those in girls, with an average differences as 0.56-0.76 kg, 0.89-1.12 cm, 0.64-0.91 cm and 0.31-0.52 kg/m(2). Conclusion: The percentiles reference curves on growth, constructed by the longitudinal observational data and scientific method, were important in reflecting the development of breastfed children in urban areas.

Percentile curves for skinfold thickness for Canadian children and youth.

Background. Skinfold thickness (SFT) measurements are a reliable and feasible method for assessing body fat in children but their use and interpretation is hindered by the scarcity of reference values in representative populations of children. The objective of the present study was to develop age- and sex-specific percentile curves for five SFT measures (biceps, triceps, subscapular, suprailiac, medial calf) in a representative population of Canadian children and youth. Methods. We analyzed data from 3,938 children and adolescents between 6 and 19 years of age who participated in the Canadian Health Measures Survey cycles 1 (2007/2009) and 2 (2009/2011). Standardized procedures were used to measure SFT. Age- and sex-specific centiles for SFT were calculated using the GAMLSS method. Results. Percentile curves were materially different in absolute value and shape for boys and girls. Percentile girls in girls steadily increased with age whereas percentile curves in boys were characterized by a pubertal centered peak. Conclusions. The current study has presented for the first time percentile curves for five SFT measures in a representative sample of Canadian children and youth.

The Anthropometric Measurements and Percentile Curves of Children Aged 0-5 Years in Eastern Turkey

ABSTRACT Objective: To determine the growth reference value of children in our province and to compare these values with current values of the USA and other local values of our country. Methods: A total of 615 boys and 586 girls with different socioeconomic levels and ages of 0-5 years were included in the study. In all children, weight, height, head circumference, abdominal circumference, hip circumference, mid-arm circumference, and lower segment length were taken. All measurements were performed by the same paediatrician. The lambda-mu-sigma method was used for the preparation of percentile curves. Results: The body weight, head circumference and chest circumference measurements of boys were significantly higher than those in girls. Anthropometric measurements of children in high-income groups were higher than those in the low-income group. All of the anthropometric parameters except upper mid-arm circumference were higher in children fed with breast milk and formula milk than in children who only fed with breast milk. The relation between the mother's education level and anthropometric parameters was insignificant. Conclusion: Our results showed that the anthropometric measurements of our children were similar to those of west Turkey as well as those of the United States. On the other hand, our children's anthropometric measurements were higher than other local values. Relatively high values of height have been interpreted as a genetic feature.

Fat Mass Centile Charts for Brazilian Children and Adolescents and the Identification of the Roles of Socioeconomic Status and Physical Fitness on Fat Mass Development.

This paper presents fat mass centile charts for Brazilian youth and investigates the roles of socioeconomic status and physical fitness (PF) on fat mass (FM) development. Two northeast Brazilian samples were used: a cross-sectional sample of 3659 (1921 girls) aged 8 to 16 years and a mixed-longitudinal series of cohorts (8-10, 10-12, 12-14, 14-16 years) with 250 boys and 250 girls. A measure of somatic maturity was used as a marker of biological maturation; PF comprised agility, explosive and static strength, and aerobic capacity. Socioeconomic status was based on school attended; public or private. Slaughter's anthropometric equations were used to estimate FM. Percentile charts was constructed using the LMS method. HLM (Hierarchical Linear Model) 7 software modeled FM changes, identifying inter-individual differences and their covariates. Girls and boys had different FM percentile values at each age; FM increased nonlinearly in both girls and boys. Higher PF levels reduced FM changes across time in both sexes. Sex-specific non-linear FM references were provided representing important tools for nutritionists, pediatriciann and educators. Physical fitness levels were found to act as a protective factor in FM increases. As such, we emphasize PF importance as a putative health marker and highlight the need for its systematic development across the school years.

New Reference Centiles for Left Ventricular Mass Relative to Lean Body Mass in Children.

BACKGROUND: Echocardiographic measurement of left ventricular (LV) mass is routinely performed in pediatric patients with elevated cardiovascular risk. The complex relationship between heart growth and body growth in children requires normalization of LV mass to determine its appropriateness relative to body size. LV mass is strongly determined by lean body mass (LBM). Using new LBM predictive equations, the investigators generated sex-specific LV mass-for-LBM centile curves for children 5 to 18 years of age. METHODS: This retrospective study used M-mode echocardiographic data collected from 1995 through 2003 from 939 boys and 771 girls between 5 and 18 years of age (body mass index < 85th percentile for sex and age) to create smoothed sex-specific LV mass-for-LBM reference centile curves using the Lamda Mu Sigma method. The newly developed reference centiles were applied to children with essential hypertension and with chronic kidney disease, groups known to be at high risk for LV hypertrophy (LVH). The identification of LVH using two different normalization approaches was compared: LV mass-for-LBM and LV mass index-for-age percentiles. RESULTS: Among 231 children at risk for LVH, on average, relative LV mass was higher using the LV mass index-for-age percentile method than the LV mass-for-LBM percentile method. LVH was more likely to be diagnosed among overweight children and less likely among thin children. CONCLUSIONS: This study provides new LV mass reference centiles expressing LV mass relative to LBM, the strongest determinant of LV mass. These reference centiles may allow more accurate stratification of cardiovascular risk in children.

Triceps and Subscapular Skinfold Thickness Percentiles and Cut-Offs for Overweight and Obesity in a Population-Based Sample of Schoolchildren and Adolescents in Bogota, Colombia.

The assessment of skinfold thickness is an objective measure of adiposity. The aims of this study were to establish Colombian smoothed centile charts and LMS L (Box-Cox transformation), M (median), and S (coefficient of variation) tables for triceps, subscapular, and triceps + subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic (ROC) analysis based on a population-based sample of children and adolescents in Bogotá, Colombia. A cross-sectional study was conducted in 9618 children and adolescents (55.7% girls; age range of 9-17.9 years). Triceps and subscapular skinfold measurements were obtained using standardized methods. We calculated the triceps + subscapular skinfold (T + SS) sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived using the LMS method. ROC curve analyses were used to evaluate the optimal cut-off point of skinfold thickness for overweight and obesity, based on the International Obesity Task Force definitions. Subscapular and triceps skinfolds and T + SS were significantly higher in girls than in boys (p < 0.001). The ROC analysis showed that subscapular and triceps skinfolds and T + SS have a high discriminatory power in the identification of overweight and obesity in the sample population in this study. Our results provide sex- and age-specific normative reference standards for skinfold thickness values from a population from Bogotá, Colombia.