Secular Trends in Birthweights in Two Epochs Over 40 Years in a Tertiary Care Center

Objective: To compare the average birthweights and the weight centiles of the ‘new’ growth charts with the ‘old’ (1974) charts developed in the same unit four decades ago. Methods: Birthweight and gestation data of the eligible 12,355 singleton neonates born between 2009 and 2016 at a level-3 neonatal unit at a public sector hospital were used to develop the new growth chart. We then compared the prevalence of small for gestational age (SGA) and large for gestational age (LGA) classified by the new charts and the old charts, the incidence of short-term adverse outcomes among them, and the diagnostic performance of both the charts to identify the adverse outcomes in a separate validation cohort. Results: The mean birthweights of boys and girls across all gestations were higher by 150-200 g and 100-150 g, respectively, in the new chart. The prevalence of SGA doubled (9.8% vs 4.7%), but LGA decreased by one-third (17.5% vs 25.9%) with the new chart. However, the proportion of SGA and LGA having one or more short-term adverse outcomes, and the diagnostic performance of both the charts to identify neonates with shortterm adverse outcomes, were comparable. Conclusion: There was an upward shift in the birthweights by about 150 g across all gestations in the new chart compared to the old chart developed 40 years ago. The findings imply the need to consider using updated growth charts to ensure accurate classification of size at birth of neonates.

Skill up; gradation of anganwadi workers pertaining to growth chart plotting and interpretation in rural areas of Varanasi district, India

Background: The task of using the growth chart by Anganwadi Workers (AWWs) for growth monitoring requires technical skill. It was hypothesized that skill up-gradation can make a difference in the performance of AWWs in regard with growth monitoring. The aim of the study was to evaluate the effect of intervention in improving skill of AWWs regarding growth chart plotting and interpretation.Methods: It was a field based interventional study, which was conducted in rural areas of Varanasi district, India. A total of 66 AWWs each from Chiraigaon (intervention) and Cholapur (control) community development blocks of Varanasi district was selected for the study. Each AWW was provided 3 weight readings of different ages for plotting and 4 filled growth charts for interpretation. Chi square test has been applied to assess the significant difference.Results: Only around 10% of AWWs could correctly plot all 3 growth charts and similar proportion of AWWs could also correctly interpret all 4 filled growth charts. The planned intervention could significantly improve their skill of growth chart plotting and interpretation and during end line survey 41% and 77% of AWWs could correctly plot all 3 growth charts and interpret all the four growth charts, respectively.Conclusions: The developed hypothesis is proved, and intervention was found effective in significantly improving the skills of AWWs in regard with growth monitoring.

Development of disease-specific growth charts in Turner syndrome and Noonan syndrome

Many congenital diseases are associated with growth failure, and patients with these diseases have specific growth patterns. As the growth patterns of affected individuals differ from those of normal populations, it is challenging to detect additional conditions that can influence growth using standard growth charts. Disease-specific growth charts are thus very useful tools and can be helpful for understanding the growth pattern and pathogenesis of congenital diseases. In addition, disease-specific growth charts allow doctors to detect deviations from the usual growth patterns for early diagnosis of an additional condition and can be used to evaluate the effects of growth-promoting treatment for patients. When developing these charts, factors that can affect the reliability of the charts should be considered. These factors include the definition of the disease with growth failure, selection bias in the measurements used to develop the charts, secular trends of the subjects, the numbers of subjects of varying ages and ethnicities, and the statistical method used to develop the charts. In this review, we summarize the development of disease-specific growth charts for Japanese individuals with Turner syndrome and Noonan syndrome and evaluate the efforts to collect unbiased measurements of subjects with these diseases. These charts were the only available disease-specific growth charts of Turner syndrome and Noonan syndrome for Asian populations and were developed using a Japanese population. Therefore, when these charts are adopted for Asian populations other than Japanese, different growth patterns should be considered.

Gender differences in nutritional status among under five children in rural areas of Bijapur district, Karnataka, India.

Background: Malnutrition is frequently part of a vicious cycle that includes poverty and disease Socio-economic and political changes that improve health and nutrition can break the cycle, as can specific nutrition and health interventions. Malnutrition in children is a multifactorial causation. Hence this study was conducted to assess the role of gender in the nutritional status of the under five children. Objective: To assess the nutritional status of under five children and its relationship with the gender of the child. Methods: A Cross Sectional Study was conducted across the ten Villages (2 Villages per Taluk) of Bijapur District from January 2013 to November 3013.A total of 1046 children (523 Males and 523 Females) were included in the study. WHO growth Charts was used to grade the severity of Malnutrition. Results: The overall prevalence of underweight among under five children was 43% (49.8 % male and 36.7% female). The association between underweight and gender was statistically significant. The overall prevalence of stunting among under five children was 38 % (40.1 % male and 35.9% female) and significantly associated with gender. The overall prevalence of wasting among children was 28.7 % (36.5 % male and 21.2 % female) and significantly associated with gender. Conclusions: The median height and weight for the majority of children were within the normal range of WHO 2006 growth charts. Though it is believed that male children are better and well-nourished than females, the finding in our study is contradictory which a positive sign is.

Designing New Growth Charts for Low-birth Weight Babies: Need of the Hour in India.

Literature reveals theories explaining low birth weight (LBW) babies’ unplanned catch-up growth is related to several non-communicable diseases (NCDs) in adult-life. Is the current growth chart as per World Health Organization child growth standards of healthy breast feed infants and young child is applicable for even LBW or small for gestational age babies? There are high chances that these LBW babies who are growing “in their centiles” will be diagnosed as mild or moderate protein energy malnutrition (PEM) in clinical settings as the current diagnostic criteria for PEM do not include birth weight as an indicator. Besides they are encouraged for home based extra caloric food to gain weight and thereby encouraging them to “crossing the percentile” in the growth curve. Do these managements really benefit the baby or are we inadvertently exposing them to increased future risk of adult diseases must be considered seriously. Thus, we may require revision to make a separate standardized growth chart for LBW babies indicating how they should grow.

Longitudinal Growth of Infants in Qatar: Comparison with WHO and CDC Growth Standards.

Longitudinal growth data for infants in Qatar were compared to growth standards published by the CDC and WHO. 300 randomly selected full-term normal infants (150 males, 150 females) in Qatar were followed-up and weight and length were sequentially recorded at 2 months, 4 months, 6 months, 12 months and 18 months age. The mean length for age of girls was higher than those published by the CDC and WHO at 12 and 18 months of age. Using the CDC standard for weight for length detected more wasted infants (9.0% and 6.5%) compared to using WHO standards (6.27% and 6.0%) for males and females, respectively. When WHO and CDC standards are compared, more infants were identified as overweight when the former were used. The WHO standards are preferable because they are based on a leaner breastfed reference and because overweight is likely to be a greater problem in Qatar in the future.

Assessment of Clinical Nutrition Problems in Korean Adolescents / 대한소아소화기영양학회지

Nutritional assessment in adolescents is key to detect major health risks at this age, such as obesity and under nutrition, which continue as adult health risks. Recent epidemiological evidence in Korea has shown that obesity is quite prevalent. Scientific protocols assessing nutritional status should be used in various clinical settings, particularly in hospitals and schools. Recent protocols are typically based on growth charts, calorie calculating equations, and Dietary Reference Intakes in Korea which have been developed through extensive studies. Non-communicable chronic diseases, such as type II diabetes mellitus and atherosclerosis could be ameliorated by intervening in behaviors related to nutrition.

Anthropometric Changes in Korean Children and Adolescents

Anthropometric changes in infants, children, and adolescents from 1965 to 2005, during the period of 40 years, were reviewed. Those differences of adult heights were 5.3 cm from 168.9 cm to 174.2 cm in males, and 5.4 cm from 155.9 cm to 161.3 cm in females, respectively. However, the secular trends were more prominent in 13 years of age in males which was 18.6 cm, and in 12 years of age in females, 15.5 cm, which means that the age of puberty became earlier as compared to the previous generation. Looking at the changes of body weights in male and female, we can see that obesity became a serious health problem among Korean children and adolescents, particularly in males.

Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005 / 소아과

PURPOSE: The objective of this study was to provide current estimates of the prevalence and examine trends of overweight and obesity in children and adolescents. METHODS: Height and weight measurements from 183,159 (112,974 in 1997, 70,185 in 2005) children and adolescents aged 2 to 18 years were obtained via the 1997 and 2005 National Growth Survey. Obesity among children and adolescents was defined as being at or above the 95th percentile of the gender-specific body mass index (BMI) for age in the 2007 Korean National Growth Charts or a BMI of 25 or higher; overweight was defined as being at or above the 85th percentile to less than the 95th percentile BMI. RESULTS: In 2005, 9.7% (11.3% for boys, 8.0% for girls) of South Korean children and adolescents were obese; 19.0% (19.7% for boys, 18.2% for girls) were overweight or obese. The overall prevalence of obesity increased from 5.8% in 1997 to 9.7% in 2005 (from 6.1% in 1997 to 11.3% in 2005 for boys and from 5.5% in 1997 to 8.0% in 2005 for girls); the increasing trend was most evident in boys, especially those aged 13-18 years. CONCLUSION: The prevalence of obesity among children and adolescents increased significantly during the eight-year period from 1997 to 2005. This study suggests that we need to make a priority of developing strategies to control obesity in children and adolescents; the potential health effects of increases in obesity are of considerable public health importance.

Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005 / 소아과

PURPOSE: The objective of this study was to provide current estimates of the prevalence and examine trends of overweight and obesity in children and adolescents. METHODS: Height and weight measurements from 183,159 (112,974 in 1997, 70,185 in 2005) children and adolescents aged 2 to 18 years were obtained via the 1997 and 2005 National Growth Survey. Obesity among children and adolescents was defined as being at or above the 95th percentile of the gender-specific body mass index (BMI) for age in the 2007 Korean National Growth Charts or a BMI of 25 or higher; overweight was defined as being at or above the 85th percentile to less than the 95th percentile BMI. RESULTS: In 2005, 9.7% (11.3% for boys, 8.0% for girls) of South Korean children and adolescents were obese; 19.0% (19.7% for boys, 18.2% for girls) were overweight or obese. The overall prevalence of obesity increased from 5.8% in 1997 to 9.7% in 2005 (from 6.1% in 1997 to 11.3% in 2005 for boys and from 5.5% in 1997 to 8.0% in 2005 for girls); the increasing trend was most evident in boys, especially those aged 13-18 years. CONCLUSION: The prevalence of obesity among children and adolescents increased significantly during the eight-year period from 1997 to 2005. This study suggests that we need to make a priority of developing strategies to control obesity in children and adolescents; the potential health effects of increases in obesity are of considerable public health importance.

The methodology for developing the 2007 Korean growth charts and blood pressure nomogram in Korean children and adolescents / 소아과

PURPOSE: This study was to provide the methods of developing the growth charts and the blood pressure nomogram among Korean children and adolescents. METHODS: The growth charts were developed based on the data from the national growth surveys for children and adolescents in 1998 and 2005. The percentile charts were developed through two stages. At the first stage, the selected empirical charts were smoothed through several fitting procedures including parametric and non-parametric methods. At the second stage, a modified LMS (lambda, mu, sigma) statistical procedure was applied to the smoothed percentile charts. The LMS procedure allowed to estimate any percentile and to calculate standard deviation units and z-scores. The charts for weight-for-age, height-for-age, BMI-for-age, weight-for-height and head circumference-for-age were developed by sex. Age and normalized height controlled sex-specific nomograms of systolic and diastolic blood pressure were developed by a fixed effect model of general regression using the data from 2005 national growth survey. RESULTS: The significant systemic differences between the percentiles of growth charts and the empirical data were not found. The final output of the study is available from Korean Center for Disease Control and Prevention homepage, http://www.cdc.go.kr/webcdc/. Blood Pressure nomogram was tabulated by height percentiles and age using the regression coefficients analyzed with regression model. CONCLUSION: 2007 growth charts and blood pressure nomogram were the first products based on the statistical modeling using the national survey data. The further study on the methodology including data collection, data cleaning and statistical modeling for representative growth charts would be needed.