Noemí López-Ejeda

Weight and height percentiles calculated by the LMS method in Argentinean schoolchildren. A comparative references study

Abstract Background: The Argentinean population is characterized by ethnic, cultural and socio-economic diversity. Aim: To calculate the percentiles of weight-for-age (W/A) and height-for-age (H/A) of schoolchildren from Argentina employing the LMS method; and to compare the obtained percentiles with those of the international and national references. Subjects and methods: Anthropometric data of 18 698 students (8672 girls and 10 026 boys) of 3–13 years old were collected (2003–2008) from Buenos Aires, Catamarca, Chubut, Jujuy, La Pampa and Mendoza. Percentiles of W/A and H/A were obtained with the LMS method. Statistical and graphical comparisons were established with the WHO (international reference) and with that published by the Argentinean Paediatric Society (national reference). Results: Differences in W/A and H/A, regarding the references, were negative and greater at the highest percentiles and in most of the age groups. On average, the differences were greater for boys than girls and for national than international references. Conclusion: The distribution of weight and height of schoolchildren, coming from most regions of the country, differs from those of national and international references. It should be advisable to establish a new national reference based on internationally recognized methodological criteria that adequately reflect the biological and cultural diversity of the Argentinean populations.

UTILIDAD DE LOS DATOS ANTROPOMÉTRICOS AUTO-DECLARADOS PARA LA EVALUACIÓN DE LA OBESIDAD EN LA POBLACIÓN ESPAÑOLA; ESTUDIO EPINUT-ARKOPHARMA

INTRODUCTION Epidemiological studies frequently use weight and height collected by questionnaires, but the inaccuracy of self-reported data may bias the evaluation result. The aim of this study is to validate the self-report in Spanish adult population emphasizing the effect of age and nutritional status of the subjects. METHODS The sample consist of 9,294 adults (8,072 women and 1,222 men) recruited from dietetic counselling centers dependents of Arkopharma laboratories in 46 Spanish provinces. Weight and height were asked and subsequently measured, calculating differences between self-reported and real parameters. Error in the estimation of body mass index (BMI) was evaluated considering the effect of age and nutritional status (T-test and multiple linear regression). Correlation between the classification based on self-reported BMI and anthropometric was analyzed using the Kappa test. RESULTS AND DISCUSSION Using the self-reported data, BMI was underestimated (2.62% in men, 3.10% in women). The error increases with age and extreme nutritional categories. The agreement between self-reported and real BMI in the nutritional assessment was good and correctly classified 74.71% of the males and 89.5% of women (Kappa: 0.695 and 0.782 respectively). CONCLUSIONS Considering the effect of age and nutritional status on the self-awareness of body size, we recommend caution in the use of questionnaires for epidemiological assessment.

High Blood Pressure and Diet Quality in the Spanish Childhood Population

The objective is to analyze the association between the degree of compliance with Mediterranean Diet and blood pressure in 1078 Spanish schoolchildren (514 boys, 564 girls) aged 9 to 16 years. We measured weight (kg), height (cm), waist circumference (cm), skinfold thicknesses (bicipital, tricipital, subscapular and suprailiac) and blood pressure. The Waist-to-Height Ratio (WtHR), Body Mass Index (BMI), and the percent body fat (%BF) were calculated. Subjects were classified as “underweight”, “normal weight”, “overweight” or “obese” according to the International Obesity Task Force (IOTF). Diet quality was assessed by the KIDMED Index and the hypertensive status according to National High BP Education Program Working Group. Results show that media values of systolic and diastolic blood pressure significantly increase at the same time that diminished the quality of the diet. Schoolchildren with high blood pressure (4.66% boys; 4.78% girls) are not distributed uniformly in the different KIDMED categories. In the “poor” diet category (KIDMED-score 7). A multiple linear regression analysis found that KIDMED index had a negative correlation with systolic and diastolic pressure. Also BMI and WtHR were positively correlated with both blood pressure levels, and % BF was associated only with diastolic BP. In conclusion, although the KIDMED index is a fast and simple tool to assess diet quality, it clearly reveals an inverse association between adherence to Mediterranean diet and blood pressure in healthy Spanish schoolchildren.

Influence of malnutrition upon all-cause mortality among children in Swaziland

OBJECTIVE To analyze the effect of the type of malnutrition, sex, age and the presence of edema upon all-cause mortality in children under 5 years of age. MATERIAL AND METHODS A cross-sectional study was conducted during 2010 and 2011 in Swaziland. Sex, age, weight and height were taken to classify nutritional status according to the 2006 WHO growth standards: stunting (low height for age), wasting (low weight for height or low body mass index for age) and underweight (low weight for age). The sample (309 boys and 244 girls under 5 years of age) was analyzed by sex and age groups (under and equal/over 12 months). The association between variables was evaluated using the χ2 test. Cox regression analysis (HR, 95% CI) was used to assess the likelihood of mortality. RESULTS The mortality risk in malnourished children under one year of age was lower among females and increased in the presence of severe edema. Wasting combined with underweight increased the mortality risk in children under 12 months of age 5-fold, versus 11-fold in older children. The combination of stunting, wasting and underweight was closely associated to mortality. Stunting alone (not combined with wasting) did not significantly increase the mortality risk. CONCLUSIONS Sex, severe edema and wasting are predictors of mortality in malnourished children. Regardless of these factors, children with deficiencies referred to weight for height and weight for age present a greater mortality risk in comparison with children who present stunting only.

Anthropometric parameters in screening for excess of adiposity in Argentinian and Spanish adolescents: evaluation using receiver operating characteristic (ROC) methodology

Abstract Background: Various anthropometric parameters have been proposed for defining overweight in adolescence, but few studies have evaluated their diagnostic accuracy in comparative terms, using samples from different regions. Aim: To compare the performance of anthropometric parameters in determining the excess of adiposity in Argentinian and Spanish adolescents. Subjects and methods: The sample is composed of 1781 Argentinian and 1350 Spanish subjects, aged 12–17 years. Excess adiposity was defined as percentage BF in the 90th percentile or higher. ROC curves established the validity of parameters to define excess adiposity. Results: Descriptive statistics showed differences between the Argentinian and Spanish samples. ROC curves indicate that all the parameters analysed had, in the Spanish and Argentinian samples, a positive and elevated association with excess of adiposity. The waist-to-height ratio had the highest value of the area under ROC curve (AUC), while conicity index and waist-to-hip ratio had the lowest. Conclusions: Differences exist with respect to size and body composition between the Argentinian and Spanish samples. ROC curves reflect a general pattern of variation. Waist-to-hip ratio and conicity index are less desirable in the diagnosis of excess adiposity and the most desirable is waist-to-height ratio.

Development of subcutaneous fat in Spanish and Latin American children and adolescents: Reference values for biceps, triceps, subscapular and suprailiac skinfolds

Subcutaneous fat skinfolds represent a reliable assessment instrument of adiposity status. This study provides current percentile references for four subcutaneous skinfolds (biceps, triceps, subscapular, suprailiac) applicable to children and adolescents in Spain and in Latin American countries where data are scarce. The design consisted of a cross-sectional multicenter study performed with identical methods in 5 countries (Argentina, Cuba, Mexico, Spain and Venezuela). Total sample comprised 9163 children and youths (boys 4615 - girls 4548) aged 6-18 years, healthy and without apparent pathologies. Percentiles 3, 5, 10, 25, 50, 75, 90, 95 and 97 were calculated by the LMS method. Sexual dimorphism was assessed using the t-test and age differences with ANOVA. Normalized growth percentile references were obtained according to sex and age for each skinfold. The mean values of four skinfolds were significantly greater in girls than boys (p<0.001) and, in both sexes, all skinfolds show statistical differences through age (p<0.001) with different magnitudes. Except triceps in girls, peaks between 11 and 12 years of age are more noticeable in boys than in girls. Although the general model of growth is known, the skinfold measurements show variability among populations and differences of magnitude are presented according to the analyzed population. Therefore, these age and sex-specific reference percentile values for biceps, triceps, subscapular and suprailiac skinfolds, derived from a large sample of Spanish and Latin American children and adolescents, are a useful tool for adiposity diagnosis in this population for which no reference values were available.

Prevalence of the Metabolically Healthy Phenotype in Overweight and Obese Spanish Adults

The EPINUT research group (reference 920325) at the Universidad Complutense de Madrid conducts research into the links between obesity and cardiovascular risk in Spain, in partnership with Arkopharma Pharmaceutical laboratories and the Spanish Society of Dietetics and Food Sciences (Sociedad Española de Dietética y Alimentación [SEDCA]). Here we present preliminary data on the prevalence of metabolic syndrome components and the ‘‘metabolically healthy’’ phenotype in a large population of adults with overweight or obesity. Cross-sectional data were collected from 7972 study participants (6683 women and 1289 men) with a body mass index (BMI) 25. Participants were aged 18 to 74 years and were recruited by Arkopharma dieticians during consultations at 137 locations distributed across 47 of the 50 Spanish provinces. Recruitment took place between January 15, 2013 and February 15, 2014, and the study population represents 85.50% of patients treated in this period. The study was conducted in compliance with the Declaration of Helsinki. For each participant, measurements were taken of body height (cm), body mass (kg), and waist circumference (cm), and BMI (body mass in kg divided by the square of body height in m) and the waist-to-height ratio were calculated. Hypertension, hyperglycemia, and hypercholesterolemia were assessed from blood pressure, serum glucose, and serum cholesterol recordings according to International Diabetes Federation criteria. Participants were also considered to have these metabolic syndrome components if they were taking specific medication to control them. Participants with normal values for these parameters were considered metabolically healthy. Study participants were classified according to age (18-24, 25-34, 35-44, 45-54, 55-64, and 65-74 years) and BMI range (overweight: BMI 25.0-29.9 kg/m; grade-1 obesity: BMI 30.034.9 kg/m; grade-2 obesity: BMI 35.0-39.9 kg/m; grade-3 obesity: BMI > 39.9 kg/m). Between-category comparisons were made with Student’s t test and the ANOVA and chi-square tests, using SPSSv.21.0. Within the study population, 50.1% of men and 42.5% of women were hypertensive ( 130/85 mmHg). The figures were similar for hypercholesterolemia, which affected 47.3% of men (high-density lipoprotein cholesterol <40 mg/dL) and 42.3% of women (highdensity lipoprotein cholesterol < 50 mg/dL). Elevated fasting glucose ( 100 mg/dL) was recorded in 25.5% of men and 20% of women. For all 3 of these metabolic syndrome components, differences were statistically significant (P < .001) between the youngest participants (18-24 years) and the oldest (65-74 years). The prevalence of the metabolically healthy phenotype declined significantly with obesity grade (P < .001) and was higher for women in all BMI categories (P < .001) (Table 1). The overall proportion of metabolically healthy obese participants (31.7%) was similar to that reported in a series of 11 520 Spanish adults (28.9%). Among male participants, 27.1% had only 1 metabolic syndrome component, 17.5% had 2, and 7.4% had all 3 (hypertension, hypercholesterolemia, and hyperglycemia). A lower proportion of women had metabolic-syndrome components (P < .05): 24.9% had 1 component, 12.5% had 2, and 4.7% had all 3. Table 2 shows the relationship between the number of metabolic syndrome components and age category. The proportion of metabolically healthy participants declined with age, and the decline was particularly notable from the age of 45 years. The instability of healthy obesity was highlighted by an 11-year study of 1051 participants aged 18 to 65 years in Pizarra (Málaga, Spain), which showed the importance of considering how long an individual has been overweight. Further important information came from a 20-year study of 2561 adults in the UK aged 19 to 62 years; by the end of the study, half of the obese participants who initially had no other risk factors had developed a metabolic Rev Esp Cardiol. 2016;69(2):216–228

Migration and nutritional status of Tarahumara schoolchildren from Chihuahua State (México)

The Tarahumara ethnic group is composed of indigenous people from the Sierra Madre Occidental of Mexico. Conditions of isolation and poverty compel them to migrate to the city in search of better opportunities. This work aims to explore the influence of migration on the growth and nutritional status of Tarahumara schoolchildren.

SUBSCAPULAR AND TRICEPS SKINFOLDS REFERENCE VALUES OF HISPANIC AMERICAN CHILDREN AND ADOLESCENTS AND THEIR COMPARISON WITH THE REFERENCE OF CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC).

INTRODUCTION the assessment of the skinfold thickness is an objective measure of adiposity. Therefore, it is a useful tool for nutritional diagnosis and prevention of metabolic risk associated with excess fat in chilhood and adolescence. OBJECTIVE to provide percentiles of subscapular and triceps skinfolds for Hispanic American schoolchildren and compare them with those published by the Centers for Disease Control and Prevention (CDC) from United States, that it have been commonly used as a reference in most of these countries. METHODS subscapular and triceps skinfolds were measured in 9.973 schoolchildren 4-19 aged from Spain, Argentina, Cuba, Venezuela and Mexico with Holtain caliper with 0.2 mm accuracy. Percentiles were obtained with the LMS statistical method and were presented in tables divided in stages of 6 months and in curves graphics. The difference between Hispanic American and CDC mean values were provided for P3, P50 and P97 in mm and also were graphically represented. RESULTS skinfolds measurements obviously increased with age in both sexes but, in boys, this increase is much more marked in highest percentiles between 8 and 13 years; this maximum is reached earlier than what occurs in CDC reference. In both sexes, all percentiles analized in Hispanic American schoolchildren were higher than the CDC reference except P97 up to 10 or 13 years that was notably smaller. CONCLUSIONS the skinfolds percentiles of Hispanic American children and adolescents differ from CDC that are usually used as reference. The values of subscapular and triceps skinfolds provided in this study, could be applied to populations of a similar ethnic background, especially in comparative studies of body composition.