Centers For Disease Control Reference Research Articles

BMI status relative to international and national growth references among Pakistani school-age girls

BackgroundA sizable proportion of school-going children from developing countries has abnormal growth parameters, often not standardized with international reference values. We aimed to assess the prevalence of underweight, overweight, and obesity in the schoolgirls of Punjab according to international and local references.MethodsIn this population-based cross-sectional study, 10,050 school-going girls aged 8–16 years from 12 districts of northern, central, and southern Punjab were recruited. Estimates of normal weight, underweight, overweight and obesity were calculated in the girls according to three international BMI references including centers for disease control (CDC) 2000, the international obesity task force (IOTF) 2012 and world health organisation (WHO) 2007 in addition to a local reference for the population under study. We used Cohen’s kappa statistics to analyse the agreement of our data with reference values.ResultsThere was marked overestimation of underweight (23.9%, 14.5%, 15.2% and 4.37%), slight underestimation of overweight (5.3%, 7.3%, 7.9% and 8.97%) and moderate underestimation of obesity (1.9%, 1.5%, 2.2% and 5.67%) according to CDC, IOTF, WHO and local reference, respectively. When the weight status of the study cohort was compared with the local data, we found comparable results in all four weight categories.ConclusionWe recommend population-wide further studies to estimate the prevalence of weight status in school-age girls for devising appropriate references and for planning strategies for public health policy and management.

Reference Values Matter: Fewer Patients With Malnutrition Using American Compared to More Recent German Growth Charts.

Reference values are important for patient care as well as for comparisons between different centers or countries. We investigated two anthropometric reference datasets, the US Centers for Disease Control (CDC) growth charts and the German Health Interview and Examination Survey for Children and Adolescents Study (KiGGS) percentiles, which were established in Germany between 2003 and 2006. A smaller proportion of children with cystic fibrosis had decreased z scores <-2 with CDC (5.0% for weight and 3.0% for height) compared to KiGGS (7.4% for weight and 6.3% for height) values (P < 0.0001). Median z scores were higher using the CDC reference data. Thus, the choice of growth reference is important, may influence clinical management and must be considered when comparing the outcomes of different institutions.

Body mass index trajectories in pediatric multiple sclerosis.

To characterize growth trajectories of children who develop multiple sclerosis compared to typically developing, regional peers and Centers for Disease Control (CDC) normative values. This case-control study collected weight, height, and body mass index (BMI) in 40 consecutive pediatric patients with multiple sclerosis (28 females, 12 males), in addition to 120 typically developing peers (84 females, 36 males), identified and matched for year of birth, sex, ethnicity, and socio-economic status. BMI values were converted to z-scores based on CDC reference values and were compared with respect to age between our two cohorts and by years relative to multiple sclerosis onset for cases. Median age for the clinical onset of multiple sclerosis was 15years. BMI z-scores are significantly higher for patients with multiple sclerosis compared to typically developing, demographically-matched peers and CDC standards. These significant differences in BMI are noted from 4years of age and onward. Height trajectories were similar among case and control individuals and CDC normative values. BMI in pediatric multiple sclerosis is markedly higher, beginning in early childhood, years before the clinical-onset of the disease. Children with multiple sclerosis are significantly more overweight than typically developing peers at the time of diagnosis. Body mass index trajectories are significantly higher years before the clinical manifestation(s) of multiple sclerosis.

Charting the course of young children with cystic fibrosis

In addition to aggressive monitoring of disease course and the use of novel strategies for respiratory and antimicrobial therapies, marked attention to the maintenance of excellent growth and nutrition has played a key role in improving long-term outcomes of children with cystic fibrosis (CF). CF centers play particular attention to changes in growth measurements as useful markers of nutrition and disease activity, leading to earlier and more rigorous evaluations and interventions. As such, the optimal care of young children with CF is highly dependent on the use of standardized growth charts. In this study, Zhang et al analyzed data from 2587 children followed in the Cystic Fibrosis Foundation Patient Data Registry in order to compare differences in the classification of growth status of young children with CF as assessed by the World Health Organization (WHO) and Centers for Disease Control (CDC) growth percentiles. Currently, WHO standards often are followed up to 23.9 months, followed by the use of CDC references. Among several findings, this study reports that using weight status measures (weight-for-length and body mass index) at 24 months, 26% of children who were classified as normal growth using WHO references were underweight using CDC references. These findings are important to ensure greater understanding of the potential impact of changing growth standards on the interpretation of individual growth status, the impact on clinical practice, and to allow accurate comparisons between CF centers. These findings further set the stage to explore relationships between early nutritional interventions and long-term growth and pulmonary outcomes.Article page 1089▶ In addition to aggressive monitoring of disease course and the use of novel strategies for respiratory and antimicrobial therapies, marked attention to the maintenance of excellent growth and nutrition has played a key role in improving long-term outcomes of children with cystic fibrosis (CF). CF centers play particular attention to changes in growth measurements as useful markers of nutrition and disease activity, leading to earlier and more rigorous evaluations and interventions. As such, the optimal care of young children with CF is highly dependent on the use of standardized growth charts. In this study, Zhang et al analyzed data from 2587 children followed in the Cystic Fibrosis Foundation Patient Data Registry in order to compare differences in the classification of growth status of young children with CF as assessed by the World Health Organization (WHO) and Centers for Disease Control (CDC) growth percentiles. Currently, WHO standards often are followed up to 23.9 months, followed by the use of CDC references. Among several findings, this study reports that using weight status measures (weight-for-length and body mass index) at 24 months, 26% of children who were classified as normal growth using WHO references were underweight using CDC references. These findings are important to ensure greater understanding of the potential impact of changing growth standards on the interpretation of individual growth status, the impact on clinical practice, and to allow accurate comparisons between CF centers. These findings further set the stage to explore relationships between early nutritional interventions and long-term growth and pulmonary outcomes. Article page 1089▶ Comparing the Use of Centers for Disease Control and Prevention and World Health Organization Growth Charts in Children with Cystic Fibrosis through 2 Years of AgeThe Journal of PediatricsVol. 167Issue 5PreviewTo examine differences between use of World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) growth reference in children with cystic fibrosis (CF) up to 2 years of age. Full-Text PDF

Prevalence of overweight and obesity in preschool children in Thessaloniki, Greece.

Data on obesity in preschoolers are scarce in Greece, a country particularly affected by the obesity epidemic. The present study aimed to assess overweight and obesity prevalence of preschoolers in Thessaloniki, Greece, by using three different standards for defining childhood overweight and obesity. One thousand two hundred and fifty (1250) preschool children (657 boys and 593 girls) aged 2.0-6.0 years old from all public municipality kindergartens of Thessaloniki, Greece, participated in this cross-sectional survey conducted from 2009 to 2010.Body weight and height were measured and detailed anthropometry measurement was undertaken. BMI was classified to weight categories based on the CDC (US Centers for Disease Control and Prevention), IOTF (the International Obesity Task Force) and WHO (the World Health Organization) references. Rates of excess body weight varied significantly according to the different international criteria: IOTF: overweight (including obesity) 21.2%, obesity 5.8%;CDC: overweight (including obesity) 30.5%, obesity 13.5%; and WHO: overweight (including obesity) 32.6%, obesity 5%. Boys and older children were particularly affected. Overweight prevalence is high in Greek preschoolers and varies significantly according to the different criteria used, from 21.2% (IOTF reference) to 32.6% (CDC reference).

Comparing Growth Assessments Using CDC and WHO Reference Data in Native Hawaiian Pacific Islander Children: Baseline Data from the Children's Healthy Living (CHL) Program in Hawaiʻi

In the diverse US Affiliated Pacific Centers for Disease Control (CDC) 2000 and 2006 World Health Organization (WHO) reference data are available to assess child growth. WHO reference data includes children who met recommended breastfeeding guidelines from six countries, while CDC data describes growth of US children where few were breastfed. Baseline data from the CHL program in Hawai'i (n=941) was used to calculate BMI z‐scores and percentiles to compare growth relative to the two reference data sets and identify the role of breastfeeding history, age, sex, and ethnicity on growth assessment. Mean BMI z‐scores calculated with CDC reference data were lower than WHO (z‐score difference=‐0.31, p&lt;0.001). A general linear model on BMI z differences against child age, sex, ethnicity and breastfeeding history showed the difference by CDC reference was greater in boys than girls (z score difference = 0.20, p&lt;0.001). No difference was found by breastfeeding history, age or ethnicity. Kappa statistics showed strong agreement between the two references on CDC defined BMI categories (weighted Kappa=0.50, p&lt;0.001), with percentage of agreement highest for healthy weight (92%), followed by obese (85%), then overweight (76%). CDC and WHO growth reference data samples differ by breastfeeding history and ethnicity; differences between BMI z‐scores calculated from the two reference data sets were not related to either factor. Researchers and practitioners can choose either reference data to analyze BMI and child growth in NHPI children but should be cautious that CDC growth references may underestimate childhood overweight and obesity, and delay early intervention.

Prevalencia de sobrepeso y obesidad en escolares jujeños de diferente nivel altitudinal según las referencias IOTF, CDC y OMS

INTRODUCTION. Prevalences of overweight and obesity in students from different altitudinal zones of Jujuy are compared using the International Obesity Task Force (IOTF), the Centers for Disease Control (CDC) and the World Health Organization (WHO) references, and the agreement among them. MATERIAL AND METHODS. Weight and height data from 15 541 students were grouped in highlands (HL) (≥2500 MASL) and lowlands (LL) (<2500 MASL) and in two age groups (5-6.99 years old and 11-12.99 years old). Overweight and obesity prevalences were calculated according to the different references. The differences in outcome measures and prevalences were established using the ?2 test and the t test, and agreement among the criteria was calculated using the kappa index. RESULTS. Students from the HL had lower weight, height and body mass index (BMI) values (p< 0.05). Overweight and obesity prevalences compared to the WHO reference were higher, except for overweight in students of both sexes, from 11 to 12.99 years old, from the HL and the LL. Regardless of the references, gender and age, overweight and obesity prevalences were generally higher in the LL. Agreement between the IOTF and the CDC was good-very good, and agreement among them and the WHO was fair-moderate. CONCLUSIONS. Students from the HL had a lower overweight and obesity prevalence. The greatest agreement was observed between the IOTF and the CDC references.

Growth measures among preschool-age Inuit children living in Canada and Greenland

The present study reports findings from a study of preschool-age Inuit children living in the Arctic regions of Canada and Greenland. We compare stature and obesity measures using cutoffs from the Centers for Disease Control and the International Obesity Task Force references. The sample is comprised of 1121 Inuit children (554 boys and 567 girls) aged 3-5 years living in Nunavut (n=376) and Nunavik (n=87), Canada, in the capital city of Nuuk, Greenland (n=86), and in Greenland's remaining towns and villages (n=572). Greenland Inuit children were significantly taller than their Canadian counterparts, with greatest height and weight observed among children from Nuuk. Overall prevalence of stunting was low with the three cutoffs yielding similar values for height-for-age z-scores. Obesity prevalence was higher among Canadian Inuit children than their Greenland counterparts. Inuit children have stature values consistent with those of the Centers for Disease Control reference and low prevalence of stunting, though geographic variability in mean stature values between Canadian and Greenlandic samples likely reflects differences in both socioeconomic status and genetic admixture. Obesity prevalence is high among both Canadian and Greenland Inuit preschoolers, with children living in the city of Nuuk exhibiting lower obesity prevalence than children living in either Nunavut or Nunavik, Canada or Greenland's towns and villages. Varying obesity prevalence may reflect varying degrees of food security in remote locations as well as the influence of stature and sitting height which have not been well studied in young Inuit children.

Growth references for Brazilian children and adolescents: Healthy growth in Cariri study

Aim: To construct reference values for height, body mass and BMI of children and adolescents from the Cariri region, Brazil; to compare the growth of Cariri children with those from CDC (Centers for Disease Control and Prevention) and with references from other Brazilian regions; to verify the associations between socioeconomic status and height, body mass and BMI in children and youth from both sexes.Subjects and methods: The sample comprised 3311 girls and 3280 boys aged 7–17 years, participating in the study ‘Healthy Growth in Cariri’. Socioeconomic status was defined according to school attendance: private and public. Centile curves for height, body mass and BMI were constructed using the LMS method.Results: Significant differences between children and adolescents from Cariri and those from other Brazilian regions and the CDC references were found for height and body mass. In girls from private schools, average differences in height compared to the CDC references ranged from 0.79–5.9 cm and in boys from 2.9–8.6 cm.Conclusion: Children from Cariri show a growth pattern in height, body mass and BMI that closely resembles the patterns observed in developed countries, but the absolute values in height and body mass are markedly lower than CDC references and growth references for other regions in Brazil.

Donor-Derived Strongyloides stercoralis Infections in Renal Transplant Recipients

Donor-derived Strongyloides stercoralis infection occurs rarely after transplantation, and the risk factors are not well understood. We present cases of two renal allograft recipients who developed Strongyloides hyperinfection syndrome after receipt of organs from a common deceased donor who received high-dose steroids as part of a preconditioning regimen. The two renal transplant patients who developed Strongyloides hyperinfection syndrome are reported in case study format with review of the literature. Microscopic examination of stool from one renal transplant patient and of tracheal and gastric aspirates from the other transplant patient revealed evidence of S. stercoralis larvae. Retrospective testing of serum from the deceased donor for Strongyloides antibodies by enzyme-linked immunosorbent assay was positive at 11.7 U/mL (Centers for Disease Control reference >1.7 U/mL positive). One patient was treated successfully with oral ivermectin. The other patient also had complete resolution of strongyloidiasis, but required a course of parenteral ivermectin because of malabsorption from severe gastrointestinal strongyloidiasis. These case studies provide some of the best evidence of transmission of S. stercoralis by renal transplantation. Because of the high risk of hyperinfection syndrome and its associated morbidity and mortality, high-risk donors and recipients should be screened for Strongyloides infection, so that appropriate treatment can be initiated before the development of disease. This study indicates that parenteral ivermectin can be used safely and effectively in patients in whom severe malabsorption would preclude the effective use of oral formulation. These cases also suggest that reconsideration should be given for the safety of steroids in donor-preconditioning regimens.

German height references for children aged 0 to under 18 years compared to WHO and CDC growth charts

Aim: The objective is to present height-for-age percentiles representative for infants, children, and adolescents in Germany and to compare them with older German height references by Kromeyer-Hauschild which are based on heterogeneous pooled data (KH) and with international growth charts from the Centers for Disease Control (CDC) as well as the growth standard and the growth reference of the World Health Organization (WHO).Subjects and methods: The reference population consists of a nationally representative sample of 17 079 children and adolescents aged 0–17 years (KiGGS study 2003–2006) with standardized height measurements. Height reference curves were created using Cole's LMS method. To compare KiGGS with other reference systems, KiGGS height values were transformed to SD-scores using the KH, WHO and CDC references.Results: Height-for-age percentiles in KiGGS increase until age 16 years in girls and until the end of the observed age range (17.98 years) for boys. In general, boys are taller than girls, except for the age range 10.5–13.0 years. The difference in height between boys and girls is negligible before puberty and reaches 13 cm at age 17.98 years. KiGGS and KH percentiles differ only slightly. However, there are substantial differences in SD-score levels between KiGGS on the one hand and WHO and CDC on the other hand, KiGGS generally being higher, especially in the extreme percentiles.Conclusion: The KiGGS height-for-age references can be recommended as a national height reference for screening and monitoring growth in infants (starting from 4 months of age), children and adolescents in Germany. In German samples, the WHO and CDC references can be used for international comparisons.

German height references for children aged 0 to under 18 years compared to national and international data

Objectives: The objective of the present study is to present height-for-age percentiles representative for infants, children and adolescents in Germany and to compare them with existing German height references by Kromeyer-Hauschild (KH) and with international growth charts from the Centers for Disease Control (CDC) as well as the growth standard and the growth reference of the World Health Organization (WHO). Methods: The reference population consists of a nationally representative sample of 17 079 children and adolescents aged 0–17 years (KiGGS study 2003–2006) with standardized height measurements. Height reference curves were created using Cole's LMS method. To compare KiGGS with other reference systems, KiGGS height values were transformed to SD-scores using the KH, WHO and CDC references. Results: Height-for-age percentiles in KiGGS increase until age 16 years in girls and until the end of the observed age range (17.98 years) for boys. The difference in height between boys and girls is negligible before puberty and reaches 13cm at age 17.98 years. KiGGS and KH percentiles overlap almost completely with only slight differences. However, there are substantial differences in SD-score levels between KiGGS and international data. Especially in the extreme percentiles, KiGGS percentiles are generally positioned above WHO and CDC. For example, the KiGGS 3rd height percentile corresponds to the 8th percentile according to CDC and WHO (5–18 years) and to the 6th percentile in the 0- to 5-year-olds in the WHO growth standard and the KiGGS 97th height percentile in boys and girls corresponds to the 99th percentile in CDC and WHO. Conclusions: The KiGGS height-for-age reference can be recommended as a national height reference for screening and monitoring growth in infants (starting from 4 months of age), children and adolescents in Germany. In German samples, the WHO and CDC references can be used for international comparisons.

Growth and Safety in Term Infants Fed Reduced‐Protein Formula with Added Bovine Alpha‐Lactalbumin

ABSTRACTObjectiveTo assess growth, tolerance, and biochemical measures of protein status in term infants fed an experimental formula with reduced total protein concentration and enriched in bovine alpha‐lactalbumin prepared from an alpha‐lactalbumin dominant bovine whey.MethodsHealthy, term, exclusively formula‐fed infants ≤14 days postnatal age, between 10th and 90th percentiles in weight and length for age were studied in this randomized, masked, multicenter study. Infants received ad libitum feedings of either experimental or control formula for 12 weeks. Adverse events and acceptability of formulas were assessed every 2 weeks. Weight, length, and head circumference were measured at baseline and every 4 weeks. Serum creatinine, albumin, and blood urea nitrogen were assessed at baseline and study completion. Anthropometric measures were compared to Centers for Disease Control reference ranges using Z scores.ResultsOne hundred ninety‐three infants were enrolled. One hundred thirty‐four completed the protocol. Seventy‐two received experimental formula, and 62 received control formula. The mean baseline body weight was higher in infants fed experimental formula (P = 0.042), so baseline weight was used as a covariate in statistical analyses. There were no differences between groups in gains in weight, length, or head circumference during the study. Mean serum albumin and blood urea nitrogen (BUN) levels were similar at study initiation. At study completion, serum albumin levels were the same in both groups, whereas BUN was significantly higher in infants fed control formula (P = 0.0016). More infants fed control (n = 20) than experimental (n = 15) formula discontinued the study because of adverse events. There were no differences in the adverse event profiles of the groups completing the study. Most of the adverse events were mild and resolved without treatment or sequelae. Acceptability and tolerance of the experimental formula was greater than the control formula, except at 2 weeks. Unacceptable ratings ranged from 0% to 10% (mean, 4.1%) in the experimental formula group and from 1.6% to 14.1% (mean, 7.0%) in the control formula group.ConclusionsGrowth and serum albumin were comparable in infants fed experimental and control formulas for the first 12 weeks of life, suggesting adequate protein nutrition from the alpha‐lactalbumin–rich formula, despite its lower total protein content. Growth and adverse events data support the safety of the experimental formula. Fewer discontinuations and unsatisfactory ratings among infants fed the experimental formula suggest that it is better tolerated than control formula.

Timing of growth faltering in rural Malawi

Aim: To determine the timing of growth faltering among under 3 year old children. Methods: Prospective population based cohort study in Lungwena, rural Malawi, southeast Africa. A total of 767...

Microsampling technique and determination of blood lead by zeeman atomic absorption spectrophotometry

Quality control materials and participation in proficiency testing programmes were used for assessing the long-term performance of our blood lead analysis. The accuracy and precision of the blood controls, Metals 1 and 2 from the Behring Institute, were evaluated over a 1-year period. The accuracy of the method was also monitored by the Centers for Disease Control (CDC) Blood Lead Proficiency Testing Programme over a 3-year period. Nearly 85% (28 out of 33 samples) of our results were within ± 5% of the CDC reference values. There were excellent correlations between our results and the target values of several proficiency testing samples, with correlation coefficient values of 0.9959–0.9970. The method was used for the screening of blood lead in children in conjunction with microsampling techniques.

Accuracy and comparability of long-term measurements of cholesterol.

Laboratories of the Lipid Research Clinics Program (LRC) maintained the accuracy of their measurements of total cholesterol by using seven pooled serum calibrators supplied by the Centers for Disease Control (CDC). Over the 11-year life of the LRC, each calibrator was prepared in succession and a target value was assigned by the CDC reference method for cholesterol. The results of a special experiment in which six of the seven calibrators were analyzed simultaneously demonstrated that the target values were accurately assigned. Deviations of the target values from the experimental means ranged from zero to 1.7% of the original target value. The experiment revealed no evidence of drift in the bias of the reference method over the life of LRC and demonstrated the accuracy, consistency, and the comparability of the values assigned to the successive calibrator pools used by the LRC laboratories during more than eight years. It demonstrated the reliability of a reference method and the suitability of frozen serum pools for maintaining an accurate measurement base for serum cholesterol.

Quality control of lipid measurements in epidemiological studies: the U.S. Air Force HEART program.

A special standardization and quality assurance program, similar to that created for the Lipid Research Clinics Program (LRC), was developed for the American Health Foundation Laboratory by the Centers for Disease Control (CDC) to assure the quality of lipid measurements in the U.S. Air Force Health Evaluation and Risk Tabulation (HEART) Program. This study was designed to test the feasibility of reducing the incidence of heart disease in active-duty U.S. Air Force personnel through life-study intervention. During the 18-month study, CDC provided serum calibrators and reference materials for internal control and an external surveillance program for measurements of total cholesterol (TC) and high-density-lipoprotein cholesterol (HDLC). The Laboratory, using an automated enzymic method to measure cholesterol, achieved an overall goal for accuracy of less than 2% error (av systematic error, -30.6 mg/L) for TC, as measured on nine reference pools for which values were assigned by CDC. The average bias of measurements of HDLC with heparin-manganese to separate the lipoproteins in five CDC reference pools was -4.6 mg/L. Bias was estimated relative to the values assigned to the reference materials by the CDC reference methods for TC and HDLC. The average CV for TC was 0.89%, for HDLC 2.66%. Accuracy of cholesterol measurements can be assured over time with a standardization and quality-assurance program that incorporates accurately labeled reference materials for calibration, internal quality control, and external surveillance.