Comparação das curvas NCHS, CDC e OMS em crianças com risco cardiovascular / Comparison of NCHS, CDC, and WHO curves in children with cardiovascular risk

OBJETIVO: O objetivo deste trabalho foi comparar a prevalência de sobrepeso e obesidade de acordo com três curvas de crescimento: OrganizaçãoMundialde Saúde(OMS/2006), National Centre for Health Statistics (NCHS/1977) e Centers for Disease Control and Prevention (CDC/2000) em crianças com fatores de risco cardiovascular. MÉTODOS: Foram avaliados dados de 118 crianças e adolescentes, com idade entre 2 e 19 anos, atendidos entre os anos de 2001 a 2009 no Ambulatório de Cardiologia Pediátrica Preventiva do Instituto de Cardiologia de Porto Alegre. As variáveis analisadas foram: peso, altura, idade e sexo. Estas foram classificadas quanto aos critérios peso/idade, estatura/idade e índice de massa corpórea (IMC). Os pontos de corte adotados foram de três curvas de crescimento OMS/2006, NCHS/1977, CDC/2000. RESULTADOS: Quanto ao critério peso/idade pelo NCHS, 18% das crianças foram classificadas com eutrofia e 82% com peso elevado; pelo CDC, 28% eutróficas e 72% peso elevado; e pela OMS, 16,0% com eutrofia e 84% com peso elevado. Segundo o IMC, foram classificadas com baixo peso 0,8% da população, segundo CDC e OMS; eutróficos 7,6% e 6,8%, sobrepeso 26,3% e 11,9%, e com obesidade 65,3% e 80,5%, pelo CDC e OMS, respectivamente. Quanto ao critério estatura/idade, não houve diferença significativa entre os referenciais; em média, 98,3% da população estudada apresentou estatura adequada para idade. CONCLUSÃO: Conclui-se que as novas curvas da OMS são mais sensíveis para identificar obesidade em uma população de risco, o que tem importantes implicações para o manejo preventivo e terapêutico.

OBJECTIVE: The study aimed to compare the prevalence of overweight and obesity according to three growth curves, created by theWorld Health Organization (WHO/2006), by the National Center for Health Statistics (NCHS/1977), and by the Centers for Disease Control and Prevention (CDC/2000) in children with cardiovascular risk factors. METHODS: Data from 118 children and adolescents, aged between 2 and 19 years, treated between the years 2001 to 2009 at the Pediatric Preventive Cardiology Outpatient Clinic of the Instituto de Cardiologia de Porto Alegre were evaluated. The variables analyzed were: weight, height, age, and gender. Variables were classified according to the following criteria: weight/age, height/age, and body mass index (BMI). The cutoff points used were obtained from the three growth curves: WHO/2006, NCHS/1977, and CDC/2000. RESULTS: Regarding the criterion weight/age by the NCHS curve, 18% of the children were classified as having normal weight, and 82% had excess weight; by the CDC curve, 28% had normal and 72% had excess weight; by the WHO curve, 16.0% had normal weight and 84% had excess weight. According to the BMI, 0.8% of the population was underweight. According to the CDC and WHO curves, 7.6% and 6.8% had normal weight; 26.3% and 11.9% were overweight; and 65.3% and 80.5% were obese, respectively. Regarding the height/age criterion, there was no significant difference between the references and, on average, 98.3% of the population showed adequate height for age. CONCLUSION: The new WHO curves are more sensitive to identify obesity in a population at risk, which has important implications for preventive and therapeutic management.

Clasificación de niños colombianos con desnutrición según la referencia NCHS o el estándar OMS

Se realizó un estudio descriptivo para evaluar la concordancia en la clasificación de niños colombianos con desnutrición según la referencia del National Center for Health Statistics (NCHS) y los estándares de la Organización Mundial de la Salud (OMS). Participaron 660 niños entre 0 y 59 meses con desnutrición aguda moderada (P/TZ<-2) y grave (P/TZ<-3 o edematizados), en recuperación nutricional hospitalaria entre 2000 y 2009. Se analizaron los indicadores talla para la edad (T/E) al ingreso y peso para la talla al ingreso (P/Tin) y egreso (P/Teg). Se compararon medias con la prueba t de Student pareada; la concordancia entre NCHS y OMS se estimó con Coeficiente de Correlación Intraclase (CCI) y el Índice Kappa; se evaluó el cambio de clasificación de los niños según el instrumento utilizado, con prueba de McNemar. Los instrumentos mostraron alta concordancia en los indicadores T/E (CCI=0,988; k=0,866) y P/Tin (CCI=0,901; k=0,578). Del total de niños clasificados con T/E normal por NCHS, 10,4% se clasificaron con retraso del crecimiento según OMS. Al ingreso 64,0% de los niños presentó desnutrición aguda moderada según NCHS, de éstos 44,8% clasificaron con emaciación severa según OMS, en consecuencia aumentó la emaciación severa de 36,0% hasta 63,3% con OMS. De los niños que egresaron 5% necesitarían más días de hospitalización si hubieran sido evaluados con OMS. En conclusión los estándares OMS captan más niños desnutridos y formas más severas de emaciación y baja talla, con su uso se espera hospitalizar más niños para recuperación nutricional y por más días.

A descriptive study was conducted to evaluate the concordance of National Center for Health Statistics reference (NCHS) used to classify undernourished children from Colombia with the WHO Child Growth Standards. We used data from children aged 6 to 59 months with acute malnutrition (Z <-2) and severe (Z <-3) who were admitted to the “Unidad Vida Infantil” nutrition program in Colombia. Indicators height-for-age, weight for-height were analyzed when they were admitted to the hospital and weight for-height leaving the hospital. A statistical method used to compare means was T-student. Correlation coefficient intraclass (CCI) and Kappa index evaluated the concordance between NCHS and OMS; McNemar method evaluated the changes on the nutritional classification for children according to growth devices used. Of the total number of children classified as normal by NCHS, 10.4% were classified as stunted by WHO. 64% of the children admitted to the hospital presented acute malnutrition according to NCHS, of these 44,8% presented severe emaciation according to OMS, indeed severe emaciation increased of 36,0% to 63,3% using OMS. 5% of children leaving the hospital could need to stay more days if they had been evaluated with OMS. Growth devices shown high concordance in height-for-age (CCI=0,988; k=0,866) and weight for-height (CCI=0,901; k=0,578). Concluded that OMS growth standards classified more malnourished children and more severe states, in addition more malnourished children could be hospitalized and they could stay more days.

Comparação das curvas de crescimento da Organização Mundial da Saúde em relação ao padrão da national Center for Health Statistics em crianças com até cinco anos de idade / Comparison of the growth curves from the World Health Organization in relation to the standards of the National Center for Health statistics in children up to five years of age

Objetivo. Comparar os novos padrões de curva de avaliação de crescimento da Organização Mundial da Saúde(OMS) com aqueles do National Center for Health Statistics (NCHS) em crianças de até cinco anos, atendidas no Hospital Universitário da Universidade Católica de Brasília. Método. Estudo transversal com análise de 302 prontuários de crianças com até cinco anos de idade, atendidas no período de 13-5-2004 a 31-5-2006. O protocolo de pesquisa consistiu na elaboração de planilha do Excel, com dados demográficos e antropométricos. Foram verificados os indicadores altura e idade, peso e altura por meio do escore Z para os padrões do NCHS e da OMS. Para avaliar a concordância entre os dois padrões utilizou-se o teste de simetria de Bowker e o kappa ponderado. Para efeito de análise usou-se nível de significância de 5%. Resultados. As percentagens de baixa estatura moderada e desnutrição moderada foram maiores quando foi usado o padrão da OMS. Os resultados dos testes de simetria evidenciaram valores p < 1. Na interpretação do coeficiente kappa, evidenciou-se concordância em relação ao acaso. Conclusões. Houve concordância na forma de avaliação pelos padrões retrocitados, sendo estes comparáveis entre si. A desnutrição moderada foi mais observada pela nova curva da OMS em ambos os sexos. O padrão da OMS mostrou maior tendência em diagnosticar baixa estatura no sexo masculino. As novas curvas de crescimento da OMS servem como modelo normativo para o crescimento e o desenvolvimento das crianças, o que imprime assim um padrão internacional único.

Objective. To compare the new World Heath Organization (WHO) curves with the National Center For Health Statistics (NCHS) pattern in children younger than 5 years old at the hospital of the Universidade Católica de Brasília. Method. A cross-sectional study analyzing 302 medical records of children less than under 5 years old seen atthat hospital from may 2004 to may 2006. The research protocol consisted of Excel worksheet with demographic and anthropometric data. Height-age and weight-height were verified at the Z score under the NCHS and WHO patterns. To analyze the accordance between the two patterns the Bowker symmetry test and kappa ponderado were used. To analyse it, a significance level of 5% was used. Results. The percentage of low moderate height and moderate subnutrition was higher with WHO pattern. The symmetry test results showed values of p < 1. The kappa coefficient interpretation demonstrated accordance to randomization. Conclusions. There was concordance between the NCHS and WHO patterns, thus both were camparable. Moderate subnutrition was seen more often with the WHO data at both sexes. WHO pattern showed tendency to diagnose low height at the male. The new WHO data is useful to establish children's growth and development, being considered as an unique international pattern

[Anthropometrical parameters in infants in Monastir region, Tunisia]

We evaluated the distribution of anthropometrical parameters in infants in Monastir and compared them with the National Center of Health Statistics reference. Our prospective study included 3033 infants attending primary health care centres for vaccinations who were followed for 18 months. In each visit, we measured weight-for-age, height-for-age and weight-for-height. We found a difference between our distribution curve and the NCHS reference. The prevalence of growth retardation increased with age. The prevalence of under-weight and of wasting were less than 10%. Obesity was seen 6.2% of infants aged 3 months and 11.6% aged 9 months

Diferencias en las prevalencias de desnutrición al usarse referencias nacionales e internacionales / Differences in the prevalence of malnutrition resulting from using a national growth reference or an international growth reference

OBJETIVO: Evaluar si el empleo de dos referencias distintas (internacional y nacional) ocasiona diferencias en las prevalencias de emaciación y retraso del crecimiento en una muestra de niños de 8 a 14 años. MÉTODOS: Se realizó un estudio transversal en una muestra de 1 470 escolares de ambos sexos de la ciudad de La Plata (Provincia de Buenos Aires, Argentina). A partir de los datos de peso y talla se calcularon las puntuaciones Z respecto a los valores de referencia de la primera y la segunda encuesta estadounidense de salud y nutrición (National Health and Nutrition Examination Survey, NHANES I y II), y de la Sociedad Argentina de Pediatría. Las prevalencias de emaciación y retraso del crecimiento se calcularon tomando un punto de corte de dos desviaciones estándar (DE) por debajo de la mediana de referencia. Se compararon las prevalencias mediante la prueba de ji al cuadrado con corrección de Yates y se calcularon la razón de posibilidades (odds ratio, RP) y los intervalos de confianza del 95 por ciento (IC95 por ciento). RESULTADOS: La referencia internacional se asoció positivamente a una mayor prevalencia de retraso del crecimiento, tanto en la muestra total (RP = 5,12; IC95 por ciento: 3,27 a 8,05) como en varones (RP = 4,36; IC95 por ciento: 2,43 a 7,93) y en mujeres (RP = 6,32; IC95 por ciento: 3,10 a 13,27). La prevalencia de emaciación fue similar con ambas referencias. La distribución de la talla para la edad presentó un sesgo a la izquierda respecto de la referencia internacional y a la derecha respecto de la nacional, mientras que la del peso para la talla se superpuso a ambas referencias. CONCLUSIONES: Las diferencias en las prevalencias de retraso del crecimiento calculadas según las dos referencias utilizadas reflejan cuadros disímiles del estado nutricional de la población evaluada. El incremento de la talla de los niños respecto a la referencia nacional apunta a la presencia de una tendencia secular positiva y puede explicar parte de las diferencias en la prevalencia de retraso del crecimiento.

Growth charts of heights and weights of male children and adolescents of Isfahan, Iran.

Measurements of height and weight are important data source relating to growth and development, puberty, and nutritional status of children and adolescents. In clinical setting, the charts of the National Center for Health Statistics (NCHS), USA, are used in Iran. A survey identified significant differences in weight- and height-for-age across provinces, between urban and rural children. Although the percentiles derived from data of the national health survey, in 1990-1992, were substantially below the NCHS charts, the growth patterns were parallel to the NCHS percentiles. In 1997, an anthropometric assessment of male students aged 6-18 years was conducted in Isfahan, a centrally-located city in Iran. The goal of the study was to establish the normograms of heights and weights in Isfahan for use in clinical settings. By a random cluster sample survey, 4,364 of 200,000 male students aged 6-18 years were selected from all areas of the city. Trained health staff measured their heights (cm) and weights (kg), and all the percentiles were calculated. A comparison was made with weight and height data collected from other parts of the country on several occasions. Findings showed that the growth percentiles of 6-18-year male students of Isfahan in 1997 were comparable to the NCHS charts. These students were taller and heavier than their fellow-citizens 22 years earlier, their compatriots in rural areas of Isfahan (1997) and Rasht (1989). They were also taller than those who were living in Tehran (1994). A similar study was conducted at the same time on urban Isfahani female students aged 6-18 years. All the percentiles of their height and weight curves were comparable with those of the NCHS charts. Thus, it is appropriate to use the NCHS charts for school-age children and adolescents in Isfahan city. The cause of improvement in growth parameters in Isfahan should be evaluated in future studies.

Comparison of the anthropometry of Saudi Arabian urate children aged 6-11 years with the NCHS/CDC reference population

To assess the nutritional status of children based on anthropometric indicators and to develop a standard growth chart for schoolchildren in Saudi Arabia. A total of 4,154 male Saudi primary schoolchildren aged 6-11 years were randomly selected, using a three-stage stratified cluster sampling procedure that covered all regions of Saudi Arabia. Weight and height were measured and used to calculate the anthropometric indicators: weight for height, height for age and weight for age. These indicators were compared with the American National Center for Health Statistics Center for Disease Control [NCHS/CDC] reference population. There was an indicator of past malnutrition of children whose height for age fell in the lower centile range of the NCHS/CDC reference population. Weight for height, an indicator of current nutritional status, was comparable with the reference population with only 5% below -2 standard deviations of the reference population. There was a statistically significant trend in the prevalence of indicators of past and current malnutrition with age. While the indicator of past malnutrition increased with age, the prevalence of the indicator of current malnutrition decreased with age. The level of obesity increased from 3.8% at age 6 years to 8.3% at 11 years, with the overall level of obesity of 6.6%. These findings showed high reliability of the interpretation of the anthropometric indicators, and that the Saudi male primary schoolchildren appear to enjoy a comparable nutritional status with their American counterparts. The generated growth charts are more applicable to the Saudis and probably to the Gulf communities as they are derived from local rather than European or American measurements

Estudo antropométrico nutricional de crianças de 0 a 60 meses em bairro de baixa renda, Araraquara, SP 1990-1 / A nutrition antropometric study of children from 0 to 60 months in low income group areas of Araraquara, SP

Com o objetivo de se conhecer os níveis nutricionais, utilizando as medidas antropométricas em crianças de 0 a 60 meses, estudou-se 457 crianças atendidas num centro de saúde municipal, no período de novembro de 1990 a abril de 1991. A maior porcentagem segundo o sexo foi de crianças do sexo feminino, 52,44 por cento. Quanto à faixa etária, a maior porcentagem foi no grupo de três a seis meses, 28,13 por cento. Quanto à procedência, 98,81 por cento eram da zona urbana e destas, 74 por cento tinham pais com baixa escolaridade, ou seja, até o primeiro grau incompleto. Na distribuiçäo das crianças com proporçäo de percentil abaixo de dez para peso e altura, segundo o sexo e faixa etária, observamos que a porcentagem de peso abaixo do percentil 10 foi crescente e gradativa na faixa de três a 24 meses para as crianças do sexo feminino (13,1 por cento a 19,6 por cento segundo os respectivos grupos etários). No grupo de 12 a 24 meses, para ambos os sexos, houve uma maior proporçäo com percentil abaixo de 10 para o peso, embora para altura os dados tenham sido normais. Concluímos portanto que as crianças do sexo feminino apresentaram uma maior proporçäo de desnutriçäo crônica na faixa etária de três a 24 meses. E uma maior proporçäo de desnutriçäo aguda na faixa de 12 a 24 meses para ambos os sexos, quando comparamos com outras faixas etárias, (10,0 por cento para o sexo masculino e 10,7 por cento para o feminino)