Worldwide variation in human growth and the World Health Organization growth standards: a systematic review

Growth of infants consuming whey-predominant term infant formulas with a protein content of 1.8 g/100 kcal: a multicenter pooled analysis of individual participant data

BACKGROUND

High protein intake during infancy may contribute to obesity later in life in infants who are not exclusively breastfed. Lowering the protein content of infant formula so it is closer to that of mature breast milk may reduce long-term risk of overweight or obesity in formula-fed infants.

OBJECTIVE

We assessed the effects of whey-predominant formulas with a protein content of 1.8 g/100 kcal (lower than that in most current formulas and closer to breast milk) on infant growth by comparing against WHO growth standards and breastfed infants.

DESIGN

A multicenter pooled analysis was conducted with the use of individual participant data (n = 1882) from 11 randomized controlled trials of healthy term infants. Mixed-effects models that used ANCOVA were generated to estimate weight-for-age z score (WAZ), as well as length-for-age, BMI-for-age, and head circumference-for-age z scores at age 4 mo in infants fed a lower-protein infant formula (LPF) or a lower-protein infant formula with additional active ingredients (probiotics, prebiotics, or both) (LPFA) and breastfed infants. Estimates, including 95% CIs, were compared with a ±0.5 SD of WHO growth standards, a benchmark for clinically significant differences.

RESULTS

The 95% CIs for pooled estimates of WAZ were within ±0.5 SD of WHO growth standards for the LPF [0.07 (-0.16, 0.29)] and LPFA [0.22 (0.01, 0.43)] groups. WAZ was higher in the LPF (P < 0.001) and LPFA (P = 0.003) groups than in the breastfed infants, likely because breastfed infants had a relatively low WAZ [-0.23 (-0.51, 0.05)] compared with WHO growth standards. The 95% CIs for all other z scores in the LPF and LPFA groups were within ±0.5 SD of WHO growth standards, except for head circumference, for which the upper limit of the 95% CI slightly exceeded 0.5 SD. No difference was observed in any z scores between the LPF and LPFA groups.

CONCLUSION

Whey-predominant infant formula with a lower protein content that more closely resembles that of breast milk supports healthy growth comparable to the WHO growth standards and close to breastfed infants.

Growth reference for Saudi school-age children and adolescents: LMS parameters and percentiles

BACKGROUND

Information on LMS parameters and percentiles reference for Saudi children and adolescents is not available.

OBJECTIVE

To report the L, M, and S parameters and percentile reference graphs for growth.

DESIGN

Field survey of a population-based sample of Saudi school-age children and adolescents (5-18 years of age).

SETTING

A stratified listing of the Saudi population.

SUBJECTS AND METHODS

Data from the national study of healthy children were reanalyzed using the Lamba-Mu-Sigma (LMS) methodology. The LMS parameters of percentiles for weight, height, and body mass index for age were calculated for children and adolescents from 5 to 18 years of age.

MAIN OUTCOME MEASURE

The main outcomes were the LMS parameters and percentiles of growth.

RESULTS

There were 19299 and 9827 (50.9%) were boys. The data for weight, height, and BMI for age for boys and girls are reported for the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles including LMS parameters for each percentile and age. Figures corresponding to each table are color coded (blue for boys and pink for girls).

CONCLUSIONS

This report provides a reference for growth and nutrition of Saudi school-age children and adolescents. The detailed LMS and percentile tables and graphs provide essential information for clinical assessment of nutritional status and growth in various clinical conditions and for research.

LIMITATIONS

This report does not reflect regional variations in growth.

Short Stature: Comparison of WHO and National Growth Standards/References for Height

The use of appropriate growth standards/references is of significant clinical importance in assessing the height of children with short stature as it may determine eligibility for appropriate therapy. The aim of this study was to determine the impact of using World Health Organization (WHO) instead of national growth standards/references on height assessment in short children. Data were collected from routine clinical practice (1998–2014) from nine European countries that have available national growth references and were enrolled in NordiNet^® International Outcome Study (IOS) (NCT00960128), a large-scale, non-interventional, multinational study. The patient cohort consisted of 5996 short pediatric patients diagnosed with growth hormone deficiency (GHD), Turner syndrome (TS) or born small for gestational age (SGA). The proportions of children with baseline height standard deviation score (SDS) below clinical cut-off values (–2 SDS for GHD and TS; –2.5 SDS for SGA) based on national growth references and WHO growth standards/references were compared for children aged <5 years and children aged ≥5 years. In seven of the countries evaluated, significantly fewer children aged ≥5 years with GHD (22%; P<0.0001), TS (21%; P<0.0001) or born SGA (32%; P<0.0001) had height below clinical cut-off values using WHO growth references vs. national references. Likewise, among children aged <5 years in the pooled analysis of the same seven countries, a significantly lower proportion of children with GHD (8%; P<0.0001), TS (12%; P = 0.0003) or born SGA (12%; P<0.0001) had height below clinical cut-off values using WHO growth standards vs. national references. In conclusion, in NordiNet^® IOS the number of patients misclassified using WHO growth standards/references was significantly higher than with national references. This study highlights that, although no growth reference has 100% sensitivity for identifying growth disorders, the most recent national or regional growth charts may offer the most appropriate tool for monitoring childhood growth in Europe.

National curves of foetal growth in singleton foetuses of Greek origin

BACKGROUND

Foetal growth monitoring is an essential component of prenatal care with postnatal impact. The aim of the study was to construct reference ranges for foetal biometric parameters in Greek foetuses and to compare them with previously published models.

MATERIALS AND METHODS

Measurements from 1200 Greek foetuses were used to construct normal curves for biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC), femoral length (FL) and the BPD/FL ratio according to the methodology described by Royston and Wright (1998). The model was validated in a second group of 1200 different foetuses using analysis of the corresponding standardized residuals (z-scores). The z-scores which were derived by our model were compared to those calculated using previously published models from other populations.

RESULTS

BPD, OFD, HC, AC, FL and the BPD/FL ratio are accurately described by simple quadratic equations (R(2) > 0·96 for most of the parameters tested). Statistically significant differences were observed for most of the z-scores when our models were compared to previously published models. Less than 10% of our foetuses were < 5th or > 95th centile of the latter models. About 10% of our foetuses were > 95th centile for FL and HC when the INTERGROWTH-21st formulas were used.

CONCLUSION

We present national foetal biometric references. Using charts from other populations (including INTERGROWTH-21st) may be unrepresentative of local populations and lead to misclassification of foetal growth status.

Growth monitoring as an early detection tool: a systematic review

Growth monitoring of apparently healthy children aims at early detection of serious underlying disorders. However, existing growth-monitoring practices are mainly based on suboptimal methods, which can result in delayed diagnosis of severe diseases and inappropriate referrals. We did a systematic review to address two key and interconnected questions underlying growth monitoring: which conditions should be targeted, and how should abnormal growth be defined? We systematically searched for studies reporting algorithms for growth monitoring in children and studies comparing the performance of new WHO growth charts with that of other growth charts. Among 1556 identified citations, 69 met the inclusion criteria. Six target conditions have mainly been studied: Turner syndrome, coeliac disease, cystic fibrosis, growth hormone deficiency, renal tubular acidosis, and small for gestational age with no catch-up after 2 or 3 years. Seven algorithms to define abnormal growth have been proposed in the past 20 years, but their level of validation is low, and their overall sensitivities and specificities vary substantially; however, the Grote and Saari clinical decision rules seem the most promising. Two studies reported that WHO growth charts had poorer performance compared with other existing growth charts for early detection of target conditions. Available data suggest a large gap between the widespread implementation of growth monitoring and its level of evidence or the clinical implications of early detection of serious disorders in children. Further investigations are needed to standardise the practice of growth monitoring, with a consensus on a few priority target conditions and with internationally validated clinical decision rules to define abnormal growth, including the selection of appropriate growth charts.

Association between nutritional status and outcomes in critically-ill pediatric patients - a systematic review

OBJECTIVES

To systematically review the evidence about the impact of nutritional status in critically-ill pediatric patients on the following outcomes during hospitalization in pediatric intensive care units: length of hospital stay, need for mechanical ventilation, and mortality.

DATA SOURCE

The search was carried out in the following databases: Lilacs (Latin American and Caribbean Health Sciences), MEDLINE (National Library of Medicine United States) and Embase (Elsevier Database). No filters were selected.

RESULTS

A total of seven relevant articles about the subject were included. The publication period was between 1982 and 2012. All articles assessed the nutritional status of patients on admission at pediatric intensive care units and correlated it to at least one assessed outcome. A methodological quality questionnaire created by the authors was applied, which was based on some references and the researchers' experience. All included studies met the quality criteria, but only four met all the items.

CONCLUSION

The studies included in this review suggest that nutritional depletion is associated with worse outcomes in pediatric intensive care units. However, studies are scarce and those existing show no methodological homogeneity, especially regarding nutritional status assessment and classification methods. Contemporary and well-designed studies are needed in order to properly assess the association between children's nutritional status and its impact on outcomes of these patients.

Head growth of undernourished children in rural Nepal: association with demographics, health and diet

BACKGROUND

Brain development in early childhood is a key determinant of later cognition, social achievement and educational success. Head circumference (HC) measurements are a simple method to assess brain growth, yet reports of these measurements are uncommon in nutritional surveys of undernourished children.

OBJECTIVE

To evaluate HC measurements in a population of rural Nepali children and relate these measurements to demographics, health and diet.

METHODS

An observational study of head growth was nested within a longitudinal evaluation of a livestock-based agricultural intervention in rural Nepal. Between 538 and 689 children (aged 6 months to 8 years) were measured (height, weight, HC) at each of six survey visits. A total of 3652 HC measurements were obtained. Results were converted to Z-scores (WHO Anthro).

RESULTS

Mean head circumference Z-scores (HCZ) diminished progressively over the first 4 years of life; a decline of 30% occurred between 3 and 4 years of age (-1.73 to -2.45, P < 0.0001). Overall, 56% of HCZ were <-2. Gender-adjusted HCZ (but not other measurements) were significantly lower for girls than boys [mean (SD) -2.31 (1.0) vs -1.99 (0.094), P < 0.0001]; girls more often had microcephaly (61% vs 50%, P < 0.0001). For children <3 years of age, HCZ were better in those who had eaten two or more animal-source foods (ASFs) within the previous 24 h [-1.69 (.05) vs -2.08 (0.10), P = 0.001] than in those who had eaten none or only one; HCZ correlated with the number of ASFs consumed (P < 0.001). Regression analyses demonstrated that the main determinants of HCZ were age, weight-for-age Z-scores (WAZ) and gender; 43% of the variance in HCZ in younger children was explained by WAZ and ASF consumption.

CONCLUSION

HCs reflect brain size in young children; brain size is linked to cognitive function. Poor head growth represents another facet of the 'silent emergency' of child undernutrition. Routine HCZ assessments may contribute to better understanding of the links between poverty and cognitive development.

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

Background

Monitoring 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).

Methods

Cross-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.

Results

Means 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).

Conclusions

The 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 material

The online version of this article (doi:10.1186/s12889-016-2946-8) contains supplementary material, which is available to authorized users.

The LMS and Z scale growth reference for Saudi school-age children and adolescents

BACKGROUND/AIM

To establish L, M, and S parameters and z score reference for the assessment of nutrition and growth of Saudi school-age children and adolescents.

SUBJECTS AND METHODS

Data from the original cross-sectional study were reanalyzed. The L, M, and S parameters and z scores were calculated for weight, height and body mass index for school-age children and adolescents.

RESULTS

A total of 19,299 subjects from 5 to 18 years of age were included. All were Saudi nationals and 9,827 (50.9%) were boys. The L M S parameters and z scores for weight for age, height for age, and BMI for age for boys and girls are presented in detailed tables across the age of commonly used z scores (+3, +2, +1, 0, -1, -2, -3). Graphs corresponding to the same parameters (weight, height, and BMI) showing the main z scores across all ages from 5 to 18 years are illustrated.

CONCLUSION

This report provides the first reference for nutritional status and growth of Saudi school-age children and adolescents. This tool is essential for more accurate assessment of growth and nutrition in various clinical conditions and research.

Growth reference for Saudi preschool children: LMS parameters and percentiles

BACKGROUND

Previous growth charts for Saudi children have not included detailed tables and parameters needed for research and incorporation in electronic records.

OBJECTIVES

The objective of this report is to publish the L, M, and S parameters and percentiles as well as the corresponding growth charts for Saudi preschool children.

DESIGN

Community-based survey and measurement of growth parameters in a sample selected by a multistage probability procedure.

SETTING

A stratified listing of the Saudi population.

SUBJECTS AND METHODS

Raw data from the previous nationally-representative sample were reanalyzed using the Lambda-Mu-Sigma (LMS) methodology to calculate the L, M, and S parameters of percentiles (from 3rd to 97th) for weight, length/height, head circumference, and body mass index-for-age, and weight for-length/height for boys and girls from birth to 60 months.

MAIN OUTCOME MEASURES

Length or height and weight of Saudi preschool children.

RESULTS

There were 15601 Saudi children younger than 60 months of age, 7896 (50.6 %) were boys. The LMS parameters for weight for age from birth to 60 months (5 years) are reported for the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentiles as well as the corresponding graphs. Similarly, the LMS parameters for length/height-for-age, head circumference-for-age, weight-for-length/height and body mass index-for-age (BMi) are shown with the corresponding graphs for boys and girls.

CONCLUSION

Using the data in this report, clinicians and researchers can assess the growth of Saudi preschool children.

LIMITATIONS

The report does not reflect interregional variations in growth.

Determinants of failure to thrive (FTT) among infants aged 6-24 months: a case-control study

INTRODUCTION

Failure to thrive (FTT) in children is one of the most important health issues around the world, especially in developing countries. Lack of success in identifying and controlling this health problem may lead to dangerous health consequences for children. The aim of this research was to explore the risk factors for this health problem in infants under two years of age in Urmia, Northwest of Iran.

METHODS

This case-control study was carried out on 445 infants of 6 to 24 months (180 as cases, and 265 as controls) in Urmia, Northwest of Iran, during 2013. The study samples were selected from six health centers, using the purposeful sampling method. To collect data, a questionnaire including items regarding sociodemographics of the children's families, and demographic and nutrition-related variables of infants was utilized. To analysis data and determine the real effect of the aforementioned factors on growth status of infants, a chi-square test and logistic regression analysis were applied.

RESULTS

The regression analysis revealed that education level of infants' mothers [AOR = 1.421, 95% CI (1.172, 1.724)], duration of breastfeeding [AOR = 1.859, 95% CI (1.212, 2.852)], birth weight of infants [AOR = 2.777, 95% CI (1.276, 7.166)], family's monthly income [AOR = 1.492, 95% CI (1.117, 2.230)] were correlated with FTT as significant risk factors (P < 0.05). Birth order of infants [AOR = .741, 95% CI ( .573- .958)], however, appeared to be a protective factor for child growth (P < 0.05).

DISCUSSION

The findings of the study may help health care providers in designing and implementing appropriate interventions for improving children's health. In addition, taking into account the importance of healthy growth of children, educating mothers/caretakers would seem beneficial in preventing dangerous diseases in children.

Kopfumfang bei Kindern und Jugendlichen in Deutschland

Der Kopfumfang zählt zu den wichtigsten anthropometrischen Messgrößen, die im Kindes- und Jugendalter untersucht werden, um frühzeitig Hinweise auf eine abweichende Entwicklung des Gehirns zu geben. Vom Robert Koch-Institut wurde von 2003 bis 2006 die „Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS)“ durchgeführt. Der Kopfumfang wurde bei über 17.000 Kindern und Jugendlichen standardisiert gemessen und geschlechtsspezifische Perzentilkurven, die in diesem Beitrag vorgestellt werden, mit statistischen Analyseverfahren modelliert. Über den gesamten Altersbereich zeigt sich, dass Jungen einen größeren Kopfumfang haben als Mädchen. Das Kopfwachstum ist im ersten Lebensjahr am stärksten und nimmt dann deutlich ab. Erst vor der Pubertät nimmt das jährliche Wachstum wieder zu. Im Alter von 16 Jahren ist das Kopfwachstum bei Mädchen beendet, während es bei Jungen noch bis zum Ende des beobachteten Altersbereichs (18. Lebensjahr) zunimmt. Der mediane Kopfumfang beträgt zu diesem Zeitpunkt bei Mädchen 55 cm und bei Jungen 57 cm. Mit der KiGGS-Studie stehen valide Daten zur Bewertung des Kopfumfangs von Kindern und Jugendlichen in Deutschland zur Verfügung. Neben den tabellierten Perzentilen kann auch jedes weitere relevante Perzentil für den gesamten Bereich des Kindes- und Jugendalters berechnet werden.

Length and height percentiles for children in the South-East Asian Nutrition Surveys (SEANUTS)

OBJECTIVE

Health and nutritional information for many countries in the South-East Asian region is either lacking or no longer up to date. The present study aimed to calculate length/height percentile values for the South-East Asian Nutrition Survey (SEANUTS) populations aged 0·5-12 years, examine the appropriateness of pooling SEANUTS data for calculating common length/height percentile values for all SEANUTS countries and whether these values differ from the WHO growth references.

DESIGN

Data on length/height-for-age percentile values were collected. The LMS method was used for calculating smoothened percentile values. Standardized site effects (SSE) were used for identifying large or unacceptable differences (i.e. $\mid\! \rm SSE \!\mid$ >0·5) between the pooled SEANUTS sample (including all countries) and the remaining pooled SEANUTS samples (including three countries) after weighting sample sizes and excluding one single country each time, as well as with WHO growth references.

SETTING

Malaysia, Thailand, Vietnam and Indonesia.

SUBJECTS

Data from 14202 eligible children were used.

RESULTS

From pair-wise comparisons of percentile values between the pooled SEANUTS sample and the remaining pooled SEANUTS samples, the vast majority of differences were acceptable (i.e. $\mid\! \rm SSE \!\mid$ ≤0·5). In contrast, pair-wise comparisons of percentile values between the pooled SEANUTS sample and WHO revealed large differences.

CONCLUSIONS

The current study calculated length/height percentile values for South East Asian children aged 0·5-12 years and supported the appropriateness of using pooled SEANUTS length/height percentile values for assessing children's growth instead of country-specific ones. Pooled SEANUTS percentile values were found to differ from the WHO growth references and therefore this should be kept in mind when using WHO growth curves to assess length/height in these populations.

Reference Ranges for Head Circumference in Ethiopian Children 0-2 Years of Age

BACKGROUND

Head circumference (HC) charts are important for early detection of hydrocephalus during childhood. In low-income countries where population-based HC charts are rarely available, hydrocephalus occurs more commonly than in developed countries, and is usually not diagnosed early enough to prevent severe brain damage. This applies to Ethiopia as well. The World Health Organization (WHO) has provided standard HC charts advocated for global use, but recent studies cast doubts whether these charts are equally applicable in various populations. The aim of the study was therefore to establish reference ranges for early childhood HC in Ethiopia.

METHODS

In this prospective, observational cross-sectional study, measurements of HC were collected from healthy children of different ethnicities between birth and 24 months, in health centers situated in 5 Ethiopian cities. Reference ranges for HC were estimated using the LMS method and compared with those recommended by WHO.

RESULTS

A total of 4019 children were included. Overall, 6.7% of boys and 7.1% of girls were above the +2 standard deviation (SD) of the WHO reference ranges, whereas the corresponding figures below -2 SD were 2.8% and 2.1%. Similarly, the +2 SD lines of the Ethiopian reference curves were considerably higher than those of the WHO growth standards, whereas the median and -2 SD lines were more comparable.

CONCLUSIONS

Ethiopian HC reference ranges for children from birth to 24 months of age were found to differ significantly from those established by WHO and should correspondingly be considered as the first choice for screening for hydrocephalus in that population.

Differences in motor performance between children and adolescents in Mozambique and Portugal: impact of allometric scaling

BACKGROUND

Children from developed and developing countries have different anthropometric characteristics which may affect their motor performance (MP).

AIM

To use the allometric approach to model the relationship between body size and MP in youth from two countries differing in socio-economic status-Portugal and Mozambique.

SUBJECTS AND METHODS

A total of 2946 subjects, 1280 Mozambicans (688 girls) and 1666 Portuguese (826 girls), aged 10-15 years were sampled. Height and weight were measured and the reciprocal ponderal index (RPI) was computed. MP included handgrip strength, 1-mile run/walk, curl-ups and standing long jump tests. A multiplicative allometric model was adopted to adjust for body size differences across countries.

RESULTS

Differences in MP between Mozambican and Portuguese children exist, invariably favouring the latter. The allometric models used to adjust MP for differences in body size identified the optimal body shape to be either the RPI or even more linear, i.e. approximately (height/mass(0.25)). Having adjusted the MP variables for differences in body size, the differences between Mozambican and Portuguese children were invariably reduced and, in the case of grip strength, reversed.

CONCLUSION

These results reinforce the notion that significant differences exist in MP across countries, even after adjusting for differences in body size.

Should the WHO growth charts be used in France?

BACKGROUND

Growth charts are an essential clinical tool for evaluating a child's health and development. The current French reference curves, published in 1979, have recently been challenged by the 2006 World Health Organization (WHO) growth charts.

OBJECTIVE

To evaluate and compare the growth of French children who were born between 1981 and 2007, with the WHO growth charts and the French reference curves currently used.

DESIGN

Anthropometric measurements from French children, who participated in 12 studies, were analyzed: 82,151 measurements were available for 27,257 children in different age groups, from birth to 18 years. We calculated and graphically compared mean z-scores based on the WHO and French curves, for height, weight and Body Mass Index (BMI) according to age and sex. The prevalence of overweight using the WHO, the French and International Obesity Task Force definitions were compared.

RESULTS

Our population of children was on average 0.5 standard deviations taller than the French reference population, from the first month of life until puberty age. Mean z-scores for height, weight and BMI were closer to zero based on the WHO growth charts than on the French references from infancy until late adolescence, except during the first six months. These differences not related to breastfeeding rates. As expected, the prevalence of overweight depended on the reference used, and differences varied according to age.

CONCLUSION

The WHO growth charts may be appropriate for monitoring growth of French children, as the growth patterns in our large population of French children were closer to the WHO growth charts than to the French reference curves, from 6 months onwards. However, there were some limitations in the use of these WHO growth charts, and further investigation is needed.

Prevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression

Several studies have reported high prevalence of risk factors for cardiovascular disease in adolescents. To perform: i) systematically review the literature on the prevalence of high blood pressure (HBP) in adolescents; ii) analyze the possible methodological factors associated with HBP; and iii) compare the prevalence between developed and developing countries. We revised 10 electronic databases up to August 11, 2013. Only original articles using international diagnosis of HBP were considered. The pooled prevalence's of HBP were estimated by random effects. Meta-regression analysis was used to identify the sources of heterogeneity across studies. Fifty-five studies met the inclusion criteria and total of 122,053 adolescents included. The pooled-prevalence of HBP was 11.2%, 13% for boys, and 9.6% for girls (P < 0.01). Method of measurement of BP and year in which the survey was conducted were associated with heterogeneity in the estimates of HBP among boys. The data indicate that HBP is higher among boys than girls, and that the method of measurement plays an important role in the overall heterogeneity of HBP value distributions, particularly in boys.

Regulation of early human growth: impact on long-term health

Growth and development are central characteristics of childhood. Deviations from normal growth can indicate serious health challenges. The adverse impact of early growth faltering and malnutrition on later health has long been known. In contrast, the impact of rapid early weight and body fat gain on programming of later disease risk have only recently received increased attention. Numerous observational studies related diet in early childhood and rapid early growth to the risk of later obesity and associated disorders. Causality was confirmed in a large, double-blind randomised trial testing the 'Early Protein Hypothesis'. In this trial we found that attenuation of protein supply in infancy normalized early growth and markedly reduced obesity prevalence in early school age. These results indicate the need to describe and analyse growth patterns and their regulation through diet in more detail and to characterize the underlying metabolic and epigenetic mechanisms, given the potential major relevance for public health and policy. Better understanding of growth patterns and their regulation could have major benefits for the promotion of public health, consumer-orientated nutrition recommendations, and the development of improved food products for specific target populations.

Percutaneous thoracic endovascular aortic repair is not contraindicated in obese patients

OBJECTIVE

There are limited data describing the preclose technique with the Perclose ProGlide device (Abbott Vascular, Redwood City, Calif) in percutaneous thoracic endovascular aortic repair (P-TEVAR), particularly in obese patients, in whom use of this technique is thought to be relatively contraindicated. The purpose of this analysis was to describe our experience with P-TEVAR and to compare outcomes in patients with or without obesity.

METHODS

All TEVAR procedures at a single institution from 2005 to 2011 were reviewed, and P-TEVAR patients were stratified by body mass index (obesity ≥ 30 kg/m2). Preoperative computed tomography scans were analyzed for access vessel depth, calcification, and morphology. Technical success was defined as the ability to achieve hemostasis and to maintain limb perfusion without the need for common femoral artery exposure or obligate surgical repair of the vessel within a 30-day postoperative period. Generalized estimating equations and stepwise logistic regression were used to develop prediction models of preclose failure.

RESULTS

The review identified 536 patients, in whom 355 (66%) P-TEVAR procedures were completed (366 arteries; n = 40 [11%] bilateral). Compared with nonobese patients (n = 264), obese patients (n = 91) were typically younger (59 ± 16 years vs. 66 ± 16 years; P = .0004) and more likely to have renal insufficiency (28% vs. 17%; P = .05) or diabetes mellitus (19% vs. 9%; P = .02). The number of Perclose deployments was similar between groups (P = NS). Mean sheath size (25.4F vs 25.0F; P = .04), access vessel inner diameters (8.5 ± 1.9 mm vs. 7.9 ± 2.0 mm; P = .02), and vessel depth (50 ± 20 mm vs. 30 ± 13 mm; P < .0001) were greater in obese patients. Adjunctive iliac stents were used in 7% of cases (10 [11%] in obese patients vs 16 [6%] in nonobese patients; P = .2). Overall technical success was 92% (92% for nonobese patients vs 93% for obese patients; P = .7). Three patients required subsequent operations for access complications, two obese patients (2%) and one nonobese patient (0.4%) (P = .3). Independent predictors of failure were adjunctive iliac stent (odds ratio [OR], 9.5; 95% confidence interval [CI], 3.3-27.8; P < .0001), more than two Perclose devices (OR, 7.0; 95% CI, 2.3-21; P = .0005), and smaller access vessel diameter to sheath size ratio (OR multiplies by 1.1 for each .01 decrease in ratio; 95% CI, 1.02-1.2; P = .007) (area under the receiver operating characteristic curve = .75).

CONCLUSIONS

Obesity is not a contraindication to P-TEVAR. P-TEVAR can be performed safely, despite the need for larger diameter sheaths. However, patients predicted to need adjunctive stenting or possessing smaller access vessel diameter to sheath size ratios are at highest risk of preclose failure with the Perclose ProGlide device, and selective use of this technique is recommended.