中国儿童身高与体重的生长模式及简单数学模型的建立

目的 探讨中国儿童身高、体重生长规律及反映规律的简单数学模型.方法 采用"2005年九市7岁以下儿童体格发育调查"及"2005年中国学生体质与健康调研"所获得的0～18岁儿童的身高、体重数据.0～6岁身高和体重曲线采用LMS法拟合,6～18岁数据采用三次样条函数平滑修匀和修正LMS法转换.生长速度根据生长曲线修匀后获得的数值计算产生.1～10岁儿童身高和体重的简单线性模型采用修匀后生长数据建立.结果 (1)我国儿童出生身长约50 cm,3、6、12、24月龄时约61、67、76、88 cm.2～10岁身高增长较为稳定,平均每年增长约6～7 cm.约3岁半和12岁时的身高分别达到出生时2倍和3倍.2～10岁估算公式:身高(cm)=年龄(岁)×6.5+76.(2)出生体重约3.3 kg.出生后第一个3个月生长速度最快,平均每月体重增加约1.0～1.1 kg;第二个3个月减慢一半,约0.5～0.6 kg,出生后第一年的后6个月又减慢一半,约0.25～0.30 kg.约3、12、24月龄时体重达到出生时的2、3、4倍.1～6岁、7～10岁体重基本呈匀速增加,平均每年分别增长2 kg和3 kg左右.1～6岁估算公式:体重(kg)=年龄(岁)×2+8,7～10岁:体重(kg)=年龄(岁)×3+2.结论 针对临床实践的需要,总结不同年龄阶段身高、体重的增长规律,提供了0～18岁儿童身高和体重的生长速度参考值,同时对1～10岁儿童身高和体重估算公式进行修订.     

中国七岁以下儿童身长/身高的体重和体块指数的生长标准值及标准化生长曲线

目的 制定中国7岁以下儿童身长/身高的体重、体块指数(BMI)的生长标准值及标准化生长曲线.方法 选择"2005年九市儿童体格发育调查"中69 622名城区7岁以下儿童的身长/身高、体重测量值,采用LMS法分别建立身长的体重和BMI模型.将3岁后身高加上0.7 cm与身长对接,构建统一身长的体重LMS模型,数据拟合后可将身长减去0.7 cm转化为身高的体蕈.BMI采取"身长BMI"和"身高BMI"分别独立拟合的方法,将身高加上0.7 cm计算"身长BMI",在整个年龄段拟合"身长BMI"LMS模型,类似地可建立"身高BMI"模型.曲线的拟合效果评价采用拟合优度X2检验.结果 制定出中国儿童45～105 cm身长的体重、65～125 cm身高的体重、0～3岁年龄的BMI(由身长计算)、2～7岁年龄的BMI(由身高计算)的按百分位数及标准差单位的生长标准值及标准化生长曲线图.该参照标准总体上略高于世界卫生组织新标准,而略低于美国疾控中心2000年修订标准(CDC2000).结论 本研究制定的身长/身高的体重及BMI标准具有国家代表性,可在全国范围内用于儿童生长监测与营养评估.     

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例1男.14岁7个月,因发现身高增长缓慢7年于2004年8月6日就诊。患儿自幼身高增长落后于同龄儿,7岁左右开始身高生长明显缓慢,每年增长约1~2cm。其父身高165cm,其母164cm。患儿身高129cm,体重39kg,面容幼稚,智力正常,心肺腹查体未见异常。采用中国人骨龄与身高预测CHN-2004版软件测定骨龄为12·4岁,骨龄与年龄差-2·3岁,靶身高174cm,TW2预测身高153·8cm,BP法预测身高155cm。甲状腺激素正常。生长激素激发试验在0,30,60,90,120min生长激素全部<0·047nmol/L,垂体MRI示鞍内可见长T1长T2信号,印象为空泡蝶鞍。使用生长激素治疗3个月后,身…     

婴幼儿出生至2岁身长和体重生长轨道变化的随访研究

目的 研究2岁内正常儿童身长、体重发生追赶生长或减速生长的状况及影响儿童身长变化的因素。方法 回顾性收集1996年8月至2008年12月,前瞻性收集2009年1月至2010年3月重庆医科大学附属儿童医院儿童保健科门诊体检儿童的资料。均以首次体检年龄<2月龄±15 d;﹤1岁,随访≥6次（至少每2个月随访1次）;～2岁,随访≥2次（至少每6个月随访1次）的原则进行随访。由专人测量儿童身长和体重,并于首次体检时询问并记录父母亲的身高。根据随访年龄,分为<2、～4、～6、～8、～10、～12、～18和～24月龄组。以首次体检（<2月龄±15 d）身长测量值为基础值计算百分位值,并计算其Z值。以～24月龄身长百分位值代表2岁时身长百分位值。生长参数参照2000年美国CDC儿童生长资料,本研究将追赶生长或减速生长定义为身长或体重百分位较前次年龄段百分位上升或下降≥1条主百分位线,且身长发生百分位线变化后能沿着新生长轨道生长,观察儿童生长轨道变化情况,采用Logistic回归分析儿童身长与儿童基础身长Z值及父母亲身高的相关性。结果 共有331名儿童(3 421人次测量数据)进入分析,其中男172例,女159例。①<2岁儿童179/331名（54.1%）的身长发生246人次追赶生长,229人次追赶生长1条百分位线,17人次追赶生长2条百分位线;56/331名（16.9%）儿童的身长出现63人次减速生长,均减速生长1条百分位线;各月龄组平均身长在P50～P75。②3～6、～12和～24月龄组儿童身长变化与母亲身高、儿童基础身长相关（均P<0.05）,～12月龄组身长变化同时还与父亲身高相关（P<0.05）。③<2岁儿童309人次体重发生追赶生长,232人次追赶生长1条百分位线,77人次追赶生长2条百分位线;641人次体重发生减速生长,596人次减速生长1条百分位线,45人次减速生长2条百分位线。各月龄组平均体重的百分位值不稳定。结论 儿童出生时的体格生长水平反映胎儿期生长,但不完全决定生后生长情况。判断2岁内儿童身长变化需综合考虑基础身长、父母亲身高遗传等因素。     

中国0~18岁儿童青少年坐高和下肢长生长参照标准值及生长曲线

背景：坐高和下肢长是线性生长评价中的有用指标,但我国儿童青少年这两个指标的生长参照标准值及标准化生长曲线并未完整公布。 目的：研究和制定中国儿童青少年坐高和下肢长的生长参照标准及曲线,供临床医学及其他相关领域参照使用。 设计：横断面调查。 方法：采用2005年“中国九市7岁以下儿童体格发育调查”和“全国学生体质与健康调研”中九省（市）城区92 494名0~18岁健康儿童青少年的身高和坐高测量数据,以身高减去坐高计算获得下肢长,应用LMS方法制定坐高（顶臀长）和下肢长的生长参照标准值及标准化生长曲线。 主要结局指标：坐高和下肢长的生长参照标准值。 结果：①建立了0~18岁男、女童坐高和下肢长的百分位和标准差单位参照标准值,并绘制了两项指标的标准化生长曲线。②坐高生后第1年增长约14 cm,第2和3年分别增长约6 cm和4 cm,之后每年以2~3 cm幅度稳定增长,男童11~13岁、女童9~11岁坐高增速略提高,之后增速减慢,男童17岁、女童15岁基本停止增长。③下肢长生后第1年增长11~12 cm,第2年增长约6.5 cm,2~5岁以每年4~5 cm幅度增长,之后每年以3~4 cm增长,男、女童分别在15岁和13岁基本停止增长。 结论：建立的坐高和下肢长的生长参照标准值与标准化生长曲线,进一步完善了我国儿童青少年生长发育评价标准的指标体系。     

Kabuki综合征一例

患儿 男,4岁1个月,因生长发育、运动智力落后4年入院.患儿出生后身高、体重增长缓慢,运动、智力发育落后,6个月抬头,1岁8个月扶站,2岁6个月独走,常摔跤.现仅能无意识叫"妈妈",能懂简单指令,听力似有减弱.既往常患"感冒、肺炎".患儿为G2P1,38周顺产,出生体重2 kg,出生身长不详.第一胎为药物流产.父母均为云南人,非近亲结婚.父身高168 cm,母身高160 cm,智力均正常.家族中无类似患者.     

294例宫内发育迟缓儿出生2年内的身长追长观察

目的：对294例宫内发育迟缓（IUGR）儿童出生2年内的身长追长观察,了解不同性别、不同胎龄、不同出生体重IUGR儿身长追长情况。方法：294例IUGR儿童与300例足月正常儿在出生后4、6、9、12、15、18、21、24月龄随访,测量其身长,计算身长增长值,比较身长增长情况。结果：IUGR儿童身长追长成功率男女分别为72.2%和71.5%（P=0.90）;早产小样儿与足月小样儿追长成功率分别为77.4%、68.6%（P=0.11）;出生体重1500~2499 g者的身长追长成功率较出生体重<1500 g和≥2500 g者高（P<0.01）。IUGR男童在4、6月龄及18、21、24月龄测得的身长增长值明显高于正常儿（P<0.05）;女童在4、6、9、12及21月龄测得的身长增长值明显高于正常儿。男童早产小样儿在6月龄及9月龄身长增长值明显大于足月小样儿,女童早产小样儿在4月龄及18月龄身长增长值明显大于足月小样儿。不论男女,出生体重<1500 g者在4月龄身长增长值均明显大于≥2500 g者;男童1500～2499 g者在4、6、18、21及24月龄身长增长值明显大于≥2500 g者,女童1500～2499 g者在4、6、9、12及21月龄身长增长明显大于≥2500 g者。结论：IUGR女童的追长以出生后第一年为主,而男童除出生半年内追长外,在出生第二年仍追长明显。早产小样儿的追长比足月小样儿好。出生体重<1500 g者及1500～2499 g者的追长比≥2500 g者好。     

0～7岁儿童生长曲线的制定及其应用

目的：制订一套0-7岁儿童的百分位生长曲线图供儿童保健及临床工作使用。方法：根据1995年第三次中国九城市城郊7岁以下儿童体格发育横断面调查所获得的数据，采用9个市城区0-7岁79154名健康男女儿童（其中0-3岁儿童53954名）的年龄别身高（3岁以下为身长）、年龄别头围的平均值、标准差以及年龄别体重和身高别体重的百分位数，先用多项式方程将他们修匀，然后修匀后的值计算各百分位并绘制曲线图。结果：为0-3岁男女儿童制定了各自的年龄别体重、年龄别身高和身高别体重的3、10、25、50、75、90及97百分位曲线图。结论：使用简便、直观的生长标准曲线图有利于个体儿童的生长监测，早期识别生长偏离的现象，为促进儿童生长和健康服务。     

中国7岁以下儿童生长标准的修订

目的建立中国7岁以下儿童的生长标准值。方法横断面研究基于2015年儿童生长发育国家调查数据, 采用分层随机整群抽样方法, 于2015年6—11月在北京、哈尔滨、西安、上海、南京、武汉、广州、福州、昆明9个城市调查7岁以下健康儿童83 628名。采用统一的测量工具按照统一的测量方法获得儿童体重、身长(身高)和头围的测量值。采用基于偏度、位置和变异的曲线平滑方法建立7岁以下男、女童年龄的体重、年龄的身长(身高)、年龄的头围、身长(身高)的体重、年龄的体质指数的生长曲线模型。将新建立的生长标准各指标的标准差单位曲线与2009年参照标准进行比较。结果制订出7岁以下男、女童年龄的体重、年龄的身长(身高)、年龄的头围、身长(身高)的体重、年龄的体质指数的百分位数(P3、P10、P25、P50、P75、P90、P97)和标准差单位(-3、-2、-1、0、+1、+2、+3)标准值。与2009年参照标准相比, 体重在P50上差值为-0.1～0.4 kg, 身长(身高)在P50上差值为0.1～1.3 cm, 头围在P50上差值为-0.2～0.2 cm, 身长(身高)的体重在P50上差值为-0.2～0.5 ...     

儿童期开始年龄及其对儿童时期生长影响的纵向研究

目的　应用婴儿 儿童 青春期 (ICP)生长模型研究儿童期开始年龄 (ACO)并探讨其对儿童时期生长的影响。方法　选择自出生纵向随访至 6岁的小儿共 16 2 3名。根据计算机绘制的每个小儿身长及其身长速率曲线对应ICP生长曲线图来判断ACO值。结果　男、女孩的平均ACO值分别为 11 2个月和 10 7个月。女孩显著早于男孩 (P <0 0 5 )。ACO值对儿童后期的生长有显著的作用 ,儿童期开始年龄延迟 1个月 ,到 5岁时其身高男孩降低 0 4cm、女孩降低 0 5 6cm。对ACO值的影响因素进行多元回归分析发现 ,性别、6月龄时身长和父母亲平均身高与ACO值均有显著关系 (P <0 0 5 )。对儿童期开始年龄和父母亲平均身高作线性相关分析发现 ,父母亲平均身高低于均数 2个标准差的男、女孩其儿童期开始年龄要比父母亲平均身高高于均数 2个标准差的男、女孩分别晚 1 5个月和 1 3个月。结论　应用ICP生长模型同样适合我国儿童体格生长的研究 ,儿童期开始年龄对儿童时期的生长起着重要作用     

Longitudinal physical development of healthy children 0 to 18 years of age. Body length/height, body weight and growth velocity]

In addition to the Dortmunder longitudinal growth study we investigated development of height, weight and height velocity in 213 healthy boys and girls 15-18 years old. Number of children decreased in the age group of 17 and 18 years old to 143. The study was performed in a longitudinal way, the measurements were taken in an one year distance. The median height gain in boys between 15 and 18 years amounted to 9.3 cm, in girls to 2.1 cm, respectively. 18 years old boys are 180.1 cm tall, girls 167.9 cm. The median increment of body weight in boys from 15-18 years amounted to 7.3 kg, in girls 4.4 kg, respectively. Median weight in 18 years old boys amounted to 65.2 kg, in girls to 58.0 kg. International comparison with other longitudinal growth studies shows a trend of somewhat higher weight, height and height velocity of the children from our study.     

Undernutrition and adolescent growth among rural Indian boys

OBJECTIVE: To evaluate impact of undernutrition on various adolescent growth parameters among rural Indian boys. DESIGN: Adolescent boys covering 8-18 yr age group were observed longitudinally for a period of 3 years. SETTING: Adolescent boys (n=673) from seven different villages within 30 to 40 km from Pune were studied. METHOD: Six monthly measurements on weight (upto 50 g) and height (upto 0.1 cm) were recorded and age assessment was done from school records with reasonable accuracy. RESULTS: Stunted and underweight boys were lighter (by 4 kg) and shorter (by 8 cm) at 10 yr age compared to their normal counterparts but this difference increased to 12 kg and 10 cm respectively by adulthood. Undernourished boys however, revealed significant height gains at later ages especially beyond 14+ yr, compared to normals suggesting slow, gradual but continual growth. Undernutrition delayed age at take-off and age at PHV by about 2 yr, and lowered attained height at PHV (by 5 cm) and adult height (by 7 cm). CONCLUSION: Normal and maluourished children from the same rural community show wide differences in their adolescent growth performance. Nutritional deprivation thus seems to affect almost all growth parameters and final adult size too.     

Physical growth characteristics in rural adolescent girls of Varanasi

Four hundred and twenty one rural girls of Varanasi in the age group 8.5-14 years were followed up for assessment of their physical growth characteristics. The observed gain in height was 15.93 cm; in weight 9.80 kg and in sitting height 7.92 cm during the age interval of 10-14 years. In the same period the biacromial and the bicristal diameters showed a gain of 5.26 and 4.20 cm, respectively. The maximum increase in these parameters was observed after 13 years of age indicating the onset of the growth spurt. The chest and the mid-arm circumference increased by 14.70 and 3.02 cm, respectively during this period. There was no rapid increase in these parameters upto 14 years of age. The head circumference showed only a modest increase of 2.22 cm. It is concluded that the rural girls have a delayed and slower gain in physical growth characteristics than urban well-to-do girls.     

Timing of growth faltering in rural Malawi

Aim: To determine the timing of growth faltering among under 3 year old children. Methods: Prospective population based cohort study in Lungwena, rural Malawi, southeast Africa. A total of 767 live born babies were regularly visited from birth until 3 years of age. Weight, height, and mid upper arm circumference were measured at monthly intervals until 18 months and at three month intervals thereafter. Growth charts were constructed using the LMS method and comparisons made to two international databases: the traditional United States National Center for Health Statistics/World Health Organisation (NCHS/WHO) reference and the recently developed 2000 Centers for Disease Control (CDC) growth reference. Results: Compared to the 2000 CDC reference population, newborns in Lungwena were on average 2.5 cm shorter and 510 g lighter. On a population level, height faltering was present at birth and continued throughout the first three years. Weight faltering, on the other hand, occurred mainly between 3 and 12 months of age. At 36 months, the mean weight and height of the study children were 2.3 kg and 10.5 cm lower than those of the reference population, respectively. The results remained essentially similar when the comparisons were made to the NCHS/WHO reference. Conclusions: The fact that weight and height faltering do not follow identical time patterns suggests that they may have different origin and determinants. Further studies on the aetiology of height faltering and different approaches to preventive interventions are needed.     

Timing of growth faltering in rural Malawi.

AIM: To determine the timing of growth faltering among under 3 year old children. METHODS: Prospective population based cohort study in Lungwena, rural Malawi, southeast Africa. A total of 767 live born babies were regularly visited from birth until 3 years of age. Weight, height, and mid upper arm circumference were measured at monthly intervals until 18 months and at three month intervals thereafter. Growth charts were constructed using the LMS method and comparisons made to two international databases: the traditional United States National Center for Health Statistics/World Health Organisation (NCHS/WHO) reference and the recently developed 2000 Centers for Disease Control (CDC) growth reference. RESULTS: Compared to the 2000 CDC reference population, newborns in Lungwena were on average 2.5 cm shorter and 510 g lighter. On a population level, height faltering was present at birth and continued throughout the first three years. Weight faltering, on the other hand, occurred mainly between 3 and 12 months of age. At 36 months, the mean weight and height of the study children were 2.3 kg and 10.5 cm lower than those of the reference population, respectively. The results remained essentially similar when the comparisons were made to the NCHS/WHO reference. CONCLUSIONS: The fact that weight and height faltering do not follow identical time patterns suggests that they may have different origin and determinants. Further studies on the aetiology of height faltering and different approaches to preventive interventions are needed.     

Regulation of growth of 7- to 36-month-old children by energy and fat intake in the prospective, randomized STRIP baby trial

OBJECTIVE: To study the fat and energy intakes of children between 7 and 36 months of age with different growth patterns. METHODS: In the Special Turku coronary Risk factor Intervention Project for Babies, children were randomized to intervention (n = 540) and control groups (n = 522) at age 7 months. The intervention was aimed at replacing part of the saturated fat intake with monounsaturated and polyunsaturated fat to reduce children's exposure to high serum cholesterol values. The control children consumed a free diet. Children followed for >2 years (n = 848) were included in the analysis. Five groups of children representing different extreme growth patterns during the first 3 years of life were formed, and their energy and fat intakes were analyzed. Relative weight was defined as deviation of weight in percentages from the mean weight of healthy children of same height and sex, and relative height as deviation of height in SD units from the mean height of healthy children of same age and sex. RESULTS: Relative fat intakes (as percent of energy intake) were similar in children showing highly different height gain patterns. The thin (mean relative weight /= 95%) and the obese (mean relative weight >/= 95%) were highest, but weight-based energy intake of the tall (at 2 years, 82 [13] kcal/kg) and the obese (79 [17] kcal/kg) were lower than that of children with normal growth (89 [16] kcal/kg). The thin children consumed relatively more energy than the children with normal growth (at 2 years, 94 [13] kcal/kg and 89 [16] kcal/kg, respectively). Parental height and body mass index and the child's absolute and relative energy intakes predicted the best children's growth patterns. Children with consistently low fat intake grew equally to the children with higher fat intake. CONCLUSIONS: Moderate supervised restriction of fat intake to values 25 to 30 E% is compatible with normal growth.     

Clinical Experience with Genotropin in Growth Hormone Deficient Children

The efficacy of Genotropin (recombinant somatropin, KabiVitrum AB, Sweden) was analysed in 194 children with GH deficiency, comprising a combined series of four multicentre trials. The linear height velocity increased from 3.3±1.4 to 9.3±2.6 cm/year in 149 prepubertal children with 12 months'data available. In 18 pubertal children the pretreatment height velocity was 4.0±1.2, and increased to 8.4±1.7 cm/year during 12 months of treatment. There was a positive correlation between the gain in height velocity and the weekly dose of Genotropin. Covariance analysis revealed significantly greater height velocity with 6-7 injections/week compared to 2-3 injections/week; corrections for chronological age, bone age, height SD score and dose were made. On average, a regimen of 6-7 injections/week was 25% more effective than one of 2-3 injections/week corresponding to an extra gain in height velocity of 1.8±0.6 cm/year. At 12 months, only 0.9% of the children had developed anti-GH antibodies. Very few side-effects have been reported from more than 1000 children on Genotropin.     

Growth velocity and stunting in rural Nepal.

In a community based study, height and weight increments of 441 Nepali children aged 0-6 years were measured before harvest and six months later and compared with centile standards derived from American children. Low mean growth velocities for height were found only in children under 2 years of age, and for weight during the first 18 months. The mean height for age standard deviation score for the 12-23 months age group was already -2.8 at first measurement. The effect of the initial thinness of the child on subsequent height and weight velocity was reciprocal: thin children seemed to catch up weight at the expense of height. These results suggest that stunting is caused largely by a reduced growth velocity during the nutrition dependent infantile phase of growth, with some additional impairment and delay in onset of the early childhood phase of growth hormone dependent growth, especially in thin children. Nutritional interventions after the second year of life are unlikely to alter the prevalence of linear growth retardation in poor communities. Growth velocity may be more useful than static anthropometry to assess the impact of such interventions.