Growth and overweight of Navajo youth: secular changes from 1955 to 1997

OBJECTIVE: To examine the growth status, prevalence of risk of overweight and of overweight, and secular changes in growth status in Navajo youth from 1955 to 1997. SUBJECTS: 526 (256 males, 270 females) Navajo children 6-12 y of age. MEASUREMENTS: Stature and mass were measured and the body mass index (BMI) was calculated. ANALYSIS: All three variables were plotted relative to age- and sex-specific US reference data and the prevalence rates for risk of overweight and of overweight were estimated using the BMI as the criterion. The cut-off for the risk of overweight was the age- and sex-specific 85th and 95th percentiles of NHANES I, while the cut-off for overweight was a BMI>/=95th percentiles. Age-specific sex differences were compared using independent samples t-tests. Secular changes for body size were estimated by comparing age- and sex-specific means for stature, mass, and the BMI in the present study and two previous studies in 1955 and 1989. RESULTS: No statistically significant differences were observed between sexes within age groups. In both sexes, mean age-specific stature appeared to be relatively stable around the 50th percentile of US reference values. Mean age-specific mass appeared to be relatively stable between the 50th and 90th percentiles of the reference values, while the mean BMI tended to fluctuate about the 85th percentile. Approximately 41% of the Navajo boys and girls 6-12 y of age had BMIs >/=85th percentiles of US reference data. Compared to corresponding data on Navajo youth in 1955 and 1989, the current sample was larger in mass and the BMI. The estimated rate of secular change in mass was about 1.5 kg/decade in younger boys and girls, and about 3 kg/decade in older boys and girls between 1955 and 1997. The estimated rate of secular change in the BMI was about 0.5-1.0 units/decade between 1955 and 1997, while that for stature was about 2 cm/decade between 1955 and 1997. CONCLUSIONS: The results are consistent with recent findings on the Navajo Health and Nutrition Survey that overweight is a serious public health concern across the lifespan in the Navajo, and that the problem begins in childhood. Furthermore, Navajo children appear to be heavier than about a decade ago. International Journal of Obesity (2000) 24, 211-218     

Prevalence of obesity among schoolchildren in Iran

The prevalence of overweight and obesity among schoolchildren aged 6.5-11.5 years in Shiraz (southern Iran) are presented in this paper. The body mass index (BMI) percentiles of these children are compared with the Center for Disease Control and Prevention (CDC) reference data and with the Iranian standard. The data are based on a random multistage sample survey of 2397 healthy school attenders (1268 boys, 1129 girls) living in Shiraz, whose heights and weights were measured in the 2002-2003 academic year. Joint height and weight measurements were obtained for 2195 schoolchildren (91.6%), consisting of 1138 boys (89.7%) and 1057 girls (93.6%). A total of 77 boys (6.8%) and 40 girls (3.8%) were overweight, and the difference between them was significant (P = 0.001). However, obesity was significantly less prevalent in boys (3.3%) than in girls (6.1%) (P = 0.001). Our children's median BMI lie almost on the 38th centile of the CDC reference data, whereas that of their counterparts born more than 10 years ago lay on the 20th centile of their American counterparts, showing the development of children's obesity in a period of less than 15 years in Iran. A positive secular trend in BMI has been seen during the past decade in Iran, suggesting policymakers and health professionals should pay special attention to children's health.     

Secular trends in body mass index in German children and adolescents: a cross-sectional data analysis via CrescNet between 1999 and 2006

To assess secular trends in alterations in body mass index (BMI) in German children and adolescents between 1999 and 2006, we performed an analysis using data from a computerized database (CrescNet) and focusing on the data ranges above the 97th percentile (P97) and below the median (P50). This cross-sectional assessment of BMI data used a total of 143 495 single values (73 290 males and 70 205 females aged 0.5-17.5 years) from screening and/or consulting visits at 1 of the 294 participating German pediatricians. Body mass index data were calculated from standardized measurements of body weight and height entered into the CrescNet database. Individual percentiles were estimated according to German reference data sets. Across all age groups, the respective mean value of children with BMI above P97 increased from 5.32% to 7.02% in boys and from 5.70% to 7.18% in girls between 1999 and 2006, whereas those below P50 decreased from 48.52% to 43.71% in boys and from 47.48% to 42.57% in girls. The proportions of obese children (above the 97th percentile) were significantly higher than estimated by German reference values throughout the study period. The significant increase in childhood obesity between 1999 and 2006 was more pronounced in boys compared to girls. In conclusion, the cross-sectional study performed at a large cohort of German children and adolescents reveals an alarming increase in the number of obese children and adolescents and an accompanied shift toward higher BMI values. As the number of children below the 50th centile decreases accordingly, the shift in the distribution panel of the German reference percentile curves affecting the whole population can be observed.     

Time trend in height,weight, and obesity prevalence in school children from Northern France, 1992-2000

OBJECTIVE: The aim of this study was to evaluate the changes in height, weight and in the prevalence of overweight and obesity between 1992 and 2000 in children living in two towns of northern France. METHODS: Two cross-sectional studies were performed in every pre-school (last section) and primary schools of the two towns in 1992 (383 girls and 421 boys enrolled) and 2000 (296 girls and 305 boys). Children were 5 to 12 year old in both studies. MEASUREMENTS: Body height and weight were measured, and BMI was calculated (weight/height(2)). Prevalence of overweight and obesity was determined according to the gender- and age- specific cut-offs of the new international reference (IOTF). We also used the 90(th) and the 97(th) percentiles of the French reference gender- and age-specific BMI curves to define two grades of overweight. RESULTS: After adjustment for age, boys were on average 1.5 cm taller in 2000 than in 1992 (p<0.001), and the same trend was observed in girls (+ 0.9 cm, p<0.075). Height-adjusted or age-adjusted weight and BMI were significantly higher in 2000 than in 1992. In girls, obesity defined by IOTF criteria increased from 1.6 to 4.4% (p<0.03) and overweight from 14.1 to 18.6% (p<0.11). In boys, the change in prevalences was significant only when the less stringent criteria (i.e. the 90(th) percentile of French references) was used (13.8% in 1992 vs 20% in 2000, p=0.03). CONCLUSION: Over an 8 years period, there was an increase in height and BMI in both boys and girls. These results show that the increase in the prevalence of obesity is accompanied by a global trend of accelerated growth.     

Validity of anthropometric indices in predicting high blood pressure risk factors in Iranian children and adolescents: CASPIAN‐V study

Anthropometric indices have been used as indicators for predicting hypertension (HTN) in children and adolescents but it is not clear which anthropometric measures are a better index for identifying elevated blood pressure (EBP) risk factors in pediatric population. Body mass index (BMI), waist circumference (WC), weight‐height ratio (WHR), a body shape index (ABSI) and blood pressure were measured in 14 008 children and adolescents aged 7‐18 years in a national school‐aged survey CASPIN V. Hypertension (HTN) was defined according to the 2017 American Academy of Pediatrics guidelines, using the 95th percentile. The predictive power of anthropometric indices for HTN risk factors was examined using receiver operating characteristic (ROC) analyses. Multivariate logistic regression analysis was used to compare areas under ROC curves (AUCs) among the four anthropometric indices. BMI, WC, WHR, and ABSI were significantly higher in adolescents than in children. EBP was more prevalent in boys (7.2%) than girls (5.5%), whereas the prevalence of HTN was higher in girls (11.3%) than boys 10.4%. Prevalence odds ratio was around 2 for BMI, WC, and WHR with AUCs scores of nearly 0.6 to predict EBP in both children and adolescents of both sexes. Thus, the ability of BMI z‐score, WC, WHR or ASBI to identify Iranian children and adolescents at higher risk of EBP was week. WC, WHR or ASBI in combination with BMI did not improve predictive power to identify subjects at higher risk of EBP.     

Secular trends in overweight and obesity among Finnish adolescents in 1977-1999

OBJECTIVE: To study the trends in overweight and obesity among Finnish adolescents in 1977-1999. DESIGN: Mailed surveys every other year. SUBJECTS: Nationally representative samples of 12, 14, 16 and 18-y-olds (n = 64,147, response rate 78.9%). METHODS: Overweight and obesity were measured by body mass index (BMI) and relative weight (RW) based on self-reported height and weight. BMI > or = the 85th percentile cut-off point for BMI in each age- and sex-specific group in the entire data set was considered as overweight, and BMI > or = 95th percentile cut-off point as obesity. RW > or = 110% and > or = 120%, calculated as the individual's weight divided by the mean weight in each age- and sex-specific height percentile group in the entire data set, were considered as overweight and obesity, respectively. The trends in overweight and obesity are described by the change in the 85th and 95th percentile cut-off points of BMI over time. The prevalence of overweight and obesity is also reported using BMI reference values recommended for international comparisons. Because of the similarity of the BMI and the RW criteria in classifying adolescents as overweight and obese, only results based on BMI are presented. RESULTS: Overweight and obesity increased linearly in all sex and age groups from 1977 to 1999. Depending on the age group, the average increase in the 85th percentile cut-off point of the BMI per 10 y was 0.6-1.1 kg/m2 in boys and 0.3-0.7 kg/m2 in girls. The 95th percentile cut-off point of the BMI for boys and girls increased by 1.1-1.6 kg/m2 and by 0.6-1.0 kg/m2 per 10 y, respectively. In boys, the increase in overweight and obesity was largest in the two youngest age groups. In girls, the increase in overweight was largest in the oldest age group, and that of obesity both in the 14 and 18-y-olds. Overweight and obesity increased more in boys than in girls in all age groups except in the 18-y-olds among whom the increase was similar in both sexes. Examination of the entire BMI distribution showed that there was little or no change over time at the lower (5th, 15th) and middle (50th) percentiles, but increasing differences at the upper end of the distribution, the increases in the 95th percentile being even more marked than those in the 85th percentile curves. According to international reference values, the age-standardized prevalence of overweight increased in boys from 7.2 to 16.7%, and in girls from 4.0 to 9.8%, between 1977 and 1999. The prevalence of obesity in boys was 1.1% in 1977 and 2.7% in 1999, and in girls 0.4 and 1.4%, respectively. CONCLUSION: Overweight and obesity increased remarkably among Finnish adolescents from 1977 to 1999. The changes concentrated at the upper end of the BMI distribution, suggesting that factors behind this development have influenced only a part of the adolescent population.     

Profile of body composition of school children (6-18y) in Bahrain

OBJECTIVE: To study the body composition of Bahraini school children. DESIGN: Cross-sectional national school survey. SUBJECTS: School children aged 6-18y. The sample comprised 818 boys and 775 girls. MEASUREMENTS: Weight, height, arm circumference and skinfold thicknesses were measured. Sum of skinfold thickness, body mass index (BMI), mid arm circumference, percentage body fat, fat weight and lean body weight were then calculated to determine body composition. RESULTS: A significant difference in the sum of skinfold thickness was observed between boys and girls. The girls have almost 50% extra skinfold thickness than boys at all ages. Similar trends were found in BMI, except at ages 9 and 18y. The percentage of body fat was higher in girls than boys. The mean BMI for Bahraini girls aged 13y and above exceeds that of their American counterparts, indicating a trend towards fat accumulation in the Bahraini girls. CONCLUSION: The data obtained are useful for monitoring obesity in school children in Bahrain as well as being usable as reference data for similar countries in the region. The high proportion of body fat among Bahraini school children, especially girls, urges an intervention program to prevent and control obesity in this age group.     

Prevalence of overweight in a triethnic pediatric population of San Antonio, Texas

OBJECTIVES: To investigate the prevalence of overweight among different ethnic and gender groups of children and adolescents in the San Antonio, Texas, area and to compare the prevalence with that of the US national figures. DESIGN: Cross-sectional study SUBJECTS: A total of 7208 schoolchildren in kindergarten through 12th grade. There were 4215 Mexican American (MA) (58.5%), 2040 non-Hispanic white (NHW) (28.3%) and 953 African American (AA) (13.2%) subjects. MEASUREMENTS: Weight, height and skinfold thicknesses. RESULTS: The body mass index (BMI, kg/m2) values of MA boys were almost consistently and significantly (P<0.05) larger than NHW boys and showed a tendency to be larger than AA boys, beginning as early as age 6 and continuing through age 17. Although rarely significant, a similar trend in ethnic difference was also noted for girls, with the smallest BMI seen in NHW girls. The subscapular skinfold thickness (SST) for MA boys and girls was significantly (P<0.05) larger than that for NHW counterparts and showed a tendency to be larger than AA counterparts. No significant ethnic differences were present in the triceps skinfold thickness (TST) for girls, but MA boys' TST were occasionally larger (P<0.05) than other ethnic-gender groups. Girls' TST were frequently larger (P<0.05) than boys for each ethnic groups. Using the population data from the National Health and Nutrition Examination Survey (NHANES) I as reference, the prevalence of overweight (BMI> or =95th percentile) was greater in MA (15-28%) and AA (11-29%) boys and girls than in NHW (7-17%) counterparts. The combined prevalence of overweight and 'at risk of overweight' (BMI>85th percentile) was much larger in MA boys (40-50%), MA girls (34-52%), and AA girls (33-51%) than other subgroups. The onset of overweight is quite early, starting at 5-6 y of age, especially in girls. Compared to the data from national surveys, the prevalence of overweight found in this study is higher than reported nationally. We found a marked increase in the skinfold thickness, especially SST for boys, but the increase is less for girls. CONCLUSIONS: The prevalence of overweight is higher in MA boys and girls and AA girls than other ethnic-gender groups in the San Antonio, Texas, area. The prevalence of childhood overweight in the San Antonio area is higher than national figures. The findings of increasing prevalence and early onset of childhood overweight are concerning, because these are known risk factors for diabetes and diseases of many other organ systems. Measures to prevent, reduce or treat childhood obesity are urgently needed.     

Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997

OBJECTIVE: To examine the prevalence of overweight and obesity in the entire population of 5- and 6-y-old children entering school in Germany, Bavaria, and to assess time trends over the last 15 y and the impact of ethnicity. DESIGN: Cross-sectional studies were based on the obligatory school entry health examinations: all health districts of Bavaria in 1997 (n=127 735); three health districts every 5 y from 1982 to 1997 (n=16 281). MEASUREMENTS: Body mass index (BMI; kg/m(2)) was calculated and the prevalence of overweight and obesity was defined based on national and international agreed cut-off points. Ethnicity was measured as German and non-German nationality. RESULTS: The prevalence of overweight and obese children as defined by international reference values was 9.4 and 3.1% for 5-y-old boys, 10.0 and 2.9% for 6-y-old boys, 12.2 and 3.3% for 5-y-old girls and 12.4 and 3.3% for 6-y-old girls. The whole BMI distribution in non-German children compared to German children was shifted to the right with median values in non-German children 0.3-0.5 kg/m(2) higher. In these the prevalence of overweight/obesity was 1.9/2.4 times higher for boys and 1.5/1.9 times higher for girls. The time trend between 1982 and 1997 shows an increase of the BMI distribution in the upper percentiles, whereas the lower percentiles did not change substantially. The increased prevalences of overweight/obesity for both sexes as defined by international references increased from 8.5/1.8% in 1982 to 12.3/2.8% in 1997. CONCLUSION: This large study on all children entering school in Bavaria in 1997 shows patterns of overweight and obesity which are comparable with other European data but are lower than US and Australian data. Increasing prevalences since 1982 indicate that overweight and obesity in children are of increasing public health importance in Bavaria. The upwards shift of the BMI distribution in non-German children needs further investigation.     

Overweight and obese children have low bone mass and area for their weight

OBJECTIVES: To determine whether girls and boys categorized from body mass index (BMI) values as overweight or obese for their age have lower bone mineral content (BMC) or lower bone area in relation to total body weight than children of normal adiposity. DESIGN: Cross-sectional study in a university bone research unit. SUBJECTS: Two hundred girls and 136 boys aged 3-19 y recruited from the general population by advertisement. MEASUREMENTS: Total body BMC (g) and bone area (cm2) measured by dual energy X-ray absorptiometry (DXA) in relation to body weight (kg), lean tissue mass (kg) and fat mass (kg) in boys and girls of three different BMI percentile groupings: normal weight (BMI<85th percentile); overweight (85 to 94th BMI percentile); obese (> or =95th BMI percentile). RESULTS: Obese children had higher BMC, bone area, and fat mass for chronological age than those of normal body weight (P<0.001). In spite of this the observed values for age-adjusted total body BMC and bone area relative to body weight were each lower than predicted values, in both overweight and obese children (2.5-10.1% less, P<0.05) than in children of lower adiposity. CONCLUSION: In overweight and obese boys and girls there is a mismatch between body weight and bone development during growth: their bone mass and bone area are low for their body weight.     

Early identification of Mexican American children who are at risk for becoming obese.

OBJECTIVE: To describe the problem of obesity in Mexican American children and provide a method for identifying Mexican American children at risk for obesity. DESIGN: Cross-sectional and retrospective cohort study. SUBJECTS: Mexican American children, ages 5-11 (kindergarten (K)-5th grade) were studied in cross-sectional (girls = 463, boys = 448) and retrospective (girls = 124, boys = 92) samples. MEASUREMENTS: Weights (kg) and heights (cm) were extracted from each child's school medical records. Measurements were made by the school nurses (one nurse per school). Body mass index (BMI [w/h2]) was calculated from obtained weights and heights. RESULTS: The prevalence of obesity in the cross-sectional sample was 27.4% for girls and 23.0% for boys. The highest prevalence was noted in 4th grade for both the girls (32.4%) and boys (43.4%). The 5 year incidence rates derived from the retrospective sample were 17.7% for girls and 21.1% for boys. The largest increase in the number of girls becoming obese was observed between K and 1st grade (15.6%). The largest increase for boys was found between the 1st and 2nd grades (13.2%). Logistic regression parameters were calculated to estimate the probability of becoming obese in 5th grade given a child's K BMI. Using the generated equation, BMIs in K equal to 16.5, 20.9, and 23.7 would have a 21.0%, 70.0%, and 91.0% probability of being obese by 5th grade. CONCLUSION: This study provides schools with a simple procedure for identifying Mexican American children at risk for obesity. This procedure may assist in the development and implementation of interventions aimed at averting the onset of obesity in this population.     

Approaching healthy body mass index norms for children and adolescents from health-related physical fitness

Current body mass index (BMI) norms for children and adolescents are developed from a reference population that includes obese and slim subjects. The validity of these norms is influenced by the observed secular increase in body weight and BMI. We hypothesized that the performance of children in health‐related physical fitness tests would be negatively related to increased BMIs, and therefore fitness tests might be used as criteria for developing a more appropriate set of BMI norms. We evaluated the existing data from a nation‐wide fitness survey for students in Taiwan (444 652 boys and 433 555 girls) to examine the relationship between BMI and fitness tests. The fitness tests used included: an 800/1600‐m run/walk; a standing long jump; bent‐leg curl‐ups; and a sit‐and‐reach test. The BMI percentiles developed from the subgroup whose test scores were better than the ‘poor’ quartile in all four tests were compared with those of the whole population and linked to the adult criteria for overweight and obesity. The BMIs were significantly related to the results of fitness testing. A total of 43% of students had scores better than the poorest quartile in all of their tests. The upper BMI percentile curves of this fitter subgroup were lower than those of the total population. The 85th and 95th BMI percentile values of the fitter 18‐year‐old‐students (23.7 and 25.5 kg m^?2 for boys; 22.6 and 24.6 kg m^?2 for girls) linked well with the adult cut‐off points of 23 and 25 kg m^?2, which have been recommended as the Asian criteria for adult overweight and obesity. Hence, the BMI norms for children and adolescents could be created from selected subgroups that have better physical fitness. We expect that the new norms based on this approach will be used not only to assess the current status of obesity or overweight, but also to encourage activity and exercise.     

Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology

OBJECTIVE: To assess the ability of simple definitions of BMI to successfully screen for children with high body fatness. DESIGN: We determined the sensitivity and specificity of the body mass index (BMI) by testing its ability to correctly identify children with high body fat percentage. Receiver operator characteristic (ROC) analyses were carried out using the top 5% of body fat percentage to define children as obese (true positives). SUBJECTS: Representative sample of 4175 7 y-old (88-92 month-old) children (2120 boys; 2055 girls) participating in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). RESULTS: The current obesity definition based on BMI (95th centile) had moderately high sensitivity (88%) and high specificity (94%). Sensitivity and specificity did not differ significantly between boys and girls. The ROC analysis showed that lower cut-offs applied to the BMI improved sensitivity with no marked loss of specificity: the optimum combination of sensitivity (92%) and specificity (92%) was at a BMI cut-off equivalent to the 92nd centile. Sensitivity of BMI using the new International Obesity Task Force (IOTF) cut-off for obesity was much lower, and differed significantly (P < 0.001) between boys (46%) and girls (72%). CONCLUSIONS: Screening for childhood obesity using the BMI is specific, and can have moderately high sensitivity if an appropriate cut-off is chosen. New recommendations based on the IOTF approach to defining childhood obesity are associated with lower sensitivity, and sensitivity differs between boys and girls.     

Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors

BACKGROUND: Body mass index (BMI) and waist circumference (WC) correlate with cardiovascular (CV) risk factors in childhood which track into adulthood. WC provides a measure of central obesity, which has been specifically associated with CV risk factors. Reference standards for WC, and for WC and BMI risk threshold values are not established in Chinese children. OBJECTIVES: To construct reference percentile charts of WC, establish relationships between WC, BMI and other risk factors, and propose WC and BMI threshold values predictive of CV risk factors in Hong Kong ethnic Chinese children. METHODS: Weight, height, waist and hip circumference were measured in 2593 (52% boys, 47% girls) randomly sampled Hong Kong school children aged 6-12 years. In 958 of these and 97 additional overweight children (n=1055), the relationships between WC, BMI, waist/hip and waist/height ratio and six age-adjusted CV risk factors (>85% percentile levels of blood pressure (BP), fasting triglycerides, low-density lipoprotein (LDL) cholesterol, glucose and insulin levels, and <15% percentile levels of high-density lipoprotein (HDL) cholesterol) were studied. Receiver-operating characteristic analysis was employed to derive optimal age-adjusted sex-specific WC and BMI thresholds for predicting these measures of risk. RESULTS: WC percentiles were constructed. WC correlated slightly more than BMI with CV risk factors and most strongly with insulin and systolic BP, but poorly or not with LDL and glucose. Optimal WC and BMI risk thresholds for predicting four of these six CV risk factors were ca. the 85th percentiles (sensitivities approximately 0.8, specificities approximately 0.87) with age-specific cutoff values in girls/boys from approximately 57/58 to approximately 71/76 cm and 17/18 to 22/23 kg/m(2). CONCLUSION: These are the first set of WC reference data for Chinese children. WC risk cutoff values are proposed which, despite a smaller waist in Chinese children, are similar to those reported for American children. WC percentiles may reflect population risk.     

Prevalence of elevated blood pressure and association with overweight in children of a rapidly developing country

We assessed the prevalence of elevated blood pressure (BP) and the association with excess body weight among a large sample of children in the Seychelles, a middle-income rapidly developing country in the African region. Weight, height and BP were measured in all children of four school grades in the Seychelles (Indian Ocean). Excess weight categories ('overweight' and 'obesity') were defined according to the criteria of the International Obesity Task Force. Two BP readings were obtained on one occasion. 'Elevated BP' was defined based on US reference tables. Data were available in 15,612 (86%) of 18,119 eligible children aged 5-16 years in 2002-2004. In all, 13.0% of Boys and 18.8% of girls were overweight or obese. The prevalence of elevated BP was 9.1% in boys and 10.1% in girls. Both systolic and diastolic BP were strongly associated with body mass index (BMI) in boys and in girls. In children with 'normal weight', 'overweight (and not obesity)' and 'obesity', respectively, proportions with elevated BP were 7.5, 16.9 and 25.2% in boys, and 7.5, 16.1 and 33.2% in girls. Overweight (including obesity) could account for 18% of cases of elevated BP in boys and 26% in girls. Further studies should examine the impact of the relationship between BMI and elevated BP on the burden of hypertension in the context of the epidemic of paediatric obesity.     

The association between low physical fitness and high body mass index or waist circumference is increasing with age in children: the 'Québec en Forme' Project

OBJECTIVE: To evaluate physical fitness and body composition of children involved in the 'Québec en Forme' (QEF) Project and to compare data obtained to the reference values of the 1981 Canada Fitness Survey (CFS). DESIGN: Cross-sectional study. SUBJECTS: A total of 1140 children (591 boys and 549 girls) of first (7 years), second (8 years) and fourth (10 years) grade from primary schools in the City of Trois-Rivières (Québec) were selected to participate in this study. MEASUREMENTS: Body mass index (BMI) and waist circumference (WC) were measured. The physical fitness tests included standing long jump, 1-min speed sit-ups and speed shuttle run. RESULTS: The prevalence of overweight in children ranged between 20 and 30%, which represents a substantial increase compared to the 1981 CFS. The relationship between BMI and WC was highly significant in boys and girls (r=0.90 and 0.86, respectively, P<0.0001). The negative correlations between BMI or WC and the performance in all physical fitness tests were mostly significant in children of both genders (-0.16 < or = r < or = -0.45, at least P<0.05), and these relationships were significantly greater in older children (P<0.05). Based on the 1981 CFS, only 4.7-14.1% of QEF boys still performed in the upper quartile of the distribution (fit boys), whereas 32.1-69% performed not much higher than the lower quartile (unfit boys) for each fitness test. In girls, the relative fitness decrease observed in 2003 was more pronounced since only 1-9.9% of subjects performed in the upper quartile of the distribution compared to 42.8-81.4% who did not perform higher than the lower quartile of the 1981 reference scores of the CFS. CONCLUSION: This study shows that BMI and WC are negatively correlated with physical fitness and that these associations are more pronounced in older children. Furthermore, physical fitness of our cohort, especially in girls, was much lower than what was documented in the 1981 CFS in subjects of the same age. This study thus emphasizes the necessity to develop early interventions to improve physical fitness in children and to prevent the increase of childhood obesity.     

Differences between recumbent length and stature measurement in groups of 2- and 3-y-old children and its relevance for the use of European body mass index references

OBJECTIVE: To compare length and stature measurements of young children and to examine the relevance of any difference for comparison with body mass index (BMI) references designed for use from birth to adulthood. SUBJECTS: A total of 426 2-y-old and 525 3-y-old children included in the Dortmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study. DATA ANALYSIS: Length and stature were measured to the nearest millimetre using a stadiometre. Agreement between both measurements at age 2 and 3 y, respectively, was determined by mean differences and by comparison with the German BMI reference. RESULTS: The average length of 2-y-old girls and boys was 88.3 (3.1) and 89.9 (3.2) cm, mean differences (stature minus length) were -0.47 (0.65) and -0.45 (0.64) cm. The corresponding BMI values were 16.18 (1.3) and 16.46 (1.2) kg/m2, with mean differences of +0.17 (0.24) and +0.16 (0.23). According to stature, 9.4% of the girls and 10.8% of the boys were overweight (>90th percentile), while length classified 7.1 and 9.4% as overweight. Similar mean differences between length and stature were observed at age 3 y: -0.53 (0.62) and -0.47 (0.65) cm in height and +0.17 (0.20) and +0.14 (0.20) kg/m2 in the BMI of girls and boys, respectively. According to stature, 7.6 and 7.3% were overweight as opposed to 5.4 and 4.8% using length. The observed differences increased with higher BMI levels. CONCLUSION: Changing measurements from length to stature results in an upward shift of BMI, not reflected in current European BMI references. This small but systematic error may result in misinterpretation of individual BMI levels or trend observations.     

Weight and height percentiles for 0-84- month-old children in Kayseri--a central Anatolian city in Turkey

Objective: The aim of this study was to present weight and height percentiles for Turkish children aged 0-84 months residing in Kayseri, Turkey and to compare these findings with national references and international standards. Methods: We used the data from the Anthropometry of Turkish Children aged 0-6 years (ATCA-06) study. This cross-sectional study conducted in Kayseri/Turkey between September 2009 and May 2010 included 2963 children (1491 girls, 1472 boys) aged 0-84 months. The centile curves were constructed using the LMS method.Results: The 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th percentiles and the LMS values for boys and girls were constructed. The 50th percentiles for weight and height of the children were compared with world health organization (WHO) standards and national data. Height and weight values in Kayseri children were lower than WHO standards and Istanbul references in the first year of life. At ages 1 to 4, weight values in both genders and height in boys were slightly higher than the national and international standards. Starting at age 4 years, the weight percentiles of Kayseri children were strikingly higher compared to the national and international standards and the boys were also taller.Conclusions: This study provides cross-sectional data for weight and height percentiles of Turkish children aged 0-84 months residing in Kayseri. These data reflect the growth status of healthy Kayseri children and also indicate that these children may be more prone to obesity than the Istanbul children. Since the above-mentioned data illustrate the current growth status of this population, we believe that they will serve as a basis for monitoring future trends.Conflict of interest:None declared.     

Association between stunting and overweight among 10-15-y-old children in the North West Province of South Africa: the THUSA BANA Study

OBJECTIVE: To investigate the relationship between stunting and overweight among 10-15-y-old children of the North West Province in South Africa. DESIGN: A single cross-sectional study design was used. The study formed part of the THUSA BANA project. SUBJECTS: The total study population of the THUSA BANA project comprised of 1257 randomly selected subjects, aged 10-15 y. MEASUREMENTS: Stunting was described as the height below the 5th percentile for age using the CDC standard percentiles. Furthermore, the definitions of overweight and obesity according to the International Obesity Task Force (IOTF) were used, where the cutoff points for body mass index (BMI) corresponds with the adult BMI of 25 and 30, respectively. Anthropometrical variables namely triceps (TSF) and subscapular skinfolds (SSF), waist circumference, weight, height and BMI of the 10-15-y-old subjects were analysed. RESULTS: Stunting was most prevalent in the rural areas (girls 23.7% and boys 26.7%) compared with urban areas (girls 11.6%, boys 17.1%). The odds ratio and the 95% CI for the association between stunting and overweight in boys and girls were 0.45 (CI 0.16, 1.30) and 0.50 (CI 0.21, 1.19) respectively. Stunted children, 10-14-y-old and living in rural areas and informal settlements, had significantly lower mean BMI and skinfold thicknesses than nonstunted children. The mean BMI and sum of TSF and SSF (TSF+SSF) were similar in stunted and nonstunted children living in urban areas. CONCLUSION: There is no significant association between stunting and overweight in 10-15-y-old children in the North West Province. However, there is a tendency for girls older than 14 y to start to gain subcutaneous fat, even though at these ages they were still stunted and underweight. Stunted girls in established urban areas had a higher mean TSF+SSF than stunted girls in informal townships. This tendency in urban stunted girls is evident at the onset of menarche and could predict possible problems of overweight as they get older.     

Change in body mass index in Australian primary school children, 1985-1997

BACKGROUND: Childhood obesity is an important, potentially modifiable risk factor for a range of concurrent and later morbidities. Despite concerns about recent increases in children's body mass index (BMI), supporting data in Australia (as elsewhere) are scant. OBJECTIVE: To seek anthropometric evidence of a recent secular increase in BMI in primary school children in Victoria, Australia. DESIGN: Data from two cross-sectional population-based surveys of primary school children (the Victorian subsample of the 1985 Australian Health and Fitness Survey and the 1997 Health of Young Victorians Study) were compared. Similar stratified random sampling and standardized measurement methods were employed in the two studies. Subjects were all children aged 7-12 y with complete height and weight data. Body mass index (BMI (weight/height2)) was used as the index of relative adiposity. Non-parametric and parametric methods were used to examine the pattern and magnitude of change in BMI over the 12 y interval. RESULTS: Data for 1421 children (50% male, 68% response) from the 1985 survey and 2277 children (51% male, 75% response) from the 1997 survey were analysed. At all ages, mean height and median weight were greater in 1997 than 1985 for both boys and girls. Median BMI was significantly higher in the 1997 sample for all but 12 y-old girls and for boys aged 7, 8 and 10 y (Mann-Whitney U test). The magnitude of the overall increase in BMI was estimated using analysis of covariance for log-transformed BMI adjusted for exact age, which indicated an increase of 1.03 kg/m2 for boys and 1.04 kg/m2 for girls (both P<0. 001). Plots of BMI against BMI percentile clearly showed a pattern of higher BMI at any given percentile, especially at the upper percentiles, for all ages and both genders. CONCLUSIONS: Primary school children in Victoria have become more obese over the last decade. Increases in BMI are most marked at the heavier end of the distribution. Lesser increases in median and mean BMI (confirmed by both parametric and non-parametric statistical models) may also have major public health implications.