Body mass index in 7-9-y-old French children: frequency of obesity, overweight and thinness.

OBJECTIVE: To assess the frequency of different grades of nutritional status (obesity, overweight and thinness) in French children aged 7-9 y using four current definitions based on body mass index (BMI). METHODS: Data were collected in 2000 in a randomly selected sample of French children following the protocol recommended by the European Childhood Obesity Group (ECOG). After computing the BMI (weight/height squared), four references were used to define grades of nutritional status: (1) the French references to define thinness and overweight (3rd and 97th percentiles respectively); (2) the Must et al references to define thinness, overweight and obesity (5th, 85th and 95th percentiles respectively); (3) the International Obesity Task Force cut-offs to define overweight and obesity; and (4) the Center for Disease Control 2000 references to define thinness, overweight and obesity (5th, 85th and 95th percentiles respectively). RESULTS: Age and gender standardized frequencies were estimated in 1582 children. According to the French, Must et al, IOTF and CDC references, overweight (including obesity) affected 16.3, 23.9, 18.1 and 20.6% of children, respectively; obesity affected 9.3, 3.8 and 6.4% of children according to the Must, IOTF and CDC references, respectively. Thinness was present in 3.9, 6.0 and 6.0% of children according to the French, Must and CDC references. Whatever the definition, little difference was observed between sexes. Through age classes, as a rule, overweight and obesity tended to decrease while thinness tended to increase. CONCLUSION: The present study revealed an increasing prevalence of overweight in comparison with previous French data and a trend for increasing prevalence of thinness. The IOTF-based prevalence of overweight (including obesity) in 2000 in France was similar with the prevalence recorded in the late 1980s in the USA and the prevalence of obesity in 2000 in France was similar to the prevalence of obesity in the late 1970s in the USA. Data in France are comparable to those reported in other studies conducted in Western Europe. This study provides baseline information for analysis of time trends and for geographical comparisons.

[Mental and behavior disorders in children placed in long term care institutions in Hunedoara, Cluj and Timis, Romania]. / Les troubles mentaux et les troubles du comportement des enfants placés en établissement de long séjour dans les judets de Hunedoara, Cluj et Timis, Roumanie.

This article originated from a descriptive study done in 1992-1993 in Romania. The study was initiated and coordinated by the French NGO "Médecins du Monde", was directed by three health organizations (the "Observatoire régional de la santé de Languedoc-Roussillon", the "Unité 265 INSERM", the Romanian League for Mental Health) and was granted by the Romanian government and the European Community Commission. There are many publications about children's mental and behavioural disorders. But there are few epidemiological studies concerning the prevalence of these disorders among children suffering from social difficulties. This article explores the prevalence of mental and behavioral disorders among Romanian children institutionalized and examines specifically the prevalence among children in homes for children ("Casa de Copii") to compare it with similar data published in other countries. First, this article explores the prevalence of mental and behavioral disorders among a population of 4.692 children institutionalized in three Romanian districts in 1992. Second, this article examines the prevalence of these disorders among a population of 1.610 children institutionalized in homes for children ("Casa de Copii"), i.e. 1,610 children ages ranging from 4 to 18 years and suffering from social difficulties. Homes for children are out of home care institutions which are specialised neither in physical deficiencies nor in mental disorders. From this population, a randomized sample of 508 children has been screened by physicians and psychologists based on an evaluation protocol. Then each disorder has been coded as a diagnosis, according to the Tenth International Disease Classification (WHO). Fifty-four percent (54%) of the children institutionalized in homes for children in three Romanian districts in 1992 had a main diagnosis of mental or behavioural disorder. Third, this article compares our results to the prevalence found in other studies. Only three studies could be selected for comparison because they were the only ones with the three following criteria: 1) a focus on a population of children or a randomized sample of children ages ranging from 4 to 18 years, 2) a focus on children suffering from social difficulties and living in out of home care, 3) disorders evaluated by health professionals or a validated methodology. Our results lies within the range of prevalence found in the literature (41-70%). A discussion follows regarding methodological matters and critiques that may be launched from such a comparative designs. Finally, the high frequency of institutionalization in Romania in 1992 illustrates how few solutions there were to social difficulties and how exaggerated institutionalization was. This was a very different situation compared to Western Europe and Northern America. This should not hide, however, the actual modifications that took place in Romania. This article concludes with a brief description of the modifications which have been generated by the evaluation protocol used here.

Evolution of GH secretion in urine during an in-patient slimming course in obese children.

OBJECTIVE: To estimate the change in GH excretion in urine (GH-U) during a slimming course, and if increased, to assess the components of the course related to the increase in obese children. DESIGN: Observational follow-up study of patients admitted for primary obesity to an in-patient slimming course lasting at least 10 weeks. SUBJECTS: 48 complete observations out of 54 consecutive pre-pubertal patients admitted to a paediatric centre for treatment of primary obesity (BMI greater than the 90th percentile of the national reference curves). MEASUREMENTS: GH excretion in urine by immunoradiometric assay, at entry and after 10 weeks, various anthropometric measurements, nutritional intake and departure from the prescribed diet, time spent in physical activity, sleep duration. RESULTS: A mean decrease of 0.90 standard deviations for BMI was accompanied by a 34% increase of GH-U. Time spent in physical activity was the only component of the course found to be related to the magnitude of GH-U increase. CONCLUSION: The results of this observational study confirm that GH-U is increased after a slimming course in children, and suggest that physical activity is a major contributor to the restoration of normal GH-U levels.

[Growth curves from birth to 6 years of age: growth in weight, height and cranial circumference according to sex]. / Courbes de croissance de la naissance à 6 ans: croissance en poids, taille et périmètre crânien selon le sexe.

UNLABELLED: The growth supervision of children using growth curves is a widespread and useful tool in general pediatric practice. In France the latest reference curves are rather ancient, therefore it seemed to us interesting to re-examine some growth parameters and to compare them to the current reference data. PATIENTS AND METHODS: The studied sample was composed of 7,000 children from the Rhône-Alpes region in France who were seen for a school health check-up. Anthropometric measurements (35,000) related to weight, height and cranial circumference of these children aged from 0 to 6 were selected from their health booklets. Centile curves for these three variables were drawn from these measurements using the LMS method, which is specifically suited to these types of data. RESULTS: If height and cranial circumference can be considered as normally distributed, weight is markedly skewed to the right, reflecting a high prevalence of children with heavy weight. Comparison with current references data shows more or less similar results for weight, height and cranial circumference: the medians and the 2.5 centile are constantly higher in our sample than those of the reference data (the discrepancy increasing with age). The differences are more important regarding the part of the distribution which concerns the highest values: overall, the 90th centile of our distribution corresponds rather closely to the 97.5th one of the current reference data. Thus, at 6 years of age, the 97.5th centile of the reference weight distribution for girls is 23,400 kg, while it is estimated at 27,770 kg in our sample. One should take in account the different characteristics of the two studies to interpret these differences. CONCLUSION: The aim and use of such growth curves is discussed, together with recent computer applications in this field.

[Relations between blood pressure at 3-4 years of age and body mass at birth: a population-based study]. / Relation entre la pression artérielle à l'âge de 3-4 ans et la corpulence à la naissance: étude en population.

BACKGROUND: To study the association between blood pressure of 3-4 year-old children and birth corpulence estimated from birth ponderal index (body weight/length3), a school based, cross sectional survey was conducted in the Rhône department. METHODS: 1296 randomly selected children were examined at the time of a school medical visit. Physicians abstracted information on pregnancy and measurements at birth from the Child Health Handbook and from parents interview. Systolic and diastolic blood pressure measurements were carried out by using an automated oscillometric device. RESULTS: Multiple linear regression analyses revealed an inverse association between systolic blood pressure and birth ponderal index (converted into Z-score adapted to gestational age), this was obtained after adjustment for current length and for current body mass index (body weight/length2--converted into Z-score), for child emotion and for linked study factors. Such a model provided an assessment of regression coefficient: -0.67 mmHg/birth ponderal index Z-score unit (95% confidence interval: -1.24 to -0.11). So, estimation of systolic blood pressure difference between two 3-4 year-old children, one at -2 SD birth ponderal index and another at +2 SD, was obtained: 2.6 mmHg. No evidence of an association between diastolic blood pressure and birth ponderal index was observed. CONCLUSION: In this large population with a limited range of age, our results show that, at age 3-4 years, systolic blood pressure is higher with lower birth ponderal index, suggesting that thinness at birth might be a risk factor of hypertension in adulthood.

[Pediatric activity in a rural hospital in Tokombéré (Cameroon). Description and qualitative approach during a one year period]. / Activité pédiatrique d'un hôpital rural en zone sahélienne à Tokombéré (Cameroun). Description et approche qualitative sur une période de 1 an.

AIM: To describe pediatric care in a North Cameroon rural hospital, the Health Promotion Centre of Tokombéré, and its coherence in a global project of development. POPULATION AND METHODS: This prospective and descriptive study concerned all the children admitted from October 1993 to October 1994. Analysis of data from a questionnaire has been conducted with EPI-INFO. RESULTS: Six hundred and thirty-one children were admitted. The average age was 3.9 years, the sex ratio was 1.45; the percentage of children coming from the Tokombéré health area was 75%. The predominant pathology involved infections, essentially respiratory and digestive. There were 13% of deaths, two out of three occurring before the 48th hour following admission: diarrhea, malaria and lung infections were the main causes of death. The laboratory tests contributed very little to therapeutic decisions, which were based more on symptomatology and its evolution, than on diagnostic certainties. Drug associations and therapeutic excess were within acceptable limits, but possibly improvable. For one-third of the diseases, simple care at home was possible, yet only performed in 50% of cases. CONCLUSION: This study points out some deficiencies in management of hospitalized children and suggests improvements without more cost: reorganization of the laboratory, emergency therapeutic protocols, and activities in the villages.

[The Association for Computerized Medical Records Users in Perinatology, Obstetrics and Gynecology sentinel network for maternity hospitals. II. Changes in practices and results. 1994-1997]. / Le Réseau Sentinelle des maternités AUDIPOG. II. Evolution des pratiques et des résultats 1994-1997. Obstétriciens participant au Réseau Sentinelle. Association des Utilisateurs d'un Dossier Informatisé en Périnatologie, Obstétrique et Gynécologie.

OBJECTIVE: The observation of medical practices and the analysis of outcome as a function of practices are essential today for monitoring and improvement of the healthcare system. The AUDIPOG Sentinel Network provides a tool for the self-assessment of practices that enables each unit to assess its position relative to a group of maternity wards. MATERIAL AND METHODS: Pooling of individual data about births that occurred during the month of January each year in about a hundred volunteer wards allows assessing perinatal health indicators and following their evolution over time. A sample rectification technique, adapted from the quota method, allows offsetting the methodological problems created by volunteering and assessing perinatal indicators at the national level. RESULTS AND CONCLUSION: The analysis of data collected from 1994 to 1997 indicates a number of trends, even in the short run, and justifies that a real practice monitoring and assessment tool be set up in order to improve perinatal health.

Birth ponderal index and body mass index reference curves in a large population.

A file of 100,716 children born between 1984 and 1988 in 22 maternity wards was used to estimate for each week of gestational age and gender, the exponent ß which makes an index Weight/Lengthß independent from length. It varied with gestational age but remained near 3. Therefore, Rohrer's index (Weight/Length3 ) appears as a good approximation to assess neonatal weight as a whole, taking length into account. However, literature suggests that Quetelet's index (Weight/Length2 ) might be a better indicator of fat mass. In both cases, percentile curves take gestational age into account. Curves by gestational age between 32 and 42 weeks of amenorrhea and by gender, for Quetelet's and Rohrer's indices have been plotted. The values vary with gestational age. For example, the tenth percentile of Quetelet's index shifts from 7.8-12.3 kg/m2 in boys and from 7.9-12.2 kg/m2 in girls. Am. J. Hum. Biol. 10:327-340, 1998. © 1998 Wiley-Liss, Inc.

Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France.

PURPOSE: To define the role of a 10-Gy boost to the primary tumor in the conservative treatment of early infiltrating breast carcinoma treated by limited surgery and radiotherapy. PATIENTS AND METHODS: Between 1986 and 1992, 1,024 women with early breast carcinoma (< or = 3 cm in diameter) were treated by local excision, axillary dissection, and conventional 50-Gy irradiation given in 20 fractions over 5 weeks and then randomly assigned to receive either no further treatment or a boost of 10 Gy by electrons to the tumor bed. The median follow-up time was 3.3 years as of September 1994. The occurrence of telangiectasia was reported, and the patients were asked to evaluate the cosmetic result. RESULTS: At 5 years, 10 patients of 521 who had received the boost (Kaplan-Meier estimate of local relapse rate, 3.6%) and 20 of 503 who had received no further treatment (Kaplan-Meier estimate of local relapse rate, 4.5%) had developed a local recurrence (P = .044). After adjustment for the main prognostic variables, the relative risk was still significantly lower for the boost group (0.3; range, 0.12 to 0.95). The boost group had a higher rate of grade 1 and 2 telangiectasia (12.4% v 5.9%), but no difference was seen between the two treatment arms in the self-assessment score for the cosmetic result. CONCLUSION: Delivery of a boost of 10 Gy to the tumor bed after 50 Gy to the whole breast following limited surgery significantly reduces the risk of early local recurrence, with no serious deterioration in the cosmetic result. Additional follow-up evaluation will be required to assess the long-term results.

[Fetal environment and coronary ischemia risk: review of the literature with particular reference to syndrome X]. / Environnement foetal et risque cardio-ischémique: revue de la littérature avec référence particulière au syndrome X.

The paper reviews epidemiological studies published since 1989, not including ecological studies and addressing the relationship between the fetal environment and component elements of the chronic insulin resistance syndrome (syndrome X). Thirty papers have been recorded. Birth weight associated or not with other perinatal characteristics are studied in 24 articles. A relationship with further occurrence of hypertension (17 papers), dyslipemia (3), non insulin-dependent diabetes or altered glucose tolerance (8), or of a combination of these disorders (2), has been sought for. A negative relationship between birth weight and these disorders is found in adults, inconstantly in children. Some findings support a mechanism implying nutritional condition during pregnancy. Methodology inaccuracies jeopardize the validity of the conclusions drawn. The interpretation of a causal relationship between fetal environment and insulin resistance is compared to alternative assumptions relating to genetic mechanisms or selection biases.

[The Association of Computerized Medical Records Users in Perinatology, Obstetrics and Gynecology Sentinel Network for maternity hospitals. I. Perinatal health indicators in 1994]. / Le "Réseau Sentinelle" de maternités AUDIPOG. I. Paramètres de santé périnatale en 1994.

A first experiment aimed at collecting data from 98 maternity hospitals grouped in the AUDIPOG Sentinel Network addressed 7,837 deliveries in January, 1994. The technique used for recovering the results was adapted from the quota method and aimed at strict respect of marginal distributions of deliveries per regional area and per hospital type, and at the best the joint distribution of deliveries per regional area/hospital type, to obtain estimates of perinatal health indicators. Selection indicators (age, family status, socio-economic conditions, previous history), practising indicators (supervision of the pregnancy, entrance motive, presentation, delivery mode, anaesthetic) and result indicators (prematurity, small for date, transfer, pathology of the new-born) are given.

[Increase in the prevalence of obesity among children aged 4-5 years in a French district between 1988 and 1993]. / Accroissement de la prévalence de l'obésité chez les enfants de 4-5 ans dans un département français entre 1988 et 1993.

Two cross-sectional studies were performed on probabilistic samples in the Hérault "département"--respectively in 1987-1988 on children born in 1983 and in 1992-1993 on children born in 1988--to measure the evolution of the prevalence of obesity. A greater proportion of high weight for height (Z score of 1.0 and more, international reference population) has been observed in comparison with the first year. A major increase in the prevalence of obesity (setting a Z score of 2 as limit) has been recorded between the two periods (odds ratio = 2.51 (1.57 to 4.02)). It cannot be explained by structural changes of the population as regards factors known to be associated with obesity (urbanization, mother's occupation, family composition, social status, unemployment, distribution according to the country of origin). The possible influence of changes in the way of life is discussed in relation with the literature. This first representative sample study confirms--at least for the district studied--the findings in various populations, suggesting that the prevalence of obesity is increasing in France. The causes of this phenomenon remain to be defined.

[Birth weight and obesity at the age of 6. Study from the growth curves of a population of schoolchildren]. / Poids de naissance et obésité à 6 ans. Etude à partir de courbes de croissance d'une population d'enfants scolarisés.

The weight and height data of 9261 children from birth onwards were gathered on their admission to primary school in 1989 in the area of Lyon, and compared to French references. In comparison with the latter data, the weight and height for age were found to be higher, and there was an excess of children with a high weight for height. The weight for height was higher than the mean of the reference distribution plus two standard deviations in 6.2% of the children. Birth hypertrophy increased the risk of obesity at age six. A new criterion of neonatal hypertrophy, taking various constitutional characteristics into account, was found to be associated to a twofold risk of subsequent obesity, and was shown to be more appropriate in predicting subsequent obesity than classical definitions based on the weight or on the weight for gestational age or sex.

[Epidemiological surveillance of nursery school children in the Hérault for the evaluation of maternal and infant health and welfare services]. / Surveillance épidémiologique des enfants des écoles maternelles de l'Hérault lors des bilans de santé du service de protection maternelle et infantile.

A random sample of 4-5 years old children born in the same year was taken from the infant schools of the Herault (France) and examined by pediatricians during a systematic check carried out by the Mother and Child Protection Department of the Health Service. This gave and estimation of the prevalence of the most widespread health problems: language, motricity, eyesight, hearing, obesity and asthma. Differences according to social and familial factors were found for language and motricity problems, as well as for access to preventive care.

Epidemiological study of children institutionalised for psychiatric disorders.

A cross-sectional and longitudinal epidemiological study of children institutionalised for psychiatric disorders has been carried out. The differences of discharge distribution allows to describe an entanglement of three differents logics: the medical logic: diagnostic (Emotional and conduct disorder, Mental retardation, Psychosis), etiological organic factors, associated somatic disorder. the social logic: father's occupational level and etiological environnemental factors. the institutional logic: child's age when admitted, institutional categories.

[Tuberculosis control in Malawi. Time distribution of cessation of treatment and proposals for reorientation of the program]. / Contrôle antituberculeux au Malawi. Répartition dans le temps des abandons de traitement et propositions pour une réorientation du programme.

In Kasungu district (Malawi), the patients with pulmonary tuberculosis are admitted in the district hospital for two months and then referred to the private organization LEPRA for further ambulatory treatment. Out of 73 patients found with positive expectoration for AAFB during 8 months, 54 were actually referred to LEPRA, 4 were sent to another hospital on died, and 15 defaulted. Later on 15% of the patients referred to LEPRA were lost to follow up during one year. 2/3 of defaulting happened during the 2 first months of the treatment. Furthermore the infectious patients case finding rate is likely to be very low. Those observations lead to propose three prioritary actions to improve tuberculosis control: case finding amelioration, relinquishment of compulsory long duration admissions, and integration of the tuberculosis care network into the general health system.