Growth Tracking in Severely Obese or Underweight Children

Chambers, Melissa; Tanamas, Stephanie K.; Clark, Elena J; Dunnigan, Diana L; Kapadia, Chirag; Hanson, Robert L.; Nelson, Robert G.; Knowler, William C.; Sinha, Madhumita

doi:10.1542/peds.2017-2248

Cited by 23 publications

(24 citation statements)

References 16 publications

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“…Further, methods other than the ICC could be used to evaluate tracking, such as examining the ability of a high BMI to predict a high BMI in later life. It should also be noted that though we did not assess the other alternative BMI metrics that have been proposed, that is, modified z score (18,19) and %BMIp95 (10,14,17,46) , these two metrics were highly correlated (r > 0•95) with adjusted % distance from the median. However, values of % distance from the median are more closely tied to the CDC growth charts and may be more interpretable than modified BMIz or %BMIp95.…”

Section: Discussionmentioning

confidence: 94%

“…These limitations have resulted in various alternatives being proposed for analyses with BMI as a continuous variable. They include focusing on changes in BMI rather than in BMIz in longitudinal analyses (15,16) , expressing a child's BMI as a percentage of the 95th percentile (%BMIp95) (9,10,14,17) and using a modified z score that extrapolates a fixed SD outwards (18) . Although these metrics avoid the compression of very high BMIs into a narrow range of z scores, it is unclear whether they are useful for lower BMIs and whether they convey similar information across ages.…”

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confidence: 99%

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Distance and percentage distance from median BMI as alternatives to BMI z score

et al. 2019

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BMI z (BMIz) score based on the Centers for Disease Control and Prevention growth charts is widely used, but it is inaccurate above the 97th percentile. We explored the performance of alternative metrics based on the absolute distance or % distance of a child’s BMI from the median BMI for sex and age. We used longitudinal data from 5628 children who were first examined <12 years to compare the tracking of three BMI metrics: distance from median, % distance from median and % distance from median on a log scale. We also explored the effects of adjusting these metrics for age differences in the distribution of BMI. The intraclass correlation coefficient (ICC) was used to compare tracking of the metrics. Metrics based on % distance (whether on the original or log scale) yielded higher ICCs compared with distance from median. The ICCs of the age-adjusted metrics were higher than that of the unadjusted metrics, particularly among children who were (1) overweight or had obesity, (2) younger and (3) followed for >3 years. The ICCs of the age-adjusted metrics were also higher compared with that of BMIz among children who were overweight or obese. Unlike BMIz, these alternative metrics do not have an upper limit and can be used for assessing BMI in all children, even those with very high BMIs. The age-adjusted % from median (on a log or linear scale) works well for all ages, while unadjusted % from median is better limited to older children or short follow-up periods.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Distance and percentage distance from median BMI as alternatives to BMI z score

et al. 2019

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“…Fourth, the findings observed here may not generalize to other Hispanic subgroups or to adolescents of a different race/ethnicity. Fifth, in this study we used the modified BMI z-score developed by the CDC to overcome recognized limitations of BMIz that hinder valid correlations with adiposity in severely obese children [49, 98]. However, the most appropriate measure for tracking BMI over time remains unclear and may depend on the population studied and degree of obesity [99].…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, BMIaz does not have an upper limit, and the values are not compressed into a fixed range. The modified z-scores correlate more strongly with measures of adiposity in obese and severely obese children and have been recommended for use with these populations in place of BMIz [55, 56]. Demographic (i.e., parents’ education and marital status) and measured height and weight data from the parent enrolled in the MACS were obtained from the MACS database.…”

Section: Methodsmentioning

confidence: 99%

Longitudinal associations of family functioning with body mass index in Mexican-origin adolescents living in the U.S.

Heredia

Wilkinson²,

Forman

et al. 2019

Preventive Medicine

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Mexican-origin adolescents have a high prevalence of obesity. Research is needed to understand how family context may shape adolescent BMI. This study examined longitudinal associations of family functioning variables with the Centers for Disease Control and Prevention’s modified BMI z-score (BMIaz) in 1,175 Mexican-origin adolescents, and explored interactions with acculturation. Adolescents (50% female, aged 11–13 y in 2005–06) were identified from an ongoing cohort study of Mexican-origin adults in Houston, TX, and were assessed three times from 2005–06 to 2010–11. In multivariate linear mixed models stratified by gender, we assessed longitudinal associations of family cohesion and family conflict with adolescent BMIaz and explored interactions with language acculturation. We disaggregated the between- (mean) and within-person (individual deviation) components of family cohesion and family conflict to assess the effects on BMIaz. Approximately one-third of adolescents were obese at baseline, and BMIaz declined during the study. In girls, higher mean family cohesion and conflict were associated with steeper declines in BMIaz. Parental linguistic acculturation modified the relationship between within-person deviation in family cohesion and BMIaz in girls, such that high parental U.S. acculturation was associated with a stronger inverse association. There were no significant associations in boys. These findings highlight the potential importance of the family context to female adolescent BMI and the promise of addressing family context in obesity-related interventions.

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“…To assess the effect of the intervention on adiposity in the child and adult we conducted a quasi-experimental, one group evaluation to measures changes in BMI from baseline to week 6 (final week of education phase). The primary outcome was the modified CDC Z-score for a child’s BMI [ 26 ]. Since 2017, the CDC has provided a modified Z-score for children that helps tracking of children in the extremes of the BMI distribution [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

Incorporating an Increase in Plant-Based Food Choices into a Model of Culturally Responsive Care for Hispanic/Latino Children and Adults Who Are Overweight/Obese

Singh

Steinbach

Nelson

et al. 2020

IJERPH

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Introduction: The national rate of obesity in US Hispanic/Latinos exceeds all other major ethnic subgroups and represents an important health disparity. Plant-based diet interventions that emphasize whole plant foods with minimal processing and less refined grains and sugar have shown have shown great promise in control of obesity, but there is a paucity of data translating this treatment effect to disparate populations. The objective of our study was to evaluate the efficacy of the Healthy Eating Lifestyle Program (HELP) for accomplishing weight management in a hospital-based, family centered, culturally tailored, plant-based diet intervention for Hispanic/Latino children who were overweight or obese. Methods: Our mixed methods evaluation included: (1) A one arm study to measure changes in body mass index (BMI) from pre- to post-intervention, and (2) A stakeholder analysis of the program staff. Results: For children ages 5–12 years who were overweight/obese, we found no evidence of excess weight gain evidenced by BMI Z scores (Zpost-pre = −0.02, p = 0.11). Among the parent/guardians who were overweight or obese, we found a decrease in BMI that was stronger in men (BMI post-pre = −0.75 kg/m2, p = 0.01) than in women (BMI post-pre = −0.12 kg/m2, p = 0.30). A program strength was the cultural tailoring of the plant-based diet choices. Conclusions: The evaluation raises the possibility that incorporating intervention components of HELP (plant-based food choices, family-based, cultural tailoring) into pediatric weight management can improve the standard of care.

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Growth Tracking in Severely Obese or Underweight Children

Abstract: The modified CDC score chart is suitable for growth tracking of children with normal and extreme growth patterns; the measures correlate well with the %BMI and the chart can be incorporated easily into existing electronic health record systems for clinical use.

Cited by 23 publications

References 16 publications

Distance and percentage distance from median BMI as alternatives to BMI z score

Distance and percentage distance from median BMI as alternatives to BMI z score

Longitudinal associations of family functioning with body mass index in Mexican-origin adolescents living in the U.S.

Incorporating an Increase in Plant-Based Food Choices into a Model of Culturally Responsive Care for Hispanic/Latino Children and Adults Who Are Overweight/Obese

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