Standards or References: A Central Question for Growth Monitoring?

Heude, Barbara; Scherdel, Pauline

doi:10.1111/ppe.12394

Cited by 7 publications

(11 citation statements)

References 13 publications

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“…In a systematic review, we have shown that the WHO growth charts were imperfectly calibrated with the growth of contemporary children in many countries, including France. 2,35 This result naturally led us to suggest the need to generate French-specific growth charts. This choice is now supported by the results of the current study, because as compared with the existing French national growth charts and WHO growth charts, the new growth charts generally better matched data from the national cross-sectional representative school surveys.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that the performance of algorithms proposed for growth monitoring can be strongly modified by the growth chart used (standards vs references), which highlights the need for calibration to improve performance. [35][36][37] The need to update height growth charts is not debated, but the relevance of updating weight growth charts could be questioned in the context of the increasing prevalence of childhood overweight and obesity worldwide. [38][39][40][41][42] In France, the most recent assessment of the prevalence of French childhood overweight, as defined by the International Obesity Task Force threshold, was 12% for boys and 14% for girls in 2015.…”

Section: Discussionmentioning

confidence: 99%

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A big-data approach to producing descriptive anthropometric references: a feasibility and validation study of paediatric growth charts

Heude

Scherdel

Werner

et al. 2019

The Lancet Digital Health

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Background Both national and WHO growth charts have been found to be poorly calibrated with the physical growth of children in many countries. We aimed to generate new national growth charts for French children in the context of huge datasets of physical growth measurements routinely collected by office-based health practitioners. Methods We recruited 32 randomly sampled primary care paediatricians and ten volunteer general practitioners from across the French metropolitan territory who used the same electronic medical records software, from which we extracted all physical growth data for the paediatric patients, with anonymisation. We included measurements from all children born from Jan 1, 1990, and aged 1 month to 18 years by Feb 8, 2018, with birthweight greater than 2500 g, to which an automated process of data cleaning developed to detect and delete measurement or transcription errors was applied. Growth charts for weight and height were derived by using generalised additive models for location, scale, and shape with the Box-Cox power exponential distribution. We compared the new charts to WHO growth charts and existing French national growth charts, and validated our charts using growth data from recent national cross-sectional surveys. Findings After data cleaning, we included 1 458 468 height and 1 690 340 weight measurements from 238 102 children. When compared with the existing French national and WHO growth charts, all height SD and weight percentile curves for the new growth charts were distinctly above those for the existing French national growth charts, as early as age 1 month, with an average difference of −0•75 SD for height and −0•50 SD for weight for both sexes. Comparison with national cross-sectional surveys showed satisfactory calibration, with generally good fit for children aged 5-6 years and 10-11 years in height and weight and small differences at age 14-15 years. Interpretation We successfully produced calibrated paediatric growth charts by using a novel big-data approach applied to data routinely collected in clinical practice that could be used in many fields other than anthropometry.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A big-data approach to producing descriptive anthropometric references: a feasibility and validation study of paediatric growth charts

Heude

Scherdel

Werner

et al. 2019

The Lancet Digital Health

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“…The importance of differentiating between references (developed using the whole population) and standards (developed on a healthy sub‐set of the population) was a central precept in the development of the World Health Organisation (WHO) postnatal growth standards, based on anthropometric measurements from multi‐country samples of low‐risk children. These standards are currently recommended for use worldwide, although their applicability to all populations has been called into question . Proponents of these standards claim that they are intended to describe normal child growth and therefore are not expected to “fit” all populations …”

Section: Introductionmentioning

confidence: 99%

“…These standards are currently recommended for use worldwide, although their applicability to all populations has been called into question. [6][7][8] Proponents of these standards claim that they are intended to describe normal child growth and therefore are not expected to "fit" all populations. 9 The IG fetal growth norms also face criticism for not accurately reflecting fetal growth in a growing number of studies, either because too few 10 or too many fetuses 11 are classified under the 10th percentile or too few are classified as over the 90th percentile.…”

Section: Introductionmentioning

confidence: 99%

Are selection criteria for healthy pregnancies responsible for the gap between fetal growth in the French national Elfe birth cohort and the Intergrowth‐21st fetal growth standards?

Heude

Guern

Forhan

et al. 2018

Paediatric Perinatal Epid

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Background The Intergrowth‐21st (IG) project proposed prescriptive fetal growth standards for global use based on ultrasound measurements from a multicounty study of low‐risk pregnancies selected using strict criteria. We examined whether the IG standards are appropriate for fetal growth monitoring in France and whether potential differences could be due to IG criteria for “healthy” pregnancies. Method We analysed data on femur length and abdominal circumference at the second and/or the third recommended ultrasound examination from 14 607 singleton pregnancies from the Elfe national birth cohort. We compared concordance of centile thresholds using the IG standards and current French references and used restricted cubic splines to plot z‐scores by gestational age. A “healthy pregnancy” sub‐sample was created based on maternal and pregnancy selection criteria, as specified by IG. Results Mean gestational age‐specific z‐scores for femur length and abdominal circumference using French references fluctuated around 0 (−0.2 to 0.1), while those based on IG standards were higher (0.3‐0.8). Using IG standards, 2.5% and 5.2% of fetuses at the third ultrasound were <10th centile for femur length and abdominal circumference, respectively, and 31.5% and 16.7% were >90th. Only 34% of pregnancies fulfilled IG low‐risk criteria, but sub‐analyses yielded very similar results. Conclusion Intergrowth standards differed from fetal biometric measures in France, including among low‐risk pregnancies selected to replicate IG's healthy pregnancy sample. These results challenge the project's assumption that careful constitution of a low‐risk population makes it possible to describe normative fetal growth across populations.

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“…As children in those countries are generally taller and heavier than those in the WHO-CGS population, the distribution shifts to the right relative to WHO-CGS. Therefore, the detection of growth problems at the lower end of the scalefor instance, Turner syndromeis delayed, while at the higher end, an overestimation of potential health problems may occur (8,(28)(29)(30) . At the same time, in children of shorter and thinner populations, such as Surinamese Asian Indian children in our study, wasting and underweight are likely to be overdetected (12,13) .…”

Section: Discussionmentioning

confidence: 99%

Misclassification of stunting, underweight and wasting in children 0–5 years of South Asian and Dutch descent: ethnic-specific v. WHO criteria

Wilde

Peters-Koning

Middelkoop

2020

Public Health Nutr.

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Objective:Several authors have questioned the suitability of WHO Child Growth Standards (WHO-CGS) for all ethnic groups. The aim of this study was to identify potential misclassification of stunting, underweight and wasting in children of Surinamese Asian Indian, South Asian (Pakistan/India) and Dutch descent.Design:A series of routine cross-sectional measurements, collected 2012–2015. South Asian-specific normative growth references for weight-for-age and weight-for-length/height were constructed using the LMS method based on historic growth data of Surinamese Asian Indians born between 1974 and 1976. WHO-CGS and ethnic-specific references were applied to calculate z-scores and prevalence of stunting, underweight and wasting.Setting:Youth HealthCare, providing periodical preventive health check-ups.Participants:11 935 children aged 0–5 years.Results:Considerable deviations from WHO-CGS were found, with higher-than-expected stunting rates, especially in the first 6 months of life. Surinamese Asian Indian children showed stunting rates up to 16·0 % and high underweight and wasting over the whole age range (up to 7·2 and 6·7 %, respectively). Dutch children consistently had mean WHO-CGS z-scores 0·3–0·5 sd above the WHO baseline (>6 months). The application of ethnic-specific references showed low rates for all studied indicators, although South Asian children were taller and larger than their Surinamese Asian Indian counterparts.Conclusions:WHO-CGS misclassify a considerable proportion of children from all ethnic groups as stunted in the first 6 months of life. Underweight and wasting are considerably overestimated in Surinamese Asian Indian children. Ethnic-specific growth references are recommended for Surinamese Asian Indian and Dutch children. The considerable differences found between South Asian subpopulations requires further research.

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Standards or References: A Central Question for Growth Monitoring?

Cited by 7 publications

References 13 publications

A big-data approach to producing descriptive anthropometric references: a feasibility and validation study of paediatric growth charts

A big-data approach to producing descriptive anthropometric references: a feasibility and validation study of paediatric growth charts

Are selection criteria for healthy pregnancies responsible for the gap between fetal growth in the French national Elfe birth cohort and the Intergrowth‐21st fetal growth standards?

Misclassification of stunting, underweight and wasting in children 0–5 years of South Asian and Dutch descent: ethnic-specific v. WHO criteria

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