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1.  Identifying the best body mass index metric to assess adiposity change in children 
Archives of Disease in Childhood  2014;99(11):1020-1024.
Objective
Although dual-energy X-ray absorptiometry (DEXA) is the preferred method to estimate adiposity, body mass index (BMI) is often used as a proxy. However, the ability of BMI to measure adiposity change among youth is poorly evidenced. This study explored which metrics of BMI change have the highest correlations with different metrics of DEXA change.
Methods
Data were from the Quebec Adipose and Lifestyle Investigation in Youth cohort, a prospective cohort of children (8–10 years at recruitment) from Québec, Canada (n=557). Height and weight were measured by trained nurses at baseline (2008) and follow-up (2010). Metrics of BMI change were raw (ΔBMIkg/m2), adjusted for median BMI (ΔBMIpercentage) and age-sex-adjusted with the Centers for Disease Control and Prevention growth curves expressed as centiles (ΔBMIcentile) or z-scores (ΔBMIz-score). Metrics of DEXA change were raw (total fat mass; ΔFMkg), per cent (ΔFMpercentage), height-adjusted (fat mass index; ΔFMI) and age-sex-adjusted z-scores (ΔFMz-score). Spearman's rank correlations were derived.
Results
Correlations ranged from modest (0.60) to strong (0.86). ΔFMkg correlated most highly with ΔBMIkg/m2 (r = 0.86), ΔFMI with ΔBMIkg/m2 and ΔBMIpercentage (r = 0.83–0.84), ΔFMz-score with ΔBMIz-score (r = 0.78), and ΔFMpercentage with ΔBMIpercentage (r = 0.68). Correlations with ΔBMIcentile were consistently among the lowest.
Conclusions
In 8–10-year-old children, absolute or per cent change in BMI is a good proxy for change in fat mass or FMI, and BMI z-score change is a good proxy for FM z-score change. However change in BMI centile and change in per cent fat mass perform less well and are not recommended.
doi:10.1136/archdischild-2013-305163
PMCID: PMC4215345  PMID: 24842797
2.  Blood pressure centiles for Great Britain 
Archives of Disease in Childhood  2006;92(4):298-303.
Objective:
To produce representative cross-sectional blood pressure reference centiles for children and young people living in Great Britain.
Design:
Analysis of blood pressure data from seven nationally representative surveys: Health Surveys for England 1995–8, Scottish Health Surveys 1995 and 1998, and National Diet & Nutrition Survey 1997.
Methods:
Blood pressure was measured using the Dinamap 8100 with the same protocol throughout. Weight and height were also measured. Data for 11 364 males and 11 537 females aged 4–23 years were included in the analysis, after excluding 0.3% missing or outlying data. Centiles were derived for systolic, diastolic, mean arterial and pulse pressure using the lambda-mu-sigma (LMS) equations method.
Results:
Blood pressure in the two sexes was similar in childhood, rising progressively with age and more rapidly during puberty. Systolic pressure rose faster and was appreciably higher in adult men than in adult women. After adjustment for age, blood pressure was related more to weight than height, the effect being stronger for systolic blood pressure. Pulse pressure peaked at 18 years in males and 16 years in females.
Conclusions:
These centiles increase our knowledge of blood pressure norms in contemporary British children and young people. High blood pressure for age should be defined as blood pressure above the 98th centile, and high-normal blood pressure for age as blood pressure between the 91st and 98th centiles. The centiles identify children and young people with increased blood pressure, and will be of benefit to both clinical practice and research.
doi:10.1136/adc.2005.081216
PMCID: PMC2083671  PMID: 16905566
3.  Regional differences in overweight: an effect of people or place? 
Archives of disease in childhood  2007;93(5):407-413.
Objective:
To examine UK country and regional differences, within England only, in childhood overweight (including obesity) at three years and determine whether any differences persist after adjustment for individual risk factors.
Design:
Nationally representative prospective study
Setting:
England, Wales, Scotland, and Northern Ireland
Participants:
13 194 singleton children from the UK Millennium Cohort Study with height and weight data at age three years.
Main outcome measure:
Overweight (including obesity) was defined by the International Obesity TaskForce cut-offs for body mass index, which are age and sex specific.
Results:
At three years, 23.0% (3102) of children were overweight or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95% Confidence Interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be overweight than children from England. There were no differences in overweight between children from Scotland and England. Within England, children from the East (0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be overweight than children from London. There were no differences in overweight between children from other English regions and children from London. These differences were maintained after adjustment for individual socio-demographic characteristics and other risk factors for overweight.
Conclusions:
UK country and English regional differences in early childhood overweight are independent of individual risk factors. This suggests a role for policies to support environmental changes that remove barriers to physical activity or healthy eating for young children.
doi:10.1136/adc.2007.128231
PMCID: PMC2679152  PMID: 18089633
obesity; preschool children; public policy
4.  Ethnic and sex differences in skeletal maturation among the Birth to Twenty cohort in South Africa 
Archives of Disease in Childhood  2014;100(2):138-143.
Aim
To examine ethnic and sex differences in the pattern of skeletal maturity from adolescence to adulthood using a novel longitudinal analysis technique (SuperImposition by Translation And Rotation (SITAR)).
Setting
Johannesburg, South Africa.
Participants
607 boys and girls of black as well as white ethnicity from the Birth to Twenty bone health study, assessed annually from 9 to 20 years of age.
Outcome measure
Bone maturity scores (Tanner–Whitehouse III radius, ulna, and short bones (TW3 RUS)) assessed longitudinally from hand-wrist radiographs were used to produce individual and mean growth curves of bone maturity and analysed by the SITAR method.
Results
The longitudinal analysis showed that black boys matured later by 7.0 SE 1.6 months (p<0.0001) but at the same rate as white boys, whereas black girls matured at the same age but at a faster rate than white girls (by 8.7% SE 2.6%, p=0.0007). The mean curves for bone maturity score consistently showed a midpubertal double kink, contrasting with the quadratic shape of the commonly used reference centile curves for bone maturity (TW3).
Conclusions
Skeletal maturity was reached 1.9 years earlier in girls than boys, and the pattern of maturation differed between the sexes. Within girls, there were no ethnic differences in the pattern or timing of skeletal maturity. Within boys, however, skeletal maturity was delayed by 7 months in black compared with white ethnicity. Skeletal maturation, therefore, varies differentially by sex and ethnicity. The delayed maturity of black boys, but not black girls, supports the hypothesis that boys have greater sensitivity to environmental constraints than girls.
doi:10.1136/archdischild-2014-306399
PMCID: PMC4316919  PMID: 25409981
Adolescent Health; Growth
5.  Blood pressure centiles for Great Britain 
Archives of Disease in Childhood  2006;92(4):298-303.
Objective
To produce representative cross‐sectional blood pressure reference centiles for children and young people living in Great Britain.
Design
Analysis of blood pressure data from seven nationally representative surveys: Health Surveys for England 1995–8, Scottish Health Surveys 1995 and 1998, and National Diet & Nutrition Survey 1997.
Methods
Blood pressure was measured using the Dinamap 8100 with the same protocol throughout. Weight and height were also measured. Data for 11 364 males and 11 537 females aged 4–23 years were included in the analysis, after excluding 0.3% missing or outlying data. Centiles were derived for systolic, diastolic, mean arterial and pulse pressure using the latent moderated structural (LMS) equations method.
Results
Blood pressure in the two sexes was similar in childhood, rising progressively with age and more rapidly during puberty. Systolic pressure rose faster and was appreciably higher in adult men than in adult women. After adjustment for age, blood pressure was related more to weight than height, the effect being stronger for systolic blood pressure. Pulse pressure peaked at 18 years in males and 16 years in females.
Conclusions
These centiles increase our knowledge of blood pressure norms in contemporary British children and young people. High blood pressure for age should be defined as blood pressure above the 98th centile, and high‐normal blood pressure for age as blood pressure between the 91st and 98th centiles. The centiles identify children and young people with increased blood pressure, and will be of benefit to both clinical practice and research.
doi:10.1136/adc.2005.081216
PMCID: PMC2083671  PMID: 16905566
6.  Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards: a secondary data analysis 
Archives of Disease in Childhood  2011;96(11):1008-1013.
Objectives
To determine wasting prevalence among infants aged under 6 months and describe the effects of new case definitions based on WHO growth standards.
Design
Secondary data analysis of demographic and health survey datasets.
Setting
21 developing countries.
Population
15 534 infants under 6 months and 147 694 children aged 6 to under 60 months (median 5072 individuals/country, range 1710–45 398). Wasting was defined as weight-for-height z-score <−2, moderate wasting as −3 to <−2 z-scores, severe wasting as z-score <−3.
Results
Using National Center for Health Statistics (NCHS) growth references, the nationwide prevalence of wasting in infant under-6-month ranges from 1.1% to 15% (median 3.7%, IQR 1.8–6.5%; ∼3 million wasted infants <6 months worldwide). Prevalence is more than doubled using WHO standards: 2.0–34% (median 15%, IQR 6.2–17%; ∼8.5 million wasted infants <6 months worldwide). Prevalence differences using WHO standards are more marked for infants under 6 months than children, with the greatest increase being for severe wasting (indicated by a regression line slope of 3.5 for infants <6 months vs 1.7 for children). Moderate infant-6-month wasting is also greater using WHO, whereas moderate child wasting is 0.9 times the NCHS prevalence.
Conclusions
Whether defined by NCHS references or WHO standards, wasting among infants under 6 months is prevalent in many of the developing countries examined in this study. Use of WHO standards to define wasting results in a greater disease burden, particularly for severe wasting. Policy makers, programme managers and clinicians in child health and nutrition programmes should consider resource and risk/benefit implications of changing case definitions.
doi:10.1136/adc.2010.191882
PMCID: PMC3195296  PMID: 21288999

Results 1-6 (6)