Overweight and obesity of school-age children in El Salvador according to two international systems: a population-based multilevel and spatial analysis.

BACKGROUND: The World Health Organization (WHO-2007) and the International Obesity Task Force (IOTF-Cole) systems assess child weight status. However, derived estimations often differ. We aimed to a) compare the prevalence of overweight and obesity, b) analyze individual and contextual factors associated with child weight using multilevel analysis and c) explore the spatial distribution of overweight and obesity using both classification systems. METHODS: We used data from the 2015/2016 National School Height and Weight Census in El Salvador. Information on 111,991 children aged 6.0-9.9 years attending the first grade was analyzed. Body mass index Z-score (BMIZ), overweight and obesity were defined with both classification systems. Weighted kappa was used to measure agreement. Child, school and municipal potential determinants of BMIZ were examined by multilevel analysis. Municipal spatial clustering of overweight and obesity was tested using Moran's Index and Getis-ord Gi* statistics. RESULTS: The combined prevalence of overweight and obesity was higher according to the WHO system than the IOTF (30.4% vs 23.1%). The weighted kappa was 0.83. Boys, children attending urban schools, children attending private schools, and children residing in municipalities with high human development index had higher BMIZ than their counterparts. The Moran's indexes were positives and significant. Clusters of high prevalence (above the national prevalence) of overweight and obesity were found in 29 municipalities using the WHO and IOTF systems. For obesity, 28 and 23 municipalities in clusters of high prevalence were detected using the WHO and IOTF criteria, respectively. CONCLUSIONS: Overweight and obesity is high among school-age children in El Salvador. The prevalence of overweight and obesity was higher when using the WHO system, as compared to the IOTF system. Irrespective of the classification system, the multilevel and spatial analysis derived similar interpretations. These results support the need for national preventive interventions with targeting strategies to reduce overweight and obesity in school-age children.

Differences in Classification Standards For the Prevalence of Overweight and Obesity in Children. A Systematic Review and Meta-Analysis.

The prevalence of childhood obesity has increased dramatically all over the world in recent years. While obesity in adults can be easily measured using the BMI calculation, determining overweight and obesity in children is more controversial. The aim was to compare the three most used international classification systems (WHO 2007, CDC 2000 and Cole-IOTF) to determine overweight and obesity in infant and adolescent populations. We performed a systematic review in accordance with the PRISMA 2020 guidelines of articles comparing any of the three classification systems. The main findings were that the WHO 2007 criteria show the highest prevalence of overweight and obesity in the child and youth population. The prevalence of childhood overweight and obesity was determined to be higher in boys than in girls in most studies, when analysing the classifications of the WHO 2007, CDC 2000 and Cole-IOTF together. However, there was a higher prevalence of overweight and obesity in girls than in boys when only the CDC 2000 and Cole-IOTF criteria were considered. Both the results of the review and the great heterogeneity found in the meta-analysis show that it is necessary to unify the criteria for the classification of childhood overweight and obesity. International standards are insufficient for working with the current population. A working group should be created to address this issue and agree on the unification of a gold standard, taking into account the geographical region, the ethnic groups and the age groups of the child and youth population and above all, the secular growth.

Glioma Grading and Determination of IDH Mutation Status and ATRX loss by DCE and ASL Perfusion.

PURPOSE: To evaluate arterial spin labeling (ASL) perfusion and dynamic contrast-enhanced (DCE) perfusion in glioma grading according to the previous WHO classification of 2007, as well as concerning isocitrate dehydrogenase (IDH) mutation status and ATRX expression as required by the new WHO 2016 brain tumor classification. METHODS: The mean values of Ktrans, Kep, Ve, and Vp by DCE perfusion, and cerebral blood flow (CBF) by ASL perfusion were assessed retrospectively in 40 patients with initial glioma diagnosis. Perfusion parameters were correlated and compared concerning glioma grading, IDH mutation status and ATRX expression. RESULTS: The DCE and ASL perfusion parameters showed merely moderate correlation. The Ktrans, Ve, and CBF by DCE perfusion were different in low-grade and high-grade gliomas (p = 0.0018, p < 0.0001, and p = 0.0038, respectively). Ve was useful in distinguishing high-grade from low-grade gliomas (p = 0.024, sensitivity = 1.00, specificity = 0.80). CBF by ASL perfusion enabled discrimination of astrocytomas with and without IDH mutation (p = 0.014, sensitivity = 0.75, specificity = 0.88) and showed a trend for the discrimination of astrocytomas with IDH mutation from oligodendrogliomas (p = 0.074). CONCLUSION: In conclusion, DCE and ASL perfusion are complementary in the differentiation of gliomas. The discrimination of low- and high-grade gliomas is possible by the DCE perfusion parameter Ve, while ASL perfusion shows potential for the differentiation of the IDH and ATRX mutation status of gliomas following the new WHO classification 2016. Both perfusion techniques might represent different aspects of brain tumor perfusion.

Concordancia entre tablas de referencia utilizadas para diagnóstico del estado nutricional de escolares de comunidades rurales

Introducción: La forma más fácil y económica para observar el crecimiento es la antropometría, Para medir el crecimiento se utilizan estándares de referencia que evalúan a la normalidad del crecimiento. Las curvas de crecimiento recomendadas por la OMS hasta antes del 2006 eran las del NCHS y CDC, a partir de abril del 2006 la OMS propuso el uso del nuevo patrón de crecimiento. Objetivo: Medir la concordancia entre las tablas de referencias de crecimiento de la OMS 2007 y del NCHS/CDC 2000 utilizando los indicadores talla para la edad (T/E) e índice de masa corporal para la edad (IMC/E). Materiales y Métodos: Estudio analítico de corte trasverso. Se estudiaron 148 niños de entre 5 y 16 años que asistieron a escuelas de tres comunidades rurales. Las variables analizadas fueron T/E e IMC/E diferenciada por sexo. Se estimó el coeficiente kappa para evaluar la concordancia entre las referencias. Se utilizó programas estadísticos WHO Antro Plus V.1.0.4, y con EpiInfo v3.5.1 2008. Resultados: La concordancia más alta se encontró entre las referencias de la OMS 2007 y el CDC 2000 con el indicador T/E en la niñas con κ=0,882 y en los niños κ=0,760; con el indicador IMC/E el coeficiente Kappa más alto se encontró en la población de niños (κ=0,733) y en las niñas (κ=0,452). Conclusiones: Se obtuvo una concordancia buena entre ambas tablas de referencias para el indicador T/E. Existen concordancia moderada con el indicador IMC/E entre las referencias de la OMS 2007 y CDC 2000 para el diagnóstico nutricional.

Introduction: The easiest and most economical way to observe growth is anthropometry. To measure growth, reference standards are used that evaluate the normality of growth. The growth curves recommended by the WHO until before 2006 were those of the NCHS and the CDC. As of April 2006, the WHO proposed the use of new growth pattern charts. Objective: To measure the concordance between the 2007 WHO growth reference tables and those of the 2000 NCHS / CDC using the height-for-age (T / E) and body-mass-index-for-age (BMI / E) indicators. Materials and Methods: This was a cross-sectional analytical study. We studied 148 children between 5 and 16 years of age who attended schools in three rural communities. The variables analyzed were T / E and BMI / E, differentiated by sex. The kappa coefficient was estimated in order to evaluate the concordance between the references. The WHO Antro Plus V.1.0.4 and Epi Info v3.5.1 2008 were used for statistical analysis. Results: The highest concordance was found between the 2007 WHO growth reference tables and the 2000 CDC tables with the T / E indicator in girls with κ = 0.882 and in boys with κ = 0.760; with the IMC / E indicator, the highest Kappa coefficient was found in the population of boys (κ = 0.733) and in girls (κ = 0.452). Conclusions: There is good concordance between both reference tables for the T / E indicator. There is moderate agreement with the IMC / E indicator between the 2007 WHO and 2000 CDC growth references tables for the diagnosis of nutritional status..