Abstract
BackgroundGrowth charts based on data collected in different populations and time periods are key tools to assess children’s linear growth. We analyzed the impact of geographic factors and the secular trend on height-for-age charts currently used in European populations, developed up-to-date European growth charts, and studied the effect of using different charts in a sample of growth retarded children.Methods and FindingsIn an international survey we obtained 18 unique national height-for-age charts from 28 European countries and compared them with charts from the World Health Organization (WHO), Euro-Growth reference, and Centers of Disease Control and Prevention (CDC). As an example, we obtained height data from 3,534 children with end-stage renal disease (ESRD) from 13 countries via the ESPN/ERA-EDTA registry, a patient group generally suffering from growth retardation. National growth charts showed a clear secular trend in height (mean height increased on average 0.6 cm/decade) and a North-South height gradient in Europe. For countries without a recent (>1990) national growth chart novel European growth charts were constructed from Northern and Southern European reference populations, reflecting geographic height differences in mean final height of 3.9 cm in boys and 3.8 cm in girls. Mean height SDS of 2- to 17-year-old ESRD patients calculated from recent national or derived European growth charts (−1.91, 95% CI: −1.97 to −1.85) was significantly lower than when using CDC or WHO growth charts (−1.55, 95% CI: −1.61 to −1.49) (P<0.0001).ConclusionDifferences between height-for-age charts may reflect true population differences, but are also strongly affected by the secular trend in height. The choice of reference charts substantially affects the clinical decision whether a child is considered short-for-age. Therefore, we advocate using recent national or European height-for-age charts derived from recent national data when monitoring growth of healthy and diseased European children.
Highlights
Age- and sex-specific growth charts are essential clinical tools to monitor the adequacy of children’s longitudinal growth.[1,2,3] Impaired growth is a major global public health issue [4], and its correct diagnosis is crucial to prompt timely intervention
We advocate using recent national or European height-for-age charts derived from recent national data when monitoring growth of healthy and diseased European children
Most national height-for-age charts showed higher mean heights than those according to the Euro-Growth reference and the World Health Organization (WHO) growth standards for one-year-old children, or according to Centers of Disease Control and Prevention (CDC) and WHO growth charts for 5, 10 and 18 year old children
Summary
Age- and sex-specific growth charts are essential clinical tools to monitor the adequacy of children’s longitudinal growth.[1,2,3] Impaired growth is a major global public health issue [4], and its correct diagnosis is crucial to prompt timely intervention. [5] and the WHO [6] released revised versions of the NCHS/ WHO growth charts As both datasets are mainly based on data collected more than forty years ago, they may be outdated because of the secular trend in height. In 2006 the WHO released international growth standards for children aged 0–5 years based on growth data of children from six countries around the globe. Most countries preferentially apply their national height-for-age charts [1] whenever available, even when these are based on ‘outdated’ data While this practice may cause problems because of the secular trend in height, the use of the CDC data may not provide a sufficient solution. We analyzed the impact of geographic factors and the secular trend on height-for-age charts currently used in European populations, developed up-to-date European growth charts, and studied the effect of using different charts in a sample of growth retarded children
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