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In summary, as a rule, increased BMI at the time of the AR mainly reflects an increase in fat rather than lean mass. Current definition of childhood obesity Different growth references Several growth curves are available to define grades of nutritional status 1 , mainly the IOTF 65 , and Cole et al. The WHO growth curves are described in another chapter in the present book. Clarification on the definitions of nutritional status in children was published by the ECOG in 1.
The following recommendations were proposed: 1. Additional definitions CDC and national references could also be used in order to provide more opportunities of comparisons of prevalence between studies; 3.
Use WHO standards years and references years in clinical studies involving growth assessment to improve comparability between results; 4. Always state explicitly the definition used and use the exact terms corresponding to each definition, clearly stating whether or not the term overweight includes obesity and specify which definition is used to assess weight deficit; 5. Whenever possible, perform additional body measurements, including arm and waist circumferences, skinfolds and bioelectrical impedance analysis; 6.
Perform anthropometric measurements according to standardized procedures. Terminology A consensus for the use of a single reference seems difficult to obtain, but there is another important issue which could be more easily solved. ECOG recommends using the exact terms corresponding to each definition.
Because of the inconsistency of existing terminologies for defining levels of overweight, ambiguous information is frequently encountered in the literature. This prevalence includes all children with a BMI greater than the centile curve that matches the value of 25 at 18 years. CDC growth charts Adv Data 69 Conclusion Assessment of nutritional status is essential for clinical, epidemiological and research purposes. Precise methods of body composition such as DEXA become more commonly used, but a suitable method to define grades of nutritional status should use indicators based on more easily available measurements.
They also must predict body fat and risk factors. With respect to these different aspects, the BMI appears to be a good indicator of adiposity in children. However, using additional methods to assess body composition is recommended to improve the interpretation of BMI measurements.
Growth references are necessary for defining nutritional status in children. A single reference should be desirable, but in the absence of such consensus it is particularly important to be informed on the suitable indicators to be selected, the instruction for their use and for their interpretation.
Improvement of knowledge of the definition of nutritional status will make inter-study comparisons more valid, and help identify factors responsible for the high rate of childhood obesity.
References Rolland-Cachera MF. Childhood obesity: current definitions and recommendations for their use. Int J Pediatr Obes ; Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med ; Definition of chronic energy deficiency in adults.
Eur J Clin Nutr ; World Health Organisation. Garrow J. Edinburgh: Churchill Livingstone.
Measurements and definition. Cambridge University Press , pp Anthropometric reference data for international use: recommendations from a World Health Organisation expert commitee.
Am J Clin Nutr ; Parizkova J. Total body fat and skinfold thickness in children. Clin Exper ; Grading body fatness from limited anthropometric data. Lohman TG. The applicability of body composition techniques and constants for children and youths. Exerc Sport Sci Rev ; Prediction of intraabdominal and subcutaneous abdominal adipose tissue in healthy pre-pubertal children. Int J Obes ; Which measure of body fat distribution is best for epidemiolologic research among adolescents?
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Am J Epidemiol ; Himes JH. Alteration in distribution of body fat tissue in response to nutritional intervention. Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int J Obesity ; Goran MI. Visceral fat in prepubertal children: influence of obesity, anthropometry, ethnicity, gender, diet, and growth.
Am J Hum Biol Arm anthropometry in nutritional assessment: normogram for rapid calculation of muscle circumference and cross sectional muscle and fat areas. Fat areas as estimates of total body fat. Arm muscle plus bone area: anthropometry and CAT scan compared.
Relation of body fat distribution to hyperinsulinemia in children and adolescents: the Bogalusa heart study. Umbilical waist-to-height ratio and trunk fat mass index DXA as markers of central adiposity and insulin resistance in Argentinean children with a family history of metabolic syndrome. J Pediatr Endocrinol Metab ; Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children.
J Pediatr ; Abdominal obesity in German adolescents defined by waist-to-height ratio and its association to elevated blood pressure: the KiGGS study. Obes Facts ; WHO Child Growth. Acta Paediatr Suppl ; Adiposity indices in children.
Cole TJ. Weight-Stature indices to measure underweight, overweight, and obesity. In Himes JH ed. Anthropometric assessment of nutritional status.
Body composition during adolescence: methods, limitations and determinants. Horm Res. Application of weight-height ratios and body indices to juvenile populations.
The utility of body mass index as a measure of body fatness in children and adolescents: differences by age, gender. Pediatrics ; Body mass index as a measure of adiposity among children and adolescents: a validation study. Comparison of weight- and height-based indices for assessing the risk of death in severely malnourished children. Some re-evaluations of the built and blood pressure study as related to ponderal index, somatotype and mortality. New Engl J Med ; Use of the body mass index BMI as a measure of overweight in children and adolescents.
Long term morbidity and mortality of overweight adolescents — a follow-up of the Harvard group study of to Childhood obesity and cardiovascular mortality: a y follow-up study based on the Boyd Orr cohort. The growth of adipose tissue in children and adolescents.
Cross sectional and longitudinal studies of adipose cell number and size. J Clin Invest ; Nutrition, growth, development and maturation. Androgyny in fat patterning is associated with obesity in adolescents and young adults.
Ann Hum Biol ; Weight and age at menache. Arch Dis Child ; Adult stature and risk of cancer.
Cancer Res ; Ann Hum Biol , Predicting obesity in young adulthood from childhood and parental obesity. Diabetologia ; N Engl J Med ; The lancet Cole TJ: Children grow and horses race: is the adiposity rebound a critical period for later obesity?
BMC Pediatr ; Growth trajectories associated with adult obesity. Massively obese adolescents were of normal weight at the age of adiposity rebound. Obesity Silver Spring ; Obes Res ; Is the adiposity rebound a rebound in adiposity?
Int J Pediatr Obes ;6 :e Adiposity rebound and the development of metabolic syndrome. Pediatrics ;e Williams S, Dickson N. Early growth, menarche and adiposity rebound. Lancet ; Early adiposity rebound and the risk of adult obesity. Pediatrics ;E5. Association of nutrition in early life with body fat and serum leptin at adult age. Int J Obes Lond ; Adiposity in Czech children followed from one month of age to adulthood: analysis of individual BMI patterns.
Int J Pediatr Obes ;6:e Early adiposity rebound: causes and consequences for obesity in children and adults. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ ; Body mass index cut offs to define thinness in children and adolescents: international survey.
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Acta Paediatr Suppl ; Like obesity, they are associated with increased health risks 19, Car Ingman. Then "How to Grow Taller" is the best solution ever for you. On the other hand hyperinsulinemia was found to be associated with advanced bone age BA in obese children 7 so it also active in modulation of skeletal growth in humans.
However, using additional methods to assess body composition is recommended to improve the interpretation of BMI measurements.
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