The prevalence of wasting in Czech infants: a comparison of the WHO child growth standards and the Czech growth references

The Low Prevalence of Overweight and Obesity in Czech Breastfed Infants and Young Children: An Anthropological Survey

The aim of this study is to evaluate the prevalence of overweight and obesity in a sample of children who were exclusively or predominantly breastfed for at least 6 months compared to Czech references that were constructed based on a representative sample of children, regardless of their mode of feeding. Between 2008 and 2011, a longitudinal study on the growth of breastfed infants was carried out in the Czech Republic. Forty-three GP pediatricians addressed parents at 18-month preventive examinations and collected data on the families' socio-economic conditions and the infants' feeding conditions. The children were measured (length, weight, and head circumference), and anthropometric measurements from 10 previous preventive examinations were obtained from the health records. Out of the collected 1775 questionnaires, 960 children were selected according to the criteria of the WHO Multicentre Growth Reference Study. For the purpose of this study, 799 children who were exclusively or predominantly breastfed for at least 6 months were selected. We found that the proportions of children who were classified as overweight (>90th percentile) or obese (>97th percentile) at 6, 12, and 18-month examinations were far below the proportions of the Czech references. An update of the Czech references and growth charts is highly recommended by GP pediatricians for the valid assessment of growth and nutritional status, including a screening of overweight and obesity in primary preventive health care.

Body parameters of Czech breastfed children compared to the Czech references and WHO growth standards

BACKGROUND

The study concerns the comparison of percentile curves of Czech breastfed children with Czech national references from 1991 and 2001 and WHO growth standards. Growth charts of breastfed children demonstrate different curve shapes, especially in the first months of life. Incorrect interpretation of the growth curve could lead to premature introduction of complementary foods or infant formula.

AIM

The comparison of four body parameters of Czech breastfed children with currently used Czech national references and WHO standards in order to recommend that Czech paediatricians use either Czech references or WHO standards in their practice.

SUBJECTS AND METHODS

Nine hundred and sixty breastfed children were included in the study of length-for-age, head circumference-for-age, weight-for-age and weight-for-length parameters. All percentile curves were compared. Values of the 50th percentile expressed in z-scores based on both Czech references and WHO standards were tested.

RESULTS

The study confirmed results of previous surveys documenting that growth of breastfed children is specific. Nevertheless, percentile curves of growth parameters of Czech breastfed children are closer to Czech references than WHO standards.

CONCLUSIONS

The Czech national references fulfil the needs of Czech paediatricians (with pointing to specifics of breastfed child growth) and WHO standards are suitable, especially for international comparison.

Growth References of Preschool Children Based on the Taiwan Birth Cohort Study and Compared to World Health Organization Growth Standards

BACKGROUND

To develop new growth references for height, weight, and body mass index (BMI) for children aged 0-5 years in the Taiwan Birth Cohort Study (TBCS) and to compare these references with both 1997 Taiwan references and World Health Organization (WHO) standards.

METHODS

Data were obtained from the TBCS of a nationally representative sample of 24,200 children. A total of 18,466 children completed the baseline survey at 6 months of age and three follow-up surveys at 18 months, 3 years, and 5.5 years of age. The modified LMS method was used to construct percentile curves by sex, including length/height for age, weight for age, and BMI for age.

RESULTS

TBCS children of both sexes were shorter and lighter at birth compared with 1997 Taiwan references and WHO standards. The growth patterns of TBCS children were close to those of the 1997 Taiwan references after 6 months of age. Compared with WHO standards, however, TBCS children were heavier after 6 months of age.

CONCLUSION

This study has developed TBCS references to monitor the growth of children in Taiwan, whose weight growth patterns differed from those "prescribed" by WHO standards.

Improving accuracy and usability of growth charts: case study in Rwanda

OBJECTIVES

We evaluate and compare manually collected paper records against electronic records for monitoring the weights of children under the age of 5.

SETTING

Data were collected by 24 community health workers (CHWs) in 2 Rwandan communities, 1 urban and 1 rural.

PARTICIPANTS

The same CHWs collected paper and electronic records. Paper data contain weight and age for 320 boys and 380 girls. Electronic data contain weight and age for 922 girls and 886 boys. Electronic data were collected over 9 months; most of the data is cross-sectional, with about 330 children with time-series data. Both data sets are compared with the international standard provided by the WHO growth chart.

PRIMARY AND SECONDARY OUTCOME MEASURES

The plan was to collect 2000 individual records for the electronic data set--we finally collected 1878 records. Paper data were collected by the same CHWs, but most data were fragmented and hard to read. We transcribed data only from children for whom we were able to obtain the date of birth, to determine the exact age at the time of measurement.

RESULTS

Mean absolute error (MAE) and mean absolute percentage error (MAPE) provide a way to quantify the magnitude of the error in using a given model. Comparing a model, log(weight)=a+b log(age), shows that electronic records provide considerable improvements over paper records, with 40% reduction in both performance metrics. Electronic data improve performance over the WHO model by 10% in MAPE and 7% in MAE. Results are statistically significant using the Kolmogorov-Smirnov test at p<0.01.

CONCLUSIONS

This study demonstrates that using modern electronic tools for health data collection is allowing better tracking of health indicators. We have demonstrated that electronic records facilitate development of a country-specific model that is more accurate than the international standard provided by the WHO growth chart.

A recurrent deletion on chromosome 2q13 is associated with developmental delay and mild facial dysmorphisms

We report two unrelated patients with overlapping chromosome 2q13 deletions (patient 1 in chr2:111415137-113194067 bp and patient 2 in chr2:110980342-113007823 bp, hg 19). Patient 1 presents with developmental delay, microcephaly and mild dysmorphic facial features, and patient 2 with autism spectrum disorder, borderline cognitive abilities, deficits in attention and executive functions and mild dysmorphic facial features. The mother and maternal grandmother of patient 1 were healthy carriers of the deletion. Previously, 2q13 deletions were reported in 27 patients, and the interpretation of its clinical significance varied. Our findings support that the 2q13 deletion is associated with a developmental delay syndrome manifesting with variable expressivity and reduced penetrance which poses a challenge for genetic counselling as well as the clinical recognition of 2q13 deletion patients.

Reappraisal of Regional Growth Charts in the Era of WHO Growth Standards

After the WHO Growth Standards (WHOGS) was published in 2006, many countries in the world endorsed and adopted the new growth references as a standard measure for the growth of infants and young children. Certainly, the WHOGS has an impact on the global policy about obesity and underweight in children. Such WHOGS innovation has influenced many regional health authorities and academies, which have managed their own growth charts for a long time, in changing their strategies to develop and use regional growth charts. In Korea, along with the tradition to create a national growth chart every decade, we now face a new era of advancing with the WHOGS.

World Health Organization growth charts for monitoring the growth of Australian children: time to begin the debate

The recently released World Health Organization growth charts are methodologically robust, as well as clinically useful tools for monitoring the growth of children. They have been endorsed by premier organisations such as the Royal College of Paediatrics and Child Health (UK), Canadian Pediatric Society, Australian Breastfeeding Association, United Nations Standing Committee on Nutrition, International Union of Nutrition Sciences, International Pediatric Association and the European Childhood Obesity Group. The Centers for Disease Control and Prevention (CDC) as well as the American Academy of Pediatrics have also recently endorsed these charts for the 0- to 24-month age group in USA. These growth charts have been adopted by many countries including Canada, UK and New Zealand. Nearly 140 countries are at various stages of implementing them. They offer significant advantages over the currently used CDC 2000 growth charts. They have the potential to contribute in reducing the worldwide incidence of obesity as well as under nutrition in children. Except Northern Territory, Australia continues to use the CDC 2000 growth charts. Paediatricians need to initiate and lead robust debate involving key stakeholders about the implementation of World Health Organization growth charts for monitoring the growth of Australian infants and children.