World Health Organization Growth Reference Research Articles

Association of dental caries and weight status in 6- to 7-year-old Filipino children

The aims of the study were (1) to assess in 6- to 7-year-old Filipino children caries prevalence and experience and the weight status and (2) to investigate the association between dental caries and weight status. Dental and anthropometric examinations were conducted on 1,962 6- to 7-year-old children during the National Oral Health Survey in 2005-2006. Dental caries assessments were carried out using World Health Organisation (WHO) criteria (1997). Weight status was assessed with body mass index according to WHO growth reference. A multivariable logistic regression model was applied to investigate the effect of dental caries and sociodemographic variables on the children's weight status. Caries prevalence was 96.8 % in primary and 39.7 % in permanent teeth, and caries experience was 8.4 dmft and 0.6 DMFT. Of the children, 17.8 % were underweight, 73.0 % had normalweight, 6.0 % were overweight and 3.2 % were obese. Girls had a lower risk of being underweight than boys odds ratios (OR) 0.70, confidence interval (CI) 0.55-0.88. Children living in rural areas and with no television at home were more likely to be underweight (OR 1.36, CI 1.07-1.72; OR 1.37, CI 1.07-1.76, respectively). Fewer primary and permanent teeth were risk factors for being underweight (OR 0.93, CI 0.92-0.95; OR 0.90, CI 0.89-0.94, respectively). Underweight was associated stronger with demographic and socioeconomic conditions than with dental variables. However, underweight and dental caries are public health issues of high priority affecting children at an important phase of their development. Definite conclusions upon an association between dental caries and weight status in high caries risk schoolchildren cannot be drawn.

WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6–9‐year‐old children

What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north-south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary-school children in Europe based on measured data lack a similar data collection protocol. What this study adds Unique dataset on overweight and obesity based on measured weights and heights in 6-9-year-old children from 12 European countries using a harmonized surveillance methodology. Because of the use of a consistent data collection protocol, it is possible to perform valid multiple comparisons between countries. It demonstrates wide variations in overweight and obesity prevalence estimates among primary-school children between European countries and regions. Nutritional surveillance in school-age children, using measured weight and height, is not common in the European Region of the World Health Organization (WHO). The WHO Regional Office for Europe has therefore initiated the WHO European Childhood Obesity Surveillance Initiative. To present the anthropometric results of data collected in 2007/2008 and to investigate whether there exist differences across countries and between the sexes. Weight and height were measured in 6-9-year-old children in 12 countries. Prevalence of overweight, obesity, stunting, thinness and underweight as well as mean Z-scores of anthropometric indices of height, weight and body mass index were calculated. A total of 168 832 children were included in the analyses and a school participation rate of more than 95% was obtained in 8 out of 12 countries. Stunting, underweight and thinness were rarely prevalent. However, 19.3-49.0% of boys and 18.4-42.5% of girls were overweight (including obesity and based on the 2007 WHO growth reference).The prevalence of obesity ranged from 6.0 to 26.6% among boys and from 4.6 to 17.3% among girls. Multi-country comparisons suggest the presence of a north-south gradient with the highest level of overweight found in southern European countries. Overweight among 6-9-year-old children is a serious public health concern and its variation across the European Region highly depends on the country. Comparable monitoring of child growth is possible across Europe and should be emphasized in national policies and implemented as part of action plans.

Clinical Profile and Complications of Childhood- and Adolescent-Onset Type 2 Diabetes Seen at a Diabetes Center in South India

This study describes the clinical characteristics of childhood- and adolescent-onset type 2 diabetes mellitus (CAT2DM) seen at a diabetes center in southern India. Between January 1992 and December 2009, 368 CAT2DM patients were registered. Anthropometric measurements were done using standardized techniques. Biochemical investigations included C-peptide measurements and glutamic acid decarboxylase antibody assay wherever feasible. Retinopathy was diagnosed by retinal photography; microalbuminuria, if urinary albumin excretion was between 30 and 299 mg/μg of creatinine; nephropathy, if urinary albumin excretion was ≥300 mg/μg; and neuropathy, if vibration perception threshold on biothesiometry was ≥20 V. The proportion of CAT2DM patients, expressed as percentage of total patients registered at our center, rose from 0.01% in 1992 to 0.35% in 2009 (P<0.001). Among the 368 cases of CAT2DM, 96 (26%) were diagnosed before the age of 15 years. The mean age at first visit and age at diagnosis of the CAT2DM subjects were 22.2±9.7 and 16.1±2.5 years, respectively. Using World Health Organization growth reference charts, 56% of boys and 50.4% of girls were >85(th) percentile of body mass index for age. Prevalence rates of retinopathy, microalbuminuria, nephropathy, and neuropathy were 26.7%, 14.7%, 8.4%, and 14.2%, respectively. Regression analysis revealed female gender, body mass index >85(th) percentile, parental history of diabetes, serum cholesterol, and blood pressure to be associated with earlier age at onset of CAT2DM. CAT2DM appears to be increasing in urban India, and the prevalence of microvascular complications is high. Female predominance is seen at younger ages.

Will introducing the new World Health Organization growth reference to Australia reduce breastfeeding rates: why not a randomised controlled trial first?

The aim is to review the implications of the introduction of new World Health Organisation (WHO) growth reference into Australia, and in particular its potential effects on breastfeeding rates in the first six months of life. A review of the velocity and trajectory of growth in the new WHO Growth Reference compared to the growth references most commonly used in Australia. The World Health Organisation has recommended the universal use of its new growth reference. However, in the first 6 months of life, the critical period for the maintenance of breastfeeding, the new WHO reference is heavier than the reference previously used in Australia. This may mean that more infants will be classified as having poor growth. It is likely that these infants will be given additional feeds or even may cease being breastfed. Maintenance of breastfeeding is important for minimising short-, medium- and long-term risks. Before the introduction of a new growth reference is contemplated, a randomised controlled trial should be conducted to be sure that there will be no adverse effect on breastfeeding.

Prevalence of short stature in Saudi children and adolescents

BACKGROUND AND OBJECTIVE:Data on stature in Saudi children and adolescents are limited. The objective of this report was to establish the national prevalence of short stature in Saudi children and adolescents.DESIGN AND SETTING:Community-based, cross-sectional study conducted over 2 years (2004, 2005)PATIENTS AND METHODS:The national data set of the Saudi reference was used to calculate the stature for age for children and adolescents 5 to 18 years of age. Using the 2007 World Health Organization (WHO) reference, the prevalence of moderate and severe short stature was defined as the proportion of children whose standard deviation score for stature for age was less than -2 and -3, respectively. In addition, the 2000 Center for Disease Control (CDC) and the older 1978 National Center for Health Statistics (NCHS)/WHO references were used for comparison.RESULTS:Using the 2007 WHO reference, sample size in the Saudi reference was 19 372 healthy children and adolescents 5 to 17 years of age, with 50.8% being boys. The overall prevalence of moderate and severe short stature in boys was 11.3% and 1.8%, respectively; and in girls, 10.5% and 1.2%, respectively. The prevalence of moderate short stature was 12.1%, 11% and 11.3% in boys and 10.9%, 11.3% and 10.5% in girls when the 1978 WHO, the 2000 CDC and the 2007 WHO references were used, respectively.CONCLUSIONS:The national prevalence of short stature in Saudi children and adolescents is intermediate compared with the international level. Improvement in the socioeconomic and health status of children and adolescents should lead to a reduction in the prevalence of short stature.

A comparison of the National Center for Health Statistics and new World Health Organization growth references for school-age children and adolescents with the use of data from 11 low-income countries

In 2007 new World Health Organization (WHO) growth references for children aged 5-19 y were introduced to replace the National Center for Health Statistics (NCHS) references. This study aimed to compare the prevalence of stunting, wasting, and thinness estimated by the NCHS and WHO growth references. NCHS and WHO height-for-age z scores were calculated with the use of cross-sectional data from 20,605 schoolchildren aged 5-17 y in 11 low-income countries. The differences in the percentage of stunted children were estimated for each year of age and sex. The z scores of body mass index-for-age and weight-for-height were calculated with the use of the WHO and NCHS references, respectively, to compare differences in the prevalence of thinness and wasting. No systematic differences in mean z scores of height-for-age were observed between the WHO and NCHS growth references. However, z scores of height-for-age varied by sex and age, particularly during early adolescence. In children for whom weight-for-height could be calculated, the estimated prevalence of thinness (WHO reference) was consistently higher than the prevalence of wasting (NCHS reference) by as much as 9% in girls and 18% in boys. In undernourished populations, the application of the WHO (2007) references may result in differences in the prevalence of stunting for each sex compared with results shown when the NCHS references are used as well as a higher estimated prevalence of thinness than of wasting. An awareness of these differences is important for comparative studies or the evaluation of programs. For school-age children and adolescents across all ranges of anthropometric status, the same growth references should be applied when such studies are undertaken.

Estado nutricional relativo ao zinco de crianças que frequentam creches do estado da Paraíba

OBJETIVO: Avaliar o estado nutricional relativo ao zinco de crianças assistidas em creches do Estado da Paraíba. MÉTODOS: O estado nutricional relativo ao zinco de 235 crianças pré-escolares foi avaliado através de sua concentração no soro, da ingestão dietética de zinco e da estatura para idade, como recomendado pelo International Zinc Consultative Group. As concentrações séricas de zinco foram determinadas por espectrofotometria de absorção atômica de chama, considerando deficiência de zinco valores &lt;65µmol/L. O consumo alimentar foi registrado mediante o recordatório de 24 horas, considerando a alimentação da criança no dia anterior e o consumo de alimentos na creche, e foi analisada a inadequação dietética de zinco de acordo com as necessidades médias estimadas de zinco segundo etapa da vida e tipo de dieta estabelecido pelo International Zinc Consultative Group. Adotou-se o Padrão de Crescimento Infantil da Organização Mundial da Saúde para o índice estatura para idade, considerando-se com deficit de estatura as crianças que apresentaram esse índice dois escores-Z abaixo do valor mediano da população de referência. Empregou-se o teste t ou análise de variância na análise estatística, programa Statistical Package for the Social Sciences-16.0. RESULTADOS: As prevalências de deficiência de zinco no soro, inadequação dietética de zinco e deficit de estatura foram de 16,2%, 16,6% e 7,7%, respectivamente. A média de zinco no soro foi estatisticamente menor nas crianças de mães com baixo peso em comparação com as crianças de mães com peso normal. CONCLUSÃO: As crianças estudadas apresentaram risco moderado de deficiência de zinco, pois são indicadas prevalências significativas de baixos níveis séricos de zinco, de consumo inadequado de zinco e de desnutrição crônica.

Mismatch between the prevalence of overweight and obese children and adolescents and recording in electronic health records: a cross-sectional study

The prevalence of obesity has increased dramatically in recent years. An electronic health record (EHR) can be used to identify and manage overweight and obesity by providing timely information. To estimate the prevalence of overweight and obesity using anthropometric data from an EHR and to compare it with the frequency of diagnoses of 'overweight' and 'obesity' registered by pediatricians. Cross-sectional, descriptive analytical study from a sample of records from children aged between 2 and 19 years who had at least one well-child visit registered in the EHR over the 24-month period between 2007 and 2008. The record of a diagnosis of overweight or obesity by physicians was compared with estimations based on body mass index (BMI; World Health Organization Growth Reference Data). Of 14 743 patients aged 2-19 years, 22.1% were overweight and 9.8% were obese. By contrast, a diagnosis of overweight was registered in the EHR for 3.3% of patients, with a figure of 1.1% for obesity. The prevalence of overweight/obesity was lower in adolescents than in children and preschoolers. Based on BMI cut-off points, we found that only 11.5% of the overweight or obese patients had these diagnoses registered in the EHR. Referral to a nutritionist or endocrinolist, and the frequency of selected laboratory tests based on BMI categories vary between 11.8 and 52.5%. An EHR can contribute to the identification of a population at risk when there is a sub-registry of these diagnoses by primary care physicians.

Management of children with severe acute malnutrition: A national priority

651 VOLUME 47__AUGUST 17, 2010 Severe acute malnutrition (SAM) among children below five years of age remains a major embarrassment, and impediment to optimal human capital development in India. The World Health Organization (WHO) and United Nations Children’s Fund proposed diagnostic criteria for severe acute malnutrition in children aged 6 to 60 months include any of the following: (i) weight for height below –3 standard deviation (SD or Z scores) of the median WHO growth reference (2006); (ii) visible severe wasting; (iii) presence of bipedal edema; and (iv) mid upper arm circumference below 115 mm(1). The Indian Academy of Pediatrics recommended diagnostic criteria (2007), adapted from the earlier WHO guidelines, are weight for height/length below 70% or ≤3SD of NCHS median and/or visible severe wasting and/or bipedal edema; mid upper arm circumference criteria may also be used for identifying severe wasting(2).

Genetic variants that affect length/height in infancy/early childhood in Vietnamese-Korean families

To identify genetic factors that influence height in infancy/early childhood, a family-based genome-wide association study was conducted using 269,888 single-nucleotide polymorphisms (SNPs) in 165 families composed of a Korean father, a Vietnamese mother and Vietnamese-Korean offspring in the International Marriage-based Immigrant Cohort in Korea. In a single-SNP-based analysis, the six SNPs in or near genes MAF, MAGI2, BMP4 and PTPN7 showed consistent suggestive associations at all height standard deviation scores using Korean, World Health Organization and Vietnamese growth references. Analyzing the haplotypes for the genes, haplotype blocks were found to be significantly associated with height. Similar to the results of a contiguous haplotype analysis using tag SNPs as above, noncontiguous haplotypes of variable length also showed a significant association near the suspected loci. Our result suggests that height during infancy/early childhood may be regulated by genetic variations that differ from those of adults.

The relationship of birthweight, muscle size at birth and post-natal growth to grip strength in 9-year-old Indian children: findings from the Mysore Parthenon study.

Foetal development may permanently affect muscle function. Indian newborns have a low mean birthweight, predominantly due to low lean tissue and muscle mass. We aimed to examine the relationship of birthweight, and arm muscle area (AMA) at birth and post-natal growth to handgrip strength in Indian children. Grip strength was measured in 574 children aged 9 years, who had detailed anthropometry at birth and every 6-12 months post-natally. Mean (standard deviation (s.d.)) birthweight was 2863 (446) g. At 9 years, the children were short (mean height s.d. -0.6) and light (mean weight s.d. -1.1) compared with the World Health Organization growth reference. Mean (s.d.) grip strength was 12.7 (2.2) kg (boys) and 11.0 (2.0) kg (girls). Weight, length and AMA at birth, but not skinfold measurements at birth, were positively related to 9-year grip strength (β = 0.40 kg/s.d. increase in birthweight, P < 0.001; and β = 0.41 kg/s.d. increase in AMA, P < 0.001). Grip strength was positively related to 9-year height, body mass index and AMA and to gains in these measurements from birth to 2 years, 2-5 years and 5-9 years (P < 0.001 for all). The associations between birth size and grip strength were attenuated but remained statistically significant for AMA after adjusting for 9-year size. We conclude that larger overall size and muscle mass at birth are associated with greater muscle strength in childhood, and that this is mediated mainly through greater post-natal size. Poorer muscle development in utero is associated with reduced childhood muscle strength.

Growth and Body Composition of Peruvian Infants in a Periurban Setting

Previous growth studies of Peruvian children have featured high stunting rates and limited information about body composition. We aimed to characterize anthropometric measures of Peruvian infants 0 to 12 months of age in relation to the international growth references and biological, environmental, and socioeconomic factors. Infants (n = 232) were followed longitudinally from birth through 12 months of age from a prenatal zinc supplementation trial conducted in Lima, Peru, between 1995 and 1997. Anthropometric measures of growth and body composition were obtained at enrollment from mothers and monthly through 1 year of age from infants. Weekly morbidity and dietary intake surveillance was carried out during the second half of infancy. The prevalence rates of stunting, underweight, and wasting did not exceed 4% based on the World Health Organization growth references. Infants of mothers from high-altitude regions had larger chest circumference (p = .006) and greater length (p = .06) by 12 months. Significant predictors of growth and body composition throughout infancy were age, sex, anthropometric measurements at birth, breastfeeding, maternal anthropometric measurements, primiparity, prevalence of diarrhea among children, and the altitude of the region of maternal origin. No associations were found for maternal education, asset ownership, or sanitation and hygiene factors. Peruvian infants in this urban setting had lower rates of stunting than expected. Proximal and familial conditions influenced growth throughout infancy.

Does breastfeeding protect against childhood overweight? Hong Kong's 'Children of 1997' birth cohort

Observational studies from mainly Western settings suggest breastfeeding may protect against childhood adiposity; however, breastfeeding and adiposity share social patterning potentially generating confounding, making evidence from other settings valuable. We used multivariable linear regression to examine the prospective adjusted associations of breastfeeding with body mass index (BMI), height and weight z-scores at 7 years of age relative to the 2007 World Health Organization (WHO) growth reference, in a large (n = 8327), population-representative Hong Kong Chinese birth cohort, recruited between April and May 1997 with high follow-up (n = 7026). Low socio-economic position (SEP) was associated with never breastfeeding and with exclusive breastfeeding for > or =3 months. We did not find any association between breastfeeding and BMI [z-score mean difference 0.07, 95% confidence interval (CI) -0.05 to 0.19], height (0.02, 95% CI -0.07 to 0.11) or weight (0.07, 95% CI -0.05 to 0.18), adjusted for sex, birth weight, gestational age, SEP, second-hand smoke (SHS) exposure, parity, mother's age at birth, mother's place of birth and serious infant morbidity. In a non-European setting, breastfeeding was not associated with child adiposity, suggesting that observed protective effects may be due to socially patterned confounding by SEP, maternal adiposity and maternal smoking.

High birth weight and overweight or obesity among Chinese children 3–6 years old

Objective To investigate the association between different levels of birth weight and the risk of overweight and obesity in children aged 3–6 years. Methods A retrospective longitudinal study of 15,852 children aged 3–6 years in Tianjin, China. Body weight and height, and other factors (age, gestational age, past and current health status, father's and mother's education, occupation and health status, family income, and sex) were obtained using standardized methods. Results After adjustment for the above other factors, Chinese children who were born with a birth weight below 2500 g are less likely to become overweight or obese (body mass index more than the 85th percentiles for age and gender specific distribution using the World Health Organization growth reference) during childhood (odd ratio [OR] 0.84, 95% confidence interval [CI] 0.47–1.52) when compared to the reference group (2500–2999 g). However, the odds ratios of becoming overweight or obese during childhood increase significantly when birth weights are 3000–3499 g (OR 1.58, 95% CI 1.33–1.88), 3500–3999 g (OR 2.09, 95% CI 1.76–2.49), and more than 4000 g (OR 3.14, 95% CI 2.60–3.79). Conclusions High levels of birth weight, defined as birth weight > 3000 g, were a stronger predictor for overweight and obesity among the Chinese children aged 3–6 years.

Avaliação nutricional de crianças do Vale do Alto Jequitinhonha com a utilização das novas curvas de crescimento do NCHS e da OMS

OBJETIVO: Analisar comparativamente a avaliação nutricional de crianças em uma região carente do estado de Minas Gerais, utilizando curva de crescimento padrão de referência do NCHS e da Organização Mundial da Saúde (OMS). MÉTODOS: Estudo transversal realizado em três municípios da região do Alto Jequitinhonha, Minas Gerais. Foram incluídas as crianças com até 24 meses de idade, residentes nas áreas rurais e urbanas. A coleta de dados foi feita em julho de 2000. Análises comparativas foram feitas utilizando-se as curvas de crescimento do NCHS e da OMS com os programas Epi-Info 6.04b, Excel e Anthro 2005. RESULTADOS: Foram analisados dados de 450 crianças. A população era predominantemente de baixo nível socioeconômico, sendo 85,3% com renda per capita inferior a meio salário mínimo. Utilizando-se respectivamente as curvas da OMS e do NCHS, o déficit peso/altura foi detectado em 4,2 e 2,2% em crianças com até cinco meses e 2,3 e 3,2% com 12 ou mais meses; o déficit altura/idade em 18,8 e 7,5% com até cinco meses e 2,8 e 7,4% com 12 meses ou mais; o sobrepeso em 12,5 e 8,6% com até cinco meses e 7,4 e 5,1% com 12 meses ou mais. CONCLUSÕES: Foram encontradas diferenças na detecção de deficiências nutricionais. As curvas da OMS são mais atualizadas e foram elaboradas a partir de uma amostra composta de crianças vivendo em boas condições ambientais e de hábitos alimentares saudáveis, o que possibilitou seu crescimento adequado, podendo ser consideradas mais apropriadas para o acompanhamento do crescimento.

Prevalence of Undernutrition among Children in the Garhwal Himalayas

Nutritional status is the best indicator of the global well-being of children. In India every third child is underweight, whereas in the Garhwal Himalayas only one-fifth of the children are nutritionally normal. Information regarding the causes of such low nutritional status in children of Garhwal is lacking. The present study was designed to identify factors that may influence the nutritional status of the children of the Garhwal Himalayas. Stunting, signifying long-term irreversible chronic undernutrition, was studied, along with wasting, which signifies acute undernutrition among children. Forty families from one town and one village in each of the three major agroclimatic situations (high, middle, and low hills) were selected at random (total 240 families). The nutritional status of 353 children (0 to 12 years of age) was assessed by nutritional anthropometry and compared with tables of weight-for-age and height-for-age z-scores (WAZ and HAZ) identifying wasting and stunting, respectively, and compared with the World Health Organization (WHO) Growth Reference charts 2007. Chi-square test was applied to analyze the effects of age, sex, altitude, and area on the nutritional status of children. Of the 353 children studied, 38.2% belonged to the school-aged group, with 7% more girls than boys. Only 11.3% of the children had normal HAZ while 10.3% had normal WAZ. The largest percentages of children (31.8% HAZ and 29.1% WAZ) were clustered in the SD1 group, that is the severely stunted or wasted group. In every age group except the 9- to 12-year group, most of the children were found in the WAZ SD1 category. Gender appeared to influence the SD1 category significantly. There were 17.0% severely stunted girls (SD1), as compared to 14.8% boys; while the percentages of WAZ girls was 16.1% and boys was 13%. The situation in the urban areas was slightly better: 6.4% of the sample had normal HAZ and 7.1% had normal WAZ, compared with 4.4% and 4.6% of the rural children. In all three agroclimatic situations, the largest percentage of children fell in the HAZ SD1 (stunted) category (15.3% in the high hills, 7.3% in the middle hills, and 9.5% in the low hills). There is a significant effect of area (rural vs. urban) on stunting and wasting among children. The child's sex affects stunting only. The other two variables, altitude and age, do not show a significant relationship with stunting or wasting. The rate of malnutrition among children in the Garhwal is very high. The majority are severely stunted and wasted, indicating a high prevalence of both chronic and acute malnutrition. Only the area of residence (rural or urban) had an influence on a child's nutritional status.

The burden of malaria and malnutrition among children less than 14 years of age in a rural village of Cameroon

Malaria and malnutrition are a major health burden in developing countries with infants and children being the most vulnerable groups. The extent of the burden of malaria and malnutrition was investigated in 339 children &#8804;14years residing in the village of Muea located in the South West Province of Cameroon. Malaria parasitaemia was determined microscopically from Giemsa stained thick blood films. Nutritional status was determined using age and the anthropometric parameters of weight and height. Height-for-age (HAZ), weight-for-age (WAZ) and weight-forheight (WHZ) Z scores were computed based on the National Centre for Health Statistics (NCHS)/World Health Organisation growth reference curves. Anaemia was assessed by measuring haemoglobin (Hb) concentration while plasma iron levels were determined by spectrophotometric assays. The prevalence of malaria in the study population was 96.2% (326/339) with a majority (68.4%) having asymptomatic disease. The geometric mean parasite density (GMPD) was 744.37 ± 89396.11 (parasitaemia range 40-153190 parasites/&#956;L blood). The mean Hb concentration was 9.29 ± 1.8g/dL (range 4-14.1g/dL) and anaemia (Hb

Limitations of the Current World Health Organization Growth References for Children and Adolescents

Since the 1970s, the World Health Organization (WHO) has recommended the use of the growth references developed by the United States National Center for Health Statistics (NCHS) based on national survey data collected in the 1960s and 1970s. These references are known as the WHO or NCHS/WHO growth references. Over the past three decades, the WHO or NCHS/WHO growth references have played an important role internationally in the assessment of child and adolescent growth and nutritional status. However, the references have a number of weaknesses. The limitations of the infant portion of the references were thoroughly assessed in WHO's effort to develop a new international growth reference for infants and preschool children. The present report discusses the limitations of the NCHS/WHO references for school-aged children and adolescents, including a number of conceptual, methodological, and practical problems. The global obesity epidemic poses another challenge that the NCHS/WHO reference cannot appropriately meet. There is a need for a single international reference to assess the nutritional status and growth of school-aged children and adolescents across different countries.

Is the 2000 CDC growth reference appropriate for developing countries?

In 2000, the Centers for Disease Control and Prevention (CDC) produced a revised growth reference. This has already been used in different settings outside the USA. Using data obtained during a nutritional survey in Madagascar, we compare results produced by using both the 2000 CDC and the 1978 National Center for Health Statistics (NCHS)/World Health Organization (WHO) growth references. We show that changing the reference has an important impact on nutritional diagnosis. In particular, the prevalence of wasting is greatly increased. This could generate substantial operational and clinical difficulties. We recommend continued use of the 1978 NCHS/WHO reference until release of the new WHO multi-country growth charts.

Growth of the Czech child population 0-18 years compared to the World Health Organization growth reference.

Nationwide anthropological surveys of 0-18-year-old children were carried out in the Czech Republic (former Czech regions of Czechoslovakia) five times during the last 40 years, at 10-year intervals. The measurements provide reference data for the growth of the Czech child population and at the same time ample material for comparison with other populations. A comparison of the results of such nationwide anthropometric surveys with the World Health Organization (WHO) growth reference implies that the growth trend of Czech children is comparable with the WHO reference. The greatest similarity in the shape of the WHO height curves and the results obtained in Czechoslovakia was in 1971. The results obtained in the nationwide surveys also imply that the secular trend still exerts its effect. In the case of height, this finding is consistent during the whole period of 40 years. Concerning weight in higher age categories, especially in girls, the trend slowed down or stopped. Furthermore, there is no problem of malnutrition in the Czech child population. Similarly, as in any other developed nations, the prevalence of overweight and obesity is the problem that merits attention. Am. J. Hum. Biol. 9:459-468, 1997. © 1997 Wiley-Liss, Inc.