Reference curves for stature and weight in British children have been available for the past 30 years, and have recently been updated. However weight by itselfis a poor indicator of fatness or obesity, and there has never been a corresponding set of reference curves to assess weight for height. Body mass index (BMI) or weight/height2 has been popular for assessing obesity in adults for many years, but its use in children has developed only recently. Here centile curves for BMI in British children are presented, from birth to 23 years, based on the same large representative sample as used to update the stature and weight references. The charts were derived using Cole's LMS method, which adjusts the BMI distribution for skewness and allows BMI in individual subjects to be expressed as an exact centile or SD score. Use of the charts in clinical practice is aided by the provision of nine centiles, where the two extremes identify the fattest and thinnest four per 1000 ofthe population. (Arch Dis Child 1995; 73: 25-29) Keywords: body mass index, growth reference, overweight, underweight. Another weight for height index suitable for the age group 4-12 years has been proposed by Chinn et al,6 based on its correlation with skinfold thickness. Defined as (weight (kg) -9)/ height (cm)3-7, it has the dual properties that its mean and coefficient of variation are both unrelated to age. This means that it does not need adjusting for age. MRC Dunn NutritionA very flexible index of overweight is provided by the power function weight/heightn, where n the power of height usually takes values in the range 1 to 3. Restricting it to whole numbers, the value for n which best adjusts weight for height, and at the same time removes most of the trend of increasing weight with age, is n=2.7 8 This leads to the body mass index (BMI) weight/height2, also known as the Quetelet index9 or the Kaup index.'0 BMI has been used widely in adults for the last 25 years as a simple summary measure of overweight," 12 but its use in childhood has developed relatively recently. Adult BMI increases fairly slowly with age, so that age independent cut offs can be used to grade obesity.'3 In children, however, BMI changes substantially with age, rising steeply in infancy, falling during the preschool years, and then rising again into adulthood. For this reason, child BMI needs to be assessed using age related reference curves.Such curves have been published for French8 14 and American'5 16 children, but they are all imperfect, either because the data are old or the age range is restricted. This paper provides up-to-date reference curves for BMI in UK children, covering the age range birth to 23 years, and presented as nine centiles. They are among the first such curves to complement existing national references for weight and height based on the same dataset. Methods SUBJECTSThe reference sample of children was obtained by combining data from 11 distinct surveys. The data were collected between 1978 and 1990, a long enough period of time for the...

The current reference curves of stature and weight for the UK were first published in 1966 and have been used ever since despite increasing concern that they may not adequately describe the growth of present day British children. Using current data from seven sources new reference curves have been estimated from birth to 20 years for children in 1990. The great majority of the data are nationally representative. The analysis used Cole's LMS method and has produced efficient estimates of the conventional centiles and gives a good fit to the data. These curves differ from the currently used curves at key ages for both stature and weight. In view of the concerns expressed about the current curves and the differences between them and the new curves, it is proposed that the curves presented here should be adopted as the new UK reference curves. (Arch Dis Child 1995; 73: 17-24)

To update the British growth reference, anthropometric data for weight, height, body mass index (weight/height2) and head circumference from 17 distinct surveys representative of England, Scotland and Wales (37,700 children, age range 23 weeks gestation to 23 years) were analysed by maximum penalized likelihood using the LMS method. This estimates the measurement centiles in terms of three age-sex-specific cubic spline curves: the L curve (Box-Cox power to remove skewness), M curve (median) and S curve (coefficient of variation). A two-stage fitting procedure was developed to model the age trends in median weight and height, and simulation was used to estimate confidence intervals for the fitted centiles. The reference converts measurements to standard deviation scores (SDS) that are very close to Normally distributed - the means, medians and skewness for the four measurements are effectively zero overall, with standard deviations very close to one and only slight evidence of positive kurtosis beyond+/-2 SDS. The ability to express anthropometry as SDS greatly simplifies growth assessment.

Recent trials of intensive glycemic control suggest a possible link between hypoglycemia and excess cardiovascular mortality in patients with type 2 diabetes. Hypoglycemia might cause arrhythmias through effects on cardiac repolarization and changes in cardiac autonomic activity. Our aim was to study the risk of arrhythmias during spontaneous hypoglycemia in type 2 diabetic patients with cardiovascular risk. Twenty-five insulin-treated patients with type 2 diabetes and a history of cardiovascular disease or two or more risk factors underwent simultaneous continuous interstitial glucose and ambulatory electrocardiogram monitoring. Frequency of arrhythmias, heart rate variability, and markers of cardiac repolarization were compared between hypoglycemia and euglycemia and between hyperglycemia and euglycemia matched for time of day. There were 134 h of recording at hypoglycemia, 65 h at hyperglycemia, and 1,258 h at euglycemia. Bradycardia and atrial and ventricular ectopic counts were significantly higher during nocturnal hypoglycemia compared with euglycemia. Arrhythmias were more frequent during nocturnal versus daytime hypoglycemia. Excessive compensatory vagal activation after the counterregulatory phase may account for bradycardia and associated arrhythmias. QT intervals, corrected for heart rate, >500 ms and abnormal T-wave morphology were observed during hypoglycemia in some participants. Hypoglycemia, frequently asymptomatic and prolonged, may increase the risk of arrhythmias in patients with type 2 diabetes and high cardiovascular risk. This is a plausible mechanism that could contribute to increased cardiovascular mortality during intensive glycemic therapy.

Speech and language therapists benefited from training on the CAPS-A, focusing on specific aspects of speech using definitions of parameters and scalar points, in order to apply the tool systematically and reliably. Ratings are enhanced by ensuring a high degree of attention to the nature of the data, standardizing the speech sample, data acquisition, the listening process together with the use of high-quality recording and playback equipment. In addition, a method is proposed for maintaining listening skills following training as part of an individual's continuing education.