International Growth Reference Research Articles

Accuracy of the international growth charts to diagnose obesity according to the body composition analysis in US children and adolescents.

This study verified the accuracy of the international BMI references and the allometric BMI reference to diagnose obesity in children and adolescents from the USA. Data from 17313 subjects were obtained from the National Health and Nutrition Examination Survey between the years 1999-2006 and 2011-2018. Fat Mass Index, Allometric Fat Mass Index and fat mass/fat-free mass were calculated. Receiver operating characteristic curve, AUC, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were estimated to evaluate the accuracy of the growth references for diagnosing obesity. The International Obesity Task Force, MULT BMI 17 years, MULT BMI 18 years and allometric BMI 19 years achieved the best sensitivity-specificity trade-off for boys, with sensitivities ranging from 0·92 to 0·96 and specificities of 0·94, with positive likelihood ratio of 15·51, 16·17, 13·46 and 18·01, respectively. The negative likelihood ratios were notably low, ranging from 0·04 to 0·08. In girls, the International Obesity Task Force, MULT BMI 17 years and MULT allometric BMI 17 years also demonstrated high sensitivity (0·95-0·97) and specificity (0·92), with positive likelihood ratio values of 11·54, 11·82 and 11·77, respectively and low negative likelihood ratio values (0·03-0·05). In summary, these international growth references presented satisfactory performance to diagnose obesity. However, the MULT growth reference performed better, and the MULT allometric BMI was the only indicator capable of detecting that girls have a higher proportion of fat mass than boys for the same index values. These findings suggest that the MULT growth reference may be a better tool to assess the nutritional status of children and adolescents internationally.

Evaluating the Validity of International Standards of Height, Weight, and Body Mass Index on Jordanian Children and Adolescents.

the variations in a child's overall body shape and figure among different countries are attributable to differences in genetics, environmental factors, and the interaction between these elements. This study aims to evaluate the validity, reliability, and appropriateness of applying international growth standards to Jordanian children and adolescents aged 2-19 years old. 65,828 Jordanian children and adolescents (43% males; 57% females) aged 2-19 years old were selected from the Hakeem Program database and various private schools across Jordan. Height-for-age, weight-for-age, and body mass index (BMI)-for-age were analyzed comparatively for Jordanian children and adolescents against international growth standards. The z-score for each record was computed based on international equations. Mean z-scores for height-for-age, weight-for-age, and BMI-for-age for both genders showed significant deviation from international standards across most age intervals. It was found that in most age groups, Jordanian children and adolescents were shorter and lighter than CDC and WHO standards, except for females at ages ≥ 16 years, who were heavier with higher BMI-for-age values than CDC standards based on weight-for-age and BMI-for-age equations. Moreover, Jordanian males at ages ≥ 12 years had lower BMI-for-age values than CDC standards. Jordanian children and adolescents showed significant deviations in their measurements from international standards and growth reference values. The development of a population-specific growth chart is highly recommended to enhance the accuracy of evaluating children's and adolescents' wellness.

Comparison of international height and BMI-for-age growth references and their correlation with adiposity in Brazilian schoolchildren.

This study verified the diagnostic accuracy of the nutritional status classified by the international height and BMI references of the World Health Organization (WHO) (WHO/2007), International Obesity Task Force (IOTF/2012) and MULT (2023). The data pool was composed by 22737 subjects aged five to 16 years from the Santos and Porto Alegre surveys. A correlation matrix between the z-scores of the BMI references and the skinfold measurements was calculated through the Pearson correlation coefficient (r), and the subject's nutritional status was classified according to the international growth references. The accuracy for diagnosing obesity was performed separately by sex and using the 95th percentile of the triceps and subscapular skinfold sum, while Lin's concordance coefficient, Bland-Altman method and the Cohen's Kappa coefficient (Kappa) were used to verify the concordance and reliability among the BMI references. The correlation matrix showed a high positive correlation among the BMI z-scores (r ≥ 0·99) and among the skinfold measurements (r ≥ 0·86). The prevalence of stunting was higher when applying the MULT reference (3·4 %) compared with the WHO reference (2·3 %). The Bland-Altman plots showed the lowest critical difference (CD) between the height references of WHO and MULT (CD = 0·22). Among the BMI references, the WHO obesity percentile presented lower performance than MULT for boys, presenting a lower +LR value (WHO = 6·99/MULT 18 years = 10·99; 19 years = 8·99; 20 years = 8·09) for the same -LR values (0·04). Therefore, MULT reference holds promise as a valuable tool for diagnosing childhood obesity, particularly when considering sex differences. This enhances its suitability for assessing the nutritional status of Brazilian schoolchildren.

Prevalence of Obesity among Children and Adolescents in Saudi Arabia: A Multicenter Population-Based Study.

Childhood obesity has increased in Saudi Arabia over the past few decades. However, a representative burden of obesity remains unclear, as most studies had relied on small samples and/or used international growth references, which may have resulted in over-or underestimations of prevalence. The study aimed to determine the prevalence of obesity among children and adolescents in Saudi Arabia using the Saudi growth chart. This population-based retrospective study included children and adolescents aged 2-19 years who visited any facility within the National Guard Health System (5 hospitals and 24 primary care centers) across Saudi Arabia between 2016 and 2021. The Saudi growth reference for children and adolescents was used for classification. Those with body mass index ≥95th percentile were considered as obese and ≥85th to <95th percentile as overweight. Chi-square tests were used to compare frequencies across groups. A total of 351,195 children and adolescents were included, of which 337,316 (96%) were Saudis. Overall, about one-fifth of the population was overweight (11.2%) or obese (9.4%). The prevalence of obesity was highest among children aged 2-6 years (12.3%), and it was higher among boys (10.4%) than girls (8.3%). In terms of region, the prevalence of obesity among Saudis was highest in the Central and Eastern regions (9.9% for both). The findings highlight an urgent need for national interventions to focus on the upstream determinants of childhood obesity and to improve healthy options for children and adolescents in terms of food and physical activities.

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.

Validation of growth standards and growth references: A review of literature.

The World Health Organization (WHO) growth standards provide the most recognized and widely accepted way of assessing child growth. To ensure its applicability, accuracy, and reliability, studies have validated WHO growth standards against local populations and other internationally recognized growth references. We reviewed outcomes of evaluations done on WHO growth standards and assess the appropriateness of using these growth standards on a global level. We undertook a systematic quantitative review of studies published from 2011 to 2020 from multiple databases. Studies were included if they considered children aged 59months and below and reported on validation of growth standards. There was an agreement in studies that validated WHO growth standards against international growth references of its superiority in identifying stunted, overweight, and obese children. However, they were less likely to identify underweight children. None of the studies reviewed reported similar growth trajectories to WHO standards in all indicators considered. Regional differences in child growth were observed in comparison to WHO growth standards. Adoption of regional-specific standards increases the sensitivity of identifying children with adverse nutrition outcomes.

Comparison of International Growth Standards for Assessing Nutritional Status in Cystic Fibrosis: The GreeCF Study.

The aim of the study was to compare 3 international growth references and explore their differences in assessing growth in Greek school-aged patients with cystic fibrosis (CF). Sample included 114 patients (50 boys, age 11.5 ± 3.9 years), provided care at Aghia Sofia Children's Hospital, Greece. Anthropometrics and predicted forced expiratory volume in 1 second (FEV1%) were measured. Body mass index (BMI) and height z scores were computed according to the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and International Obesity Task Force (IOTF) references. Agreement between methods was analyzed with kappa statistics, repeated-measures analysis of variance, and Bland-Altman analysis. The relationship between FEV1% and BMI was explored with linear regression. Mean CDC BMI z score was the lowest (0.06 ± 1.08), followed by WHO (0.17 ± 1.14) and IOTF (0.35 ± 1.05) (P ≤ 0.001 for all). The CDC and WHO growth references highly agreed for most weight status strata and stunting; all other comparisons produced lower agreements. Except for CDC and IOTF BMI z scores, all other comparisons produced wide levels of agreement and proportional bias. CDC reference classified more children as attaining low or normal weight, against WHO or IOTF (P ≤ 0.001 for all). Lowest prevalence of ideal and excess weight was recorded by CDC, compared to all other standards (P ≤ 0.001 for all). All BMI z scores provided moderate associations with FEV1%. Large variations across weight status classification were present when employing 3 growth standards in school-aged patients . Given than BMI z-scores from all references provided comparable associations with pulmonary function, our data indicate that no studied reference is better than others in assessing growth in CF.

Stillbirth at term: Does size really matter?

Placental dysfunction has a deleterious influence on fetal size and is associated with higher rates of perinatal morbidity and mortality. This association underpins the strategy of fetal size evaluation as a mechanism to identify placental dysfunction and prevent stillbirth. The optimal method of routine detection of small for gestational age (SGA) remains to be clarified with choices between estimation of symphyseal-fundal height versus routine third-trimester ultrasound, various formulae for fetal weight estimation by ultrasound, and the variable use of national, customized, or international fetal growth references. In addition to these controversies, the strategy for detecting SGA is further undermined by data demonstrating that the relationship between fetal size and adverse outcome weakens significantly with advancing gestation such that near term, the majority of stillbirths and adverse perinatal outcomes occur in normally sized fetuses. The use of maternal serum biochemical and Doppler parameters near term appears to be superior to fetal size in the identification of fetuses compromised by placental dysfunction and at increased risk of damage or demise. Multiparameter models and predictive algorithms using maternal risk factors, and biochemical and Doppler parameters have been developed, but need to be prospectively validated to demonstrate their effectiveness.

Anthropometric measurements of school-going-girls of the Punjab, Pakistan

BackgroundChild’s growth has been considered an important indicator to evaluate health trends in a population and to devise strategies accordingly. The purpose of the present study was to determine most commonly occurring weight abnormalities among school-going girls from Punjab and to compare with international growth references devised by World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC).MethodsIn this cross-sectional study a sample of 10,050 child and adolescent girls from 12 districts, 35 public/private sector schools, located in rural, semi-urban and urban areas of northern, central and southern Punjab were included. Parameters were measured according to standardised techniques and centile curves obtained by Lambda, Mu, Sigma (LMS) method.ResultsThe results showed an increase in weight, height and BMI of the Punjabi girls until 15 years. When compared with international growth references, weight and BMI in our population were significantly lowered; however, height was lower during 12–16 years of age and the differences observed were more pronounced with CDC as compared to WHO. When 3rd, 50th and 90th percentiles of weight, height and BMI in our population were compared with international standards, the values were lower in our paediatric population.ConclusionThe Punjabi schoolgirls significantly differed from CDC and WHO references, and this difference should be taken into consideration for evaluation of growth abnormalities in our paediatric population. However, in the absence of national reference data, WHO standards have been considered more appropriate for comparison.

Assessment of Agreement between the National (Indian Academy of Pediatrics) and International (Centers for Disease Control and World Health Organization) growth references among tibetan adolescent girls of Kangra District, Himachal Pradesh

Context: Various growth assessment references are available to assess nutritional status. The use of body mass index (BMI) in adolescents is well established for clinical and public health applications. It is required to compare national references with the international, to avoid over/underestimation of BMI categories. Aims: The aim of the present study was to quantify differences in the assessment of height/age and BMI/age ratios using national (Indian Academy of Pediatrics [IAP]) and international (Centers for Disease Control and Prevention [CDC], and World Health Organization [WHO]) references. Subjects and Methods: Anthropometric measurements of 276 Tibetan adolescent girls (13–18 years old) were taken. BMI-for-age and height-for-age were measured and compared using three references – IAP 2015, WHO 2007, and CDC 2000. Statistical Analysis Used: Kappa coefficient was done between different references using SPSS version 20 and MS-excel. Results: The prevalence of overweight/obesity was reported highest (23.55%) by IAP references, while stunting was highest (17.26%) with CDC references. A substantial agreement (k = 0.623) was observed in stunting and almost perfect agreement (k = 0.868) was observed for BMI categories between WHO and CDC. The disagreement level was highest in IAP and CDC for stunting and IAP and WHO for BMI categories. Conclusions: Prevalence of malnutrition differs with the application of different references. National references producing higher estimates of obesity than international definition indicates that decisions regarding whether or not to use national BMI references, should always be undertaken with caution.

Preventing term stillbirth: benefits and limitations of using fetal growth reference charts.

This review examines the variation in clinical practice with regards to ultrasound estimation of fetal weight, as well as calculation of fetal weight centiles. Placental dysfunction is associated with fetal smallness from intrauterine malnutrition as well as fetal disability and even stillbirth from hypoxemia. Although estimating fetal weight can be done accurately, the issue of which fetal weight centile chart should be used continues to be a contentious topic. The arguments against local fetal growth charts based on national borders and customization for variables known to be associated with disease are substantial. As for other human diseases such as hypertension and diabetes, there is a rationale for the use of an international fetal growth reference standard. Irrespective of the choice of fetal growth reference standard, a significant limitation of small for gestational age (SGA) detection programs to prevent stillbirth is that the majority of stillborn infants at term were not SGA at the time of demise. Placental dysfunction can present with SGA from malnutrition and/or stillbirth from hypoxemia depending on the gestational age of onset. Emerging data show that at term, fetal Doppler arterial redistribution is associated more strongly with perinatal death than fetal size. Properly conducted trials of the role for maternal characteristics, fetal size, placental biomarkers, and Doppler assessing fetal well-being are required urgently.

Anthropometric Indices in Primary School Children of Iranshahr City, Iran

Background: Malnutrition, as a serious health problem in children, has an increasing prevalence in the developing countries. This study aimed to evaluate the anthropometric indices of primary school children in Iranshahr, a city in central region of Sistan and Baluchestan province, Iran. Methods: This cross-sectional study was conducted on a sample of 1000 6-14 year-old primary school children studying in 16 public and 5 private schools in Iranshahr city from May to June 2017. The sampling was done using multistage cluster random method. The school records were used to determine the students' ages. Their weight, height, and body mass index (BMI) were measured. Anthropometric indices including weight-for-age, height-for-age, and BMI-for-age were assessed using the National Center for Health Statistics/World Health Organization international growth reference and Center for Disease Control and Prevention (2000). Results: The rate of thinness was significantly higher in public than private schools (18.1% vs 1%; P &lt; 0.0001). Overweight/obesity was lower in public schools’ children compared to students of the private schools (0.1% vs 9.3%; P = 0.007). The rates of stunting and underweight in public and private schools’ children were 50.2% vs. 53.3% (P = 0.11) and 46.6% vs 35% (P &lt; 0.0001), respectively. Conclusion: Findings showed that although nutritional status was better in private schools than public schools, malnutrition is still a potential public health problem in this area. Therefore, the nutrition interventions are suggested at national and regional levels to increase the parents' awareness.

Do Parent's Lifestyle Factors and Their Socioeconomic-Food Security Status Affected Children's Growth in Pre-Crisis Venezuela?

Life conditions are key factors for defining growth and development of future generation. Exposure to drugs, alcohol, use of tobacco and other substances in parents as part of their lifestyle, have been reported to affect children's health and wellbeing. Prenatal exposures have been documented, but less is known about influences from parental harmful habits during children 's school years. The aim of this study is to examine potential associations between parental habits and anthropometric characteristics of their children. Parental smoking, alcohol intake, food security, and socioeconomic status (SES) were explored in 1730 children recruited at private and public schools in eight Venezuelan cities. These qualitative variables were collected through a semi-structured questionnaire. Weight, height and body mass index were measured using standardized methods. Height and BMI were converted to z-scores according to WHO international growth reference. Low BMI z-scores in children were significantly associated with mothers consuming alcohol. The frequency of children with short height was higher in households with impaired access to quality foods and where mothers reported low and very low food security status. In brief, our study indicates that social environment could have detrimental effects on child anthropometry, and on adequacy of food intake affecting their wellbeing. Funding: This study was supported by an award given by Caracas’ Insurance Foundation ( from Liberty Mutual Venezuela) as the awarded best Project in 2010. The funders had no role in study design, data collection, analysis, the decision to publish, or the preparation of this manuscript. Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: The study was approved by the ethics committee of the Venezuelan Scientific Society for Obesity, and conducted in accordance with the ethical standards specified in the World Medical Association (2000) Declaration of Helsinski. Informed consent was obtained from a parent or legal guardian of each participating child.

School Start Time and the Healthy Weight of Adolescents

PurposeStudies have found that an early school start time is detrimental to the sleep, health, and well-being of youth, but its association with body weight remains unclear. We examined this association in Canadian adolescents. MethodsWe collected information on start times from 362 schools that participated in the 2013/2014 Canadian Health Behaviour in School-aged Children Study (n = 29,635 students; ages 10–18). We estimated body mass indices (BMIs) and BMI z-scores, and identified overweight and obesity using international growth references. Multilevel regression models tested the associations between school start times and our outcomes, adjusted for grade, family affluence, school rurality, latitude, and province. ResultsThe average BMI was 21.2 (standard deviation 4.9) and BMI z-score was .48 (standard deviation 1.23). Every 10-minute delay in school start time corresponded with a .02 (95% confidence interval .00, .04) smaller BMI z-score. This association translated to BMIs in the 70th and 64th percentiles when comparing students from schools that started at 8:00 a.m. and 9:30 a.m., respectively. School start time was not significantly related to overweight or obesity. ConclusionsLater school start time was linked to lower BMI in Canadian adolescents. Delaying school start time may be an additional strategy to support the healthy weight of adolescents. Future intervention and impact studies are recommended to confirm these findings.

Prevalence of Stunting and Associated Factors among Children Aged 06-59 Months In Southwest Ethiopia: A Cross-Sectional Study

Nutritional Stunting, which is height for age below that expected on the basis of International growth reference, is a very serious type of malnutrition in that it develops slowly through time before it is evident.

GROWING UP IN PORTUGAL: CAPE VERDEAN ANCESTRY CHILDREN EXHIBIT LOW OVERWEIGHT AND OBESITY COMPARED WITH PORTUGUESE IN URBAN LISBON.

Portugal has one of the highest rates of childhood overweight and obesity in Europe. However, little is known about the health of ethnic minorities living in its capital city, Lisbon. The Cape Verdean community in Lisbon tend to have low educational levels, material deprivation and struggle with discrimination and racism, factors that would probably be associated with a higher prevalence of overweight and obesity. Data for the Cape Verdean population were collected in three different time periods by three different research teams in 1993, 2009 and 2013 and included children aged 6-12 years living in the Cova da Moura neighbourhood of the Greater Lisbon Metro Area. The Portuguese national survey was conducted between 2009 and 2010 at public and private schools in mainland Portugal and included height, weight, skinfolds and arm and waist circumferences. From these survey data body mass index (BMI) and prevalence of stunting (chronic malnutrition - low height-for-age) and underweight (low weight-for-age) were calculated according to reference values proposed by Frisancho (2008). Overweight and obesity prevalence values were defined based on the references established by the International Obesity Task Force. The results show significant differences in height between Cape Verdean and Portuguese boys and girls. Generally, Cape Verdeans' growth falls within the healthy range of international growth references across all of the survey data collected. Cape Verdean rates for combined overnutrition (overweight and obesity) in 2013 (9.8% for boys and 16.7% for girls) were lower than those of the Portuguese (33% for boys and 31.7% for girls). Logistic regression models showed that Cape Verdean children had a lower risk of being overweight or obese when accounting for breast-feeding, birth weight, maternal education and occupation. Despite living in a deprived neighbourhood these Cape Verdean children seemed to have grown more healthily than Portuguese ancestry children. The challenge for policymakers will be to support improvement of the poverty-related living conditions of this community without creating a risky environment for increasing prevalence of overweight and obesity.

The height-, weight- and BMI-for-age of preschool children from Nizhny Novgorod city, Russia, relative to the international growth references.

BackgroundMonitoring a child’s growth status helps to diagnose diseases and implement curative and preventive measures.The aim of this study was to assess how well preschool children of Russian city (Nizhny Novgorod) match with, or diverge from, international growth charts (WHO2006,2007; USCDC2000).MethodsCross-sectional study included 3,130 children aged 3–7 years attending municipal preschools of Nizhny Novgorod, the city in the European part of Russia. The study was held from February 2012 to October 2013.The international WHO2006,2007 and USCDC2000 growth references were used to calculate the height, weight and BMI z-scores. The distributions of z-scores were analysed with descriptive and inferential statistical methods. Z-score equal 0.25 was considered as a benchmark for clinically significant differences.ResultsMeans height z-scores calculated with the use of WHO2006, 2007 and USCDC2000 references were above the 50th centile (0.13 – 0.47) for both boys and girls. The means height z-scores was less than 0.25 SD above the 50th centile only for WHO2006.Stunting prevalence (the height-for-age z-score less than -2) was slightly higher under WHO2006 (3-4 %) than under USCDC 2000 (2–3 %). Stunting prevalence among children aged 5–7 years was similar under WHO2007 and USCDC2000 references (1 %).For boys and girls aged 3–4 years the thinness prevalence, using WHO2006 was 2 %, using USCDC2000 was 6 % (p < 0.05). At the age 5–7 years this proportion under WHO2007 was 3 % in both sex groups, under USCDC2000 was 8 % for boys and 6 % for girls (p < 0.05).A proportion of preschoolers aged 3–4 years with overweight was slightly higher under WHO2006 reference (13–15 %) than under USCDC2000 (12–14 %). In the case of age 5–7 years the overweight prevalence under WHO2007 (13–12 %) was lower than under USCDC2000 (14 %).Obesity prevalence under WHO2006,2007 (3–4 %) was slightly higher than that under USCDC2000 reference (2–3 %).Preschoolers’ distribution by groups of normal weight, overweight, obesity didn’t significantly differ among the references (chi-square).ConclusionsThe growth assessment of children aged 3–7 years attending municipal preschools of the Russian city Nizhny Novgorod under the international references (WHO2006,2007; USCDC 2000), demonstrated that the height fit to the WHO2006 standard for the children aged 3 and 4 was generally fine, since all the mean values were within 0.25 of the standard deviations of the mean. Beyond the age of 5 the fit to the WHO2007 was poor while the fit to the USCDC2000 was poor throughout.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2946-8) contains supplementary material, which is available to authorized users.

Weight and height centiles of Argentinian children and adolescents: a comparison with WHO and national growth references

Background: Studies in several countries comparing the performance of WHO references and their own national growth standards reported differences that could affect screening and growth monitoring.Aim: To estimate weight and height centiles on a sample of Argentinian children and adolescents and compare selected centiles with WHO and national growth references.Subjects and methods: A cross-sectional school survey was conducted on 6239 boys and girls aged 5–18. Data were collected between 2005–2009 in Santa Rosa, Argentina. Smoothed weight and height centiles were estimated by the LMS method and compared with WHO 2007 and Argentinian (ARG) growth references.Results: Weight centiles were higher than those of WHO and ARG. Height centiles were above the ARG and below the WHO ones. The greatest differences with ARG were seen before puberty and then declined up to age 18. In contrast, differences with WHO increased from puberty onwards.Conclusion: Compared with the ARG reference, linear growth of these schoolchildren shows a secular acceleration without substantial improvements in the adult height. In relation to WHO, the results suggest that around the adolescent growth spurt differences in linear growth between populations became larger, limiting the clinical usefulness of international growth references in adolescents.

Growth curves for girls with Turner syndrome.

The objective of this study was to review the growth curves for Turner syndrome, evaluate the methodological and statistical quality, and suggest potential growth curves for clinical practice guidelines. The search was carried out in the databases Medline and Embase. Of 1006 references identified, 15 were included. Studies constructed curves for weight, height, weight/height, body mass index, head circumference, height velocity, leg length, and sitting height. The sample ranged between 47 and 1,565 (total = 6,273) girls aged 0 to 24 y, born between 1950 and 2006. The number of measures ranged from 580 to 9,011 (total = 28,915). Most studies showed strengths such as sample size, exclusion of the use of growth hormone and androgen, and analysis of confounding variables. However, the growth curves were restricted to height, lack of information about selection bias, limited distributional properties, and smoothing aspects. In conclusion, we observe the need to construct an international growth reference for girls with Turner syndrome, in order to provide support for clinical practice guidelines.

The reduction of Calpain-10 expression is associated with risk polymorphisms in obese children

Excessive weight gain and obesity are major public health concerns. Childhood obesity is growing at an alarming rate. Polymorphisms in the Calpain-10 gene and the reduced expression of this gene in muscle cells and adipocytes have been associated with an increased risk of type 2 diabetes mellitus in several populations. In the present study, we explored the contribution of Calpain-10 in the development of metabolic impairment in childhood. We evaluated the presence of risk polymorphisms in the CAPN10 gene (SNP-44, SNP-43, InDel-19 and SNP-63) and the associated changes in the Calpain-10 mRNA levels in a pediatric population. A total of 161 Mexican children between 4 and 18years old were included in this study. This population was classified into three groups according to international growth references: healthy weight (HW), overweight (OW) and obese (OB). Association studies of the anthropometric data, clinical values, genotyping and expression assays showed a decrease in the Calpain-10 mRNA and protein expression in the OW and OB groups with respect to the HW group. This decrease in the Calpain-10 mRNA expression was more evident in individuals homozygous for SNP-44 (T/T) and InDel-19 (3/3), alone (p<0.001 and p=0.015, respectively) or in combination (p=0.017). These polymorphisms were also associated with elevated BMI, weight percentiles, z-scores, waist circumferences, fasting glucose levels and beta cell functions in the OW and OB groups (p<0.05). Moreover, our results indicate a statistically significant decrease in the expression of the 75-kDa Calpain-10 isoform in the OW+OB group. The presence of polymorphisms and alterations in the expression of the CAPN10 gene at early ages might result in metabolic impairment in adulthood and should be further investigated.