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Growth and Metabolism > Childhood growth > Flashcards

Childhood growth Flashcards

1
Q

Define growth:

A

change in body size over time (height, weight, BMI)

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2
Q

How would you plot and label a growth chart?

A

growth rate/velocity = slope of line
time = x-axis
size = y-axis

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3
Q

Why is growth the unique paediatric indicator of well-being?

A

it monitors child endocrine, nutritional, emotional and physical health

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4
Q

Who published the first growth curve, and when?

A

Le Comte de Montbeillard (for his son), in 1777

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5
Q

Why should we assess growth?

A
  • identify abnormal growth
  • specify a growth disorder
  • proxy for general ill health
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6
Q

What are the growth assessment principles?

A
  1. Purpose to distinguish abnormal from normal
  2. Needs high quality measurement (training, calibration, quality control)
  3. Correct recording (chart plotting and interpretation)
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7
Q

What is a centile?

A

percentage point of the frequency distribution

e.g. cut-off that identifies that percentage of children with measurements below it

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8
Q

What must be made sure of centiles and SD scores?

A
  • normally distributed

- each centile corresponds to number of SDs above/below the mean (SD score = z-score)

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9
Q

In a growth distance and velocity chart, what does “current size” indicate?

A

distance travelled

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10
Q

In a growth distance and velocity chart, what does “centiles crossing” indicate?

A

velocity of travel

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11
Q

When the growth chart quantifies size/distance, we say it is….

A

centile

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12
Q

When the growth chart does not quantify growth velocity, we say it is….

A

centile crossing uncalibrated

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13
Q

What is the nine centile format?

A

improved cut-offs for screening (2nd and 0.4th centile replace 3rd centile)

  • pick up rate of different screening strategies in this
  • clear recommendation for referral
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14
Q

Let’s say you’re looking at child growth, the 3rd centile would pick up how much % of children?

A

3% (1 in 33)

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15
Q

Let’s say you’re looking at child growth, the 2nd centile would pick up how much % of children?

A

2.3% (1 in 44)

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16
Q

Let’s say you’re looking at child growth, the 0.4th centile would pick up how much % of children?

A

0.4% (1 in 260)

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17
Q

What is the aim in, lets say, constructing growth charts?

A

to define weight distribution at each age

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18
Q

What 3 things could be noted from constructing growth charts?

A
  • skewness
  • nonlinear age trend
  • variability changes with age
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19
Q

Who came up with the LMS method?

A

Cole, 1998

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20
Q

What is the LMS method?

A
  • splits data into narrow age groups

- summarises skew weight distribution in each group

21
Q

What are the variables in LMS method?

A
  • Power transform λ
  • mean μ
  • coefficient of variation σ
22
Q

Why is it called LMS method?

A 
L = curve for λ
M = curve for μ
S = curve for σ
23
Q

What is the formula for the LMS method

A

Centile(100α) =M x (1+LSzα)^(1/L)

24
Q

What is the formula for SD score from LMS method?

A

SD score = (measurement /M)^(L) − 1 DIVIDED BY (LS)

25
Q

Who came up with Cole-green LMS method?

A

peter green, 1988

26
Q

Why was the Cole-green method formulated?

A

proposed to use maximum penalised likelihood to improve LMS method

  • elegantly avoids arbitrary age groupings
  • now the STANDARD METHOD
27
Q

How many countries use LMS method?

A

40

28
Q

What did the British 1990 chart include?

A
  • Weight
  • Height/length
  • BMI
  • Head circumference
  • waist circumference
29
Q

What did the Personal Child Health Record (PCHR) include?

A
  • weight
  • length/height
  • head circumference
30
Q

what is the diff between growth reference and growth standard?

A 
reference = shows how children DO growth
standard = shows how children SHOULD grow, based on healthy reference population
31
Q

When did WHO publish the current growth standard?

A

2006

32
Q

What does the WHO growth standard include?

A
  • sample breast-fed infant and children of non-smoking, non-deprived mothers from six countries (USA, norway, india, ghana, brazil, oman)
  • very similar linear growth patterns in all centres
  • chart describes optimal not average growth
  • suitable for all children
33
Q

What does the length graph of the WHO standard growth show?

A
  • similar length across sites

- growth potential is independent of ethnicity

34
Q

What is the comparison of the British 1990 and the WHO standard weight chart for breast-fed infants?

A

British = 50:50 breast-fed and formula-fed infants

WHO = entirely on breast-fed infants

35
Q

What explains both relevance and irrelevance of using British 1990 charts?

A
  • for height, it’s accurate for current children
  • little sign of secular trend
  • for weight, and BMI, it’s out of date though
  • and the centiles for weight and BMI no longer feasible on any chart
36
Q

What does the UK-WHO chart development include?

A
  • WHO charts from age 2 weeks to 4 years
  • continues using British 1990 from age 4-20 years and birth and pre-term data
  • RCPCH design charts and produce educational materials
  • developed by expert group and tested in focus groups of staff and parents
37
Q

What is obesity again?

A

form of abnormal growth, malnutrition

- excess body fat

38
Q

What is used to measure fat?

A

simple anthropometry

  • weight
  • weight for height
  • BMI
  • waist circumference
39
Q

What is the purpose of BMI chart?

A

important for both clinical and public health

40
Q

What are the centiles used in the BMI chart?

A
  • 91st and 98th centile as the clinical cut-off
  • 85th and 95th for public health monitoring (but this is not on the chart)
    (P.s. IOTF international cut-offs for overweight and obesity included)
41
Q

What does the waist circumference chart include and exclude?

A
  • BMI ignores body composition (weight shifting between muscle and fat not detected)
  • waist circumference useful measure of abdominal fat (subcutaneous and internal)
42
Q

What initially happened in the child BMI history?

A
  • all the definitions of obesity from published papers had varying specification reference sample and centile cut-off
  • cannot compare across studies
  • hence NEED UNIFYING INTERNATIONAL REFERENCE
43
Q

What is the proposal of the International Obesity Task Force (IOTF)?

A
  • use BMI centiles to assess childhood overweight/obesity
  • centiles to pass through 25-30kg/m2 at 18yo
  • pool centiles from 6 large national surveys (brazil, britain, netherlands, hong kong, singapore, USA)
44
Q

What was the outcome for IOTF?

A
  • established standard definition for child overweight and obesity
  • body mass index cut-off to define thinness
  • BMI made cut-offs for thinness, overweight, and obesity
45
Q

What did the national child measurement programme include?

A
  • BMI of children in reception age 4-5 and year 6 (age 10-11)
  • assessed using 91st and 98th british 1990 centiles
  • parents told if child overweight/obese
46
Q

Why should childhood obesity be monitored?

A
  • prevalence high and strong
  • BMI and waist charts becoming out of date
  • charts need to be frozen so cut-off does not rise which prevalence
  • childhood fatness is a poor predictor of adult fatness
  • little value in targetting individuals unless severely obese
  • high BMI itself insufficient reason for obesity referral
47
Q

What is the mean age at peak height of the modelling height puberty chart?

A

12-14 years

48
Q

Why is the SITAR used to model growth curves?

A

adjust size, timing, and rate of puberty to superimpose individual curves

  • summaries the chaos of pubertal growth in just 3 parameters per child
  • efficiently estimates mean growth curve
  • useful for life course studies to relate early growth to later adverse outcome

Growth and Metabolism (12 decks)

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