Abstract
AimNational European growth references differ. We aimed to convert (harmonize) currently used charts into a single unified interchangeable LMS format for each European nation.MethodsNine currently used national European growth references from Belgium (2009), France (1979), Poland (2001), Sweden (2002), Switzerland (1989), the UK (1990), Italy (2006) and Germany (1979 and 1997) were harmonized and compared with the international WHO child growth standards and WHO growth reference data for 5–19 years.ResultsEuropean growth charts can be harmonized. The approach appears useful as height, and body mass index (BMI) is inappropriately represented by WHO references. European height references exhibit warping when plotted against the WHO reference. The French appears too short, the other Europeans too tall. Also, the BMI is not appropriately represented by the WHO references.ConclusionsHarmonizing references is a novel, convenient and cost-effective approach for converting historic and/or incomplete local or national growth reference charts into a unified interchangeable LMS format. Harmonizing facilitates producing growth references ‘on demand’, for limited regional purposes, for ethnically, socio-economically or politically defined minorities, but also for matching geographically different groups of children and adolescents for international growth and registry studies.
Highlights
Human growth is a dynamic process that is usually visualized by plotting individual measurements on so-called growth charts
Statistical approach We tested whether these heterogeneous European growth references can be converted into one single interchangeable LMS format consisting of full range LMS tables for height and body mass index (BMI) from birth to maturity
Table 2 exemplifies harmonized LMS for the German growth reference published by Hesse [21,22]
Summary
Human growth is a dynamic process that is usually visualized by plotting individual measurements on so-called growth charts. Growth charts are common tools in the paediatric practice [1]. They are usually derived from large local or national cross-sectional surveys. International growth reference charts based upon global rather than local samples of children are being recommended [2]. The rationale for such charts goes back to recommendations of a Working Group on infant growth established by the World Health Organization (WHO). The apparent differences in growth between the various European populations still raise inconvenient questions about the validity of so-called international references
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