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Title: Weighing in on international growth standards: Testing the case in Australian preschool children.Authors: Cassandra L. Pattinson1,2, Sally L. Staton1,2, Simon S. Smith1,3, Stewart G. Trost1, 4, Emily Sawyer5, Karen J. Thorpe1,21Institute for Health and Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, Queensland, Australia. 2School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia.3Recover Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia.4School of Exercise and Nutrition Sciences, Centre for Children’s Health Research, Queensland University of Technology, Queensland, Australia.5School of Medicine and Dentistry, James Cook University, Queensland, Australia. Key Words (3-4): Preschool, Body Mass Index, World Health Organisation, Growth StandardsRunning Title: Weighing in on international growth standardsAcknowledgments: The sampling derives from an Australian longitudinal cohort study of ECEC effectiveness, Effective Early Educational Experiences for Children (E4Kids). E4Kids is a project of the Melbourne Graduate School of Education at The University of Melbourne and is conducted in partnership with the Queensland University of Technology. E4Kids is funded by the Australian Research Council Linkage Projects Scheme (LP0990200), the Victorian Government Department of Education and Early Childhood Development, and the Queensland Government Department of Education and Training. E4Kids is conducted in academic collaboration with the University of Toronto Scarborough, the Institute of Education at the University of London and the Royal Children’s Hospital in Melbourne. The E4Kids team would like to sincerely thank the ECEC services, directors, teachers/staff, children and their families for their participation in this study. We also thank Christopher Jennings for his assistance in the development of Figure 1. Address of Corresponding Author: Cassandra L. Pattinson, Centre for Children’s Health Research (CCHR), Level 5, 62 Graham Street, South Brisbane, Queensland University of Technology, QLD, 4101, Australia. Email: cassandra.pattinson@qut.edu.auPotential Conflicts: The authors have no conflicts of interest to declare. Abstract Overweight and obesity in preschool-aged children is a major health concern. Accurate and reliable estimates of prevalence are necessary to direct public health and clinical interventions. There are currently three international growth chart standards used to determine prevalence of overweight and obesity, each using different methodologies: Center for Disease Control (CDC), World Health Organisation (WHO), and International Obesity Task Force (IOTF). Differences in outcomes from these methods were assessed through application of each method to a single Australian cohort. Adoption and use of each method was examined through a systematic review of Australian population studies (2006-2017). Our cohort was a representative sample of 1,926 Australian children, aged 3-5 years. We found that the three standards yielded significantly different estimates when applied to a single population. Prevalence of overweight/obesity was WHO - 9.3%, IOTF - 21.7% and CDC - 33.1%. Systematically identified population studies (N = 2019) reported prevalence of overweight and obesity in Australian children ranging between 15 and 381%, with most (nN = 16/19) applying the IOTF standards. Judicious selection of growth standards, taking account of their underpinning methodologies, is recommended. IntroductionPaediatric obesity is a global public health concern. While there are suggestions of a plateau in the prevalence of childhood overweight and obesity in Western developed societies ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00810.x", "ISSN" : "1467-789X", "abstract" : "The purpose was to investigate a possible levelling off in the obesity epidemic, by systematically reviewing literature and web-based sources. Eligible studies and data sources were required to have at least two measures of obesity prevalence since 1999. A literature and Internet search resulted in 52 studies from 25 different countries. The findings supported an overall levelling off of the epidemic in children and adolescents from Australia, Europe, Japan and the USA. In adults, stability was found in the USA, while increases were still observed in some European and Asian countries. Some evidence for heterogeneity in the obesity trends across socioeconomic status (SES) groups was found. The levelling off was less evident in the lower-SES groups. No obvious differences between genders were identified. We discussed potential explanations for a levelling off and the utility of investigating obesity trends to identify the driving forces behind the epidemic. It is important to emphasize that the levelling off is not tantamount to calling off the epidemic. Additionally, it is worthwhile to keep in mind that previous stable phases have been followed by further increases in the prevalence of obesity. Therefore, research into the causes, prevention and treatment of obesity should remain a priority. ", "author" : [ { "dropping-particle" : "", "family" : "Rokholm", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baker", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "S\u00f8rensen", "given" : "T I A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "genre" : "JOUR", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "835-846", "publisher" : "Blackwell Publishing Ltd", "title" : "The levelling off of the obesity epidemic since the year 1999 \u2013 a review of evidence and perspectives", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1001/jama.2014.732", "ISSN" : "0098-7484", "abstract" : "Importance More than one-third of adults and 17% of youth in the United States are obese, although the prevalence remained stable between 2003-2004 and 2009-2010.Objective To provide the most recent national estimates of childhood obesity, analyze trends in childhood obesity between 2003 and 2012, and provide detailed obesity trend analyses among adults.Design, Setting, and Participants Weight and height or recumbent length were measured in 9120 participants in the 2011-2012 nationally representative National Health and Nutrition Examination Survey.Main Outcomes and Measures In infants and toddlers from birth to 2 years, high weight for recumbent length was defined as weight for length at or above the 95th percentile of the sex-specific Centers for Disease Control and Prevention (CDC) growth charts. In children and adolescents aged 2 to 19 years, obesity was defined as a body mass index (BMI) at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts. In adults, obesity was defined as a BMI greater than or equal to 30. Analyses of trends in high weight for recumbent length or obesity prevalence were conducted overall and separately by age across 5 periods (2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012).Results In 2011-2012, 8.1% (95% CI, 5.8%-11.1%) of infants and toddlers had high weight for recumbent length, and 16.9% (95% CI, 14.9%-19.2%) of 2- to 19-year-olds and 34.9% (95% CI, 32.0%-37.9%) of adults (age-adjusted) aged 20 years or older were obese. Overall, there was no significant change from 2003-2004 through 2011-2012 in high weight for recumbent length among infants and toddlers, obesity in 2- to 19-year-olds, or obesity in adults. Tests for an interaction between survey period and age found an interaction in children (P = .03) and women (P = .02). There was a significant decrease in obesity among 2- to 5-year-old children (from 13.9% to 8.4%; P = .03) and a significant increase in obesity among women aged 60 years and older (from 31.5% to 38.1%; P = .006).Conclusions and Relevance Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance.", "author" : [ { "dropping-particle" : "", "family" : "Ogden", "given" : "Cynthia L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carroll", "given" : "MD", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "BK", "given" : "Kit", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "KM", "given" : "Flegal", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2014", "2", "26" ] ] }, "note" : "10.1001/jama.2014.732", "page" : "806-814", "title" : "Prevalence of childhood and adult obesity in the united states, 2011-2012", "type" : "article-journal", "volume" : "311" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1,2", "plainTextFormattedCitation" : "1,2", "previouslyFormattedCitation" : "1,2" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,2, approximately one in five Australian children aged between 2 and 4 years are currently classified as overweight/obese ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Australian Bureau of Statistics", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "Canberra", "title" : "4364.0.55.001 - Australian Health Survey: First Results, 2014\u201315", "type" : "report" }, "uris" : [ "", "" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3. However, the way in which we determine the prevalence of overweight and obesity is inconsistent ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00748.x", "ISSN" : "1467-789X", "abstract" : "Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24\u201360 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24\u201360 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.", "author" : [ { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "295-300", "publisher" : "Blackwell Publishing Ltd", "title" : "Defining overweight and obesity in pre-school children: IOTF reference or WHO standard?", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/978-1-4419-1788-1_2", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Youfa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chen", "given" : "Hsin-Jen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "2", "container-title" : "Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease", "editor" : [ { "dropping-particle" : "", "family" : "Preedy", "given" : "V. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "29-48", "publisher" : "Springer Science & Business Media", "publisher-place" : "London", "title" : "Use of Percentiles and Z-scores in Anthropometry", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1111/j.1467-789X.2009.00639.x", "ISSN" : "1467-789X", "PMID" : "19619261", "abstract" : "The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.", "author" : [ { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stamatakis", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lioret", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Castetbon", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frenken", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Manios", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moschonis", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Savva", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zaborskis", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rito", "given" : "A I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nanu", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caroli", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ludvigsson", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koch", "given" : "F S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Serra-Majem", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Szponar", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lenthe", "given" : "F", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brug", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-3", "issue" : "5", "issued" : { "date-parts" : [ [ "2010", "5" ] ] }, "page" : "389-98", "publisher" : "Blackwell Publishing Ltd", "title" : "Overweight and obesity in infants and pre-school children in the European Union: a review of existing data.", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4\u20136", "plainTextFormattedCitation" : "4\u20136", "previouslyFormattedCitation" : "4\u20136" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4–6. Since 2006 there have been three international standard methods available to identify overweight and obesity, estimate population prevalence, and guide clinical decision making. In this paper we examine the differences in prevalence estimates produced by these standards in a population-based cohort of Australian preschool children. Further, we assess patterns of selection and use of these standards, and the population estimates they yield, within studies focused on Australian pre-school children.The three commonly used international growth standards for BMI-for-age were determined by the World Health Organisation (WHO)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0803-5326", "PMID" : "16817681", "abstract" : "AIM: To describe the methods used to construct the WHO Child Growth Standards based on length/height, weight and age, and to present resulting growth charts. METHODS: The WHO Child Growth Standards were derived from an international sample of healthy breastfed infants and young children raised in environments that do not constrain growth. Rigorous methods of data collection and standardized procedures across study sites yielded very high-quality data. The generation of the standards followed methodical, state-of-the-art statistical methodologies. The Box-Cox power exponential (BCPE) method, with curve smoothing by cubic splines, was used to construct the curves. The BCPE accommodates various kinds of distributions, from normal to skewed or kurtotic, as necessary. A set of diagnostic tools was used to detect possible biases in estimated percentiles or z-score curves. RESULTS: There was wide variability in the degrees of freedom required for the cubic splines to achieve the best model. Except for length/height-for-age, which followed a normal distribution, all other standards needed to model skewness but not kurtosis. Length-for-age and height-for-age standards were constructed by fitting a unique model that reflected the 0.7-cm average difference between these two measurements. The concordance between smoothed percentile curves and empirical percentiles was excellent and free of bias. Percentiles and z-score curves for boys and girls aged 0-60 mo were generated for weight-for-age, length/height-for-age, weight-for-length/height (45 to 110 cm and 65 to 120 cm, respectively) and body mass index-for-age. CONCLUSION: The WHO Child Growth Standards depict normal growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socio-economic status and type of feeding.", "author" : [ { "dropping-particle" : "", "family" : "WHO Multicentre Growth Reference Study Group", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta paediatrica. 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Each of these standards has distinct reference populations and methodologies for determining the cut-points that define overweight and obese status of children aged between 2-18years (see Table 1). The WHO Multicentre Growth Reference Study (MGRS) was premised on optimal child development, and produced growth curves for children raised in healthy and socially advantaged environments from birth to 5 years. The referent population for the WHO Child Growth Standards was a pooled sample from six countries, comprised of children that met specific inclusion criteria to represent optimal healthy growthADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3945/an.111.000307", "abstract" : "Terminology and measures used in studies of weight and adiposity in children can be complex and confusing. Differences arise in metrics, terminology, reference values, and reference levels. Most studies depend on body mass index (BMI) calculated from weight and height, rather than on more direct measures of body fatness. Definitions of overweight and obesity are generally statistical rather than risk-based and use a variety of different reference data sets for BMI. As a result, different definitions often do not give the same results. A basic problem is the lack of strong evidence for any one particular definition. Rather than formulate the question as being one of how to define obesity, it might be useful to consider what BMI cut-points best predict future health risks and how efficiently to screen for such risks. The answers may be different for different populations. In addition, rather than depending solely on BMI to make screening decisions, it is likely to be useful to also consider other factors, including not only race-ethnicity, sex and age, but also factors such as family history. Despite their limitations, BMI-based definitions of overweight and obesity provide working practical definitions that are valuable for general public health surveillance and screening.", "author" : [ { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "Cynthia L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in Nutrition: An International Review Journal", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "3", "1" ] ] }, "note" : "10.3945/an.111.000307", "page" : "159S-166S", "title" : "Childhood Obesity: Are We All Speaking the Same Language?", "type" : "article-journal", "volume" : "2" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "10", "plainTextFormattedCitation" : "10", "previouslyFormattedCitation" : "10" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }10. Inclusion criteria for the study involved meeting MGRS’s recommendations for breast feeding duration, a non-smoking mother (before and after birth), and a healthy singleton birth. The WHO Child Growth Standards determines overweight and obese status using sex- and age-specific z-scores and percentiles. However, the WHO standards have been criticised; 1) due to the stringent inclusion criteria of the reference sample which potentially classifies healthy children at the extreme ends of the scale as unhealthy ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00748.x", "ISSN" : "1467-789X", "abstract" : "Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24\u201360 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24\u201360 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.", "author" : [ { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "295-300", "publisher" : "Blackwell Publishing Ltd", "title" : "Defining overweight and obesity in pre-school children: IOTF reference or WHO standard?", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "4" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 and 2) failure to account for other significant environmental and genetic factors influencing weight and growth in the sampling ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3109/03014460903089500", "ISSN" : "0301-4460", "abstract" : "AbstractBackground: In 2006, the World Health Organization published universal growth standards for all children from birth to 5 years of age, based on a sample of breastfed children.Aims: The present study documented breastfeeding prevalence in the Flemish Growth Survey 2004, and compared growth of exclusively breastfed children in Flanders with local reference charts and WHO growth standards.Subjects and methods: A subset of 3287 children 0?3 years of age from the Flemish reference population was studied. Prevalence and duration of breastfeeding were estimated with the status quo method. SD scores (SDS) of length/height, weight, BMI, and head circumference were plotted by age.Results: Breastfeeding is initiated for 68.2% of children, and approximately 25% were exclusively breastfed until at least 6 months of age. Breastfed children grow according to a typical pattern that deviates from the local reference curve. The average length of breastfed children is reasonably close to the WHO growth standard, but this does not hold for weight, BMI, or head circumference. In Flanders, breastfed children are more comparable to the local reference than to the WHO growth standards.Conclusions: Growth of breastfed children is similar to the WHO standards for length, but not for other traits. In Flanders, the use of the recent local growth reference is advised for both breastfed and formula-fed children.", "author" : [ { "dropping-particle" : "", "family" : "Roelants", "given" : "Mathieu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hauspie", "given" : "Roland", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hoppenbrouwers", "given" : "Karel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of Human Biology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010", "2", "1" ] ] }, "note" : "doi: 10.3109/03014460903089500", "page" : "2-9", "publisher" : "Taylor & Francis", "title" : "Breastfeeding, growth and growth standards: Performance of the WHO growth standards for monitoring growth of Belgian children", "type" : "article-journal", "volume" : "37" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "11", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "11" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }11. The CDC 2000 Growth Charts are also based on sex- and age-specific percentiles; however, the reference population in this case are serial representative samples of children from the USA. This population was drawn from 5 cross-sectional administrations of the National Health and Nutrition Examination Survey (NHANES), collected between 1971 and 1994 with no specific inclusion or exclusion criteria. It is important to note there have been several changes since the development of the CDC references to infant feeding, including increased breastfeeding rates ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Breastfeeding Report Card \u2013\u2013 United States, 2016", "author" : [ { "dropping-particle" : "", "family" : "Centers for Disease Control and Prevention (CDC)", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "number-of-pages" : "1-4", "publisher-place" : "Atlanta, GA", "title" : "Breastfeeding Report Card 2016", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "12", "plainTextFormattedCitation" : "12", "previouslyFormattedCitation" : "12" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }12 and lower protein content in today’s infant formula ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Grummer-Strawn", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reinold", "given" : "C R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Krebs", "given" : "N F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Morbidity and Mortality Weekly Report (MMWR), CDC", "id" : "ITEM-1", "issue" : "RR-9", "issued" : { "date-parts" : [ [ "2010" ] ] }, "number-of-pages" : "1-20", "publisher-place" : "Atlanta, GA", "title" : "Use of World Health Organization and CDC Growth Charts for Children Aged 0 \u2013 59 Months in the United States", "type" : "report", "volume" : "59" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.3945/ajcn.2008.27091", "abstract" : "Background: Protein intake during infancy was associated with rapid early weight gain and later obesity in observational studies.Objective: The objective was to test the hypothesis that higher protein intake in infancy leads to more rapid length and weight gain in the first 2 y of life.Design: In a multicenter European study, 1138 healthy, formula-fed infants were randomly assigned to receive cow milk\u2013based infant and follow-on formula with lower (1.77 and 2.2 g protein/100 kcal, respectively) or higher (2.9 and 4.4 g protein/100 kcal, respectively) protein contents for the first year. For comparison, 619 exclusively breastfed children were also followed. Weight, length, weight-for-length, and BMI were determined at inclusion and at 3, 6, 12, and 24 mo of age. The primary endpoints were length and weight at 24 mo of age, expressed as length and weight-for-length z scores based on the 2006 World Health Organization growth standards.Results: Six hundred thirty-six children in the lower (n = 313) and higher (n = 323) protein formula groups and 298 children in the breastfed group were followed until 24 mo. Length was not different between randomized groups at any time. At 24 mo, the weight-for-length z score of infants in the lower protein formula group was 0.20 (0.06, 0.34) lower than that of the higher protein group and did not differ from that of the breastfed reference group.Conclusions: A higher protein content of infant formula is associated with higher weight in the first 2 y of life but has no effect on length. Lower protein intake in infancy might diminish the later risk of overweight and obesity. This trial was registered at as NCT00338689. ", "author" : [ { "dropping-particle" : "", "family" : "Koletzko", "given" : "Berthold", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kries", "given" : "R\u00fcdiger", "non-dropping-particle" : "von", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Closa", "given" : "Ricardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Escribano", "given" : "Joaqu\u00edn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scaglioni", "given" : "Silvia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Giovannini", "given" : "Marcello", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beyer", "given" : "Jeannette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Demmelmair", "given" : "Hans", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gruszfeld", "given" : "Dariusz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dobrzanska", "given" : "Anna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sengier", "given" : "Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langhendries", "given" : "Jean-Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rolland Cachera", "given" : "Marie-Francoise", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grote", "given" : "Veit", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Clinical Nutrition ", "id" : "ITEM-2", "issue" : "6 ", "issued" : { "date-parts" : [ [ "2009", "6", "1" ] ] }, "note" : "10.3945/ajcn.2008.27091", "page" : "1836-1845", "title" : "Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial", "type" : "article-journal", "volume" : "89 " }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "13,14", "plainTextFormattedCitation" : "13,14", "previouslyFormattedCitation" : "13,14" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }13,14, which may affect growth trajectories. However, the major criticism of both the CDC and the WHO references is that they both determine prevalence of overweight and obesity using arbitrary statistical cut-points which are not associated with health outcomes ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3945/an.111.000307", "abstract" : "Terminology and measures used in studies of weight and adiposity in children can be complex and confusing. Differences arise in metrics, terminology, reference values, and reference levels. Most studies depend on body mass index (BMI) calculated from weight and height, rather than on more direct measures of body fatness. Definitions of overweight and obesity are generally statistical rather than risk-based and use a variety of different reference data sets for BMI. As a result, different definitions often do not give the same results. A basic problem is the lack of strong evidence for any one particular definition. Rather than formulate the question as being one of how to define obesity, it might be useful to consider what BMI cut-points best predict future health risks and how efficiently to screen for such risks. The answers may be different for different populations. In addition, rather than depending solely on BMI to make screening decisions, it is likely to be useful to also consider other factors, including not only race-ethnicity, sex and age, but also factors such as family history. Despite their limitations, BMI-based definitions of overweight and obesity provide working practical definitions that are valuable for general public health surveillance and screening.", "author" : [ { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "Cynthia L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in Nutrition: An International Review Journal", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "3", "1" ] ] }, "note" : "10.3945/an.111.000307", "page" : "159S-166S", "title" : "Childhood Obesity: Are We All Speaking the Same Language?", "type" : "article-journal", "volume" : "2" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "978-1-4051-8226-3", "author" : [ { "dropping-particle" : "", "family" : "Must", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "Sarah E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "28", "container-title" : "Clinical Obesity in Adults and Children", "edition" : "Third", "editor" : [ { "dropping-particle" : "", "family" : "Kopelman", "given" : "Peter G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caterson", "given" : "Ian D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dietz", "given" : "William H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "375 - 392", "publisher" : "Wiley-Blackwell Publishing Ltd.", "publisher-place" : "Singapore", "title" : "Childhood Obesity: Definition, classification and assessment", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "10,15", "plainTextFormattedCitation" : "10,15", "previouslyFormattedCitation" : "10,15" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }10,15. The IOTF ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.320.7244.1240", "author" : [ { "dropping-particle" : "", "family" : "Cole", "given" : "Tim J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bellizzi", "given" : "Mary C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dietz", "given" : "William H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-1", "issue" : "7244", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "1240", "title" : "Establishing a standard definition for child overweight and obesity worldwide: international survey", "type" : "article-journal", "volume" : "320" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "9", "plainTextFormattedCitation" : "9", "previouslyFormattedCitation" : "9" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }9 also used smoothed centile curves to map growth, however one of the key differences is that children’s weight status is determined by backward mapping from adult BMI cut-points for overweight and obesity (25 and 30 kg/m2 respectively), onto age- and sex-specific BMI z-scores. The IOTF used six large nationally representative cross-sectional survey studies on growth from Brazil, Great Britain, Hong Kong, the Netherlands, Singapore and the USA to create the BMI cut-points of overweight and obesity between birth and 20 years. One of the aims of development of the IOTF was to assist with international comparison. However, one critique is that due to the backward mapping from adult cut-points, the sensitivity of the IOTF definition of obesity is much lower than other reference data, with research indicating that this approach did not classify 40 – 50% of obese children correctly, with marked differences observed in this sensitivity between the sexes ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00748.x", "ISSN" : "1467-789X", "abstract" : "Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24\u201360 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24\u201360 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.", "author" : [ { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "295-300", "publisher" : "Blackwell Publishing Ltd", "title" : "Defining overweight and obesity in pre-school children: IOTF reference or WHO standard?", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "BACKGROUND: Definitions of overweight and obesity for children were published in 2000, derived by averaging the centiles of six countries equivalent to body mass index (BMI) at age 18 years of 25 and 30. For use in the UK it is unclear whether these present an advantage over equivalent definitions based on UK data. AIM: To compare the recently published international cut-off points for overweight and obesity in children with alternative cut-off points based on the UK 1990 reference data. SUBJECTS AND METHODS: Around 6000 white children aged 4-11 years from primary schools in 22 areas in England were measured in two cross-sectional surveys, in 1984 and 1994. Measurements included height and weight, from which BMI was calculated. Each child was classified as overweight or obese according to each cut-off point. RESULTS: The proposed international cut-off points exaggerate the difference in prevalence of overweight and obesity between English boys and girls in comparison to comparable measures based on UK data by up to 7%, and are not compatible with the UK reference charts for BMI. Using proposed UK cut-off points the prevalence of overweight in boys was 10.2% in 1984, rising to 13.8% in 1994, compared to 5.4 to 9.0% using the international definition. CONCLUSION: The limitations of the international definitions, due to averaging data from different countries and the choice of reference age, need to be known. The UK cut-off points here presented are compatible with the current UK reference curves.", "author" : [ { "dropping-particle" : "", "family" : "Chinn", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rona", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of Human Biology", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "306-313", "title" : "International definitions of overweight and obesity for children: a lasting solution?", "type" : "article-journal", "volume" : "29" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "", "ISSN" : "03070565", "abstract" : "OBJECTIVE: To assess the ability of simple definitions of BMI to successfully screen for children with high body fatness. DESIGN: We determined the sensitivity and specificity of the body mass index (BMI) by testing its ability to correctly identify children with high body fat percentage. Receiver operator characteristic (ROC) analyses were carried out using the top 5% of body fat percentage to define children as obese (true positives). SUBJECTS: Representative sample of 4175 7 y-old (88-92 month-old) children (2120 boys; 2055 girls) participating in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). RESULTS: The current obesity definition based on BMI (95th centile) had moderately high sensitivity (88%) and high specificity (94%). Sensitivity and specificity did not differ significantly between boys and girls. The ROC analysis showed that lower cut-offs applied to the BMI improved sensitivity with no marked loss of specificity: the optimum combination of sensitivity (92%) and specificity (92%) was at a BMI cut-off equivalent to the 92nd centile. Sensitivity of BMI using the new International Obesity Task Force (IOTF) cut-off for obesity was much lower, and differed significantly (P<0.001) between boys (46%) and girls (72%). CONCLUSIONS: Screening for childhood obesity using the BMI is specific, and can have moderately high sensitivity if an appropriate cut-off is chosen. New recommendations based on the IOTF approach to defining childhood obesity are associated with lower sensitivity, and sensitivity differs between boys and girls. INTERNATIONAL JOURNAL OF OBESITY: (2000) 24, 1623-1627", "author" : [ { "dropping-particle" : "", "family" : "Reilly", "given" : "J. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dorosty", "given" : "A R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Emmett", "given" : "P M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Obesity and Related Disorders", "id" : "ITEM-3", "issue" : "12", "issued" : { "date-parts" : [ [ "2000", "12" ] ] }, "language" : "English", "page" : "1623-1627", "publisher" : "Nature Publishing Group", "publisher-place" : "Hampshire", "title" : "Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4,16,17", "plainTextFormattedCitation" : "4,16,17", "previouslyFormattedCitation" : "4,16,17" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4,16,17. Furthermore, the tracking of weight from early childhood through to adult health outcomes has not yet been fully established. In sum, the reference populations on which each of the three standards is based are distinct in character, with different selection factors, sampling time frames, and criticismslimitations. Given the different sampling and statistical methodologies it is not surprising that studies using these standards report discrepant estimates of overweight and obesity in child populations ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Background: Several different sets of reference body mass index (BMI) values are available to define overweight in children.Objective: The objective of this study was to compare the prevalence of overweight in US children calculated with 3 sets of reference BMI values: the revised growth charts of the Centers for Disease Control and Prevention (CDC-US growth charts), international standards proposed by Cole et al, and values developed by Must et al.Design: Data for children and adolescents came from cross-sectional nationally representative US surveys: cycles II and III of the National Health Examination Survey (1963\u20131965 and 1966\u20131970) and the first, second, and third National Health and Nutrition Examination Surveys: NHANES I (1971\u20131974), II (1976\u20131980), and III (1988\u20131994). The reference values of Cole et al equivalent to a BMI of 25 were compared with the 85th percentiles from the other 2 methods; the values equivalent to a BMI of 30 were compared with the 95th percentiles.Results: The 3 methods gave similar but not identical results. The reference values of Cole et al gave lower estimates than did the CDC-US growth charts for young children but higher estimates for older children. The reference values of Must et al gave much higher prevalences for younger girls than did the other 2 methods.Conclusions: Differences between methods were related to differences in data sets, smoothing methods, and theoretical approaches. All 3 methods are based on statistical criteria and incorporate arbitrary assumptions. These methods should be used cautiously, with awareness of the possible limitations.", "author" : [ { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "Cynthia L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "Rong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuczmarski", "given" : "Robert L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "Clifford L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Clinical Nutrition", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2001", "6", "1" ] ] }, "page" : "1086-1093", "title" : "Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00748.x", "ISSN" : "1467-789X", "abstract" : "Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24\u201360 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24\u201360 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.", "author" : [ { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "295-300", "publisher" : "Blackwell Publishing Ltd", "title" : "Defining overweight and obesity in pre-school children: IOTF reference or WHO standard?", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1080/03014460802014625", "ISBN" : "0301-4460", "abstract" : "Background: Various charts based on body mass index (BMI) and per cent body fat (%BF) are used to classify childhood body composition but outcomes may vary. Aim: The study investigated variation in incidences of childhood obesity as depicted by four classification charts. Subjects and methods: BMI and DXA-derived %BF were assessed in 741 children. Incidences of overweight and obesity were compared between two BMI charts and two bioelectrical impedance (BIA)-based %BF charts. Results: The International Obesity Task Force (IOTF)-adopted BMI chart designated 21%, 6% (boys), and 26%, 9% (girls) as overweight and obese, respectively. Corresponding figures using the USA CDC BMI chart were 27%, 11 % (boys) and 27%, 12% (girls). Using a USA-derived %BF chart incidences were 17%, 2% (boys) and 21%, 8% (girls) and using a UK-derived %BF chart 51%, 24% (boys) and 53%, 36% (girls). Sensitivity of BMI varied according to the %BF reference chart. Conclusions: In contrast to the BMI-based charts, there were considerable variations in depicted incidences of obesity between the %BF-based charts. These discordances were considered to result from previously reported variation within and between BIA and DXA %BF assessments underlying the charts. The present study highlights the need for valid, reliable, unchanging BIA and DXA procedures.", "author" : [ { "dropping-particle" : "", "family" : "Telford", "given" : "R D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cunningham", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daly", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reynolds", "given" : "G J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lafferty", "given" : "A R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gravenmaker", "given" : "K J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Budge", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Javaid", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bass", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Telford", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of Human Biology", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "language" : "English", "page" : "334-341", "title" : "Discordance of international adiposity classifications in Australian boys and girls - The LOOK study", "type" : "article-journal", "volume" : "35" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1186/1471-2431-11-21", "ISSN" : "1471-2431", "abstract" : "Childhood obesity is a public health problem in Canada. Accurate measurement of a health problem is crucial in defining its burden. The objective of this study is to compare the prevalence estimates of overweight and obesity in preschool children using three growth references.", "author" : [ { "dropping-particle" : "", "family" : "Twells", "given" : "Laurie K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newhook", "given" : "Leigh A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Pediatrics", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "1-6", "title" : "Obesity prevalence estimates in a Canadian regional population of preschool children using variant growth references", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4,18\u201320", "plainTextFormattedCitation" : "4,18\u201320", "previouslyFormattedCitation" : "4,18\u201320" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4,18–20. Further, studies that specifically compare the prevalence of overweight and/or obesity yielded by the different international standards produce identify inconsistent patterns of prevalence. Flegal and colleaguesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Background: Several different sets of reference body mass index (BMI) values are available to define overweight in children.Objective: The objective of this study was to compare the prevalence of overweight in US children calculated with 3 sets of reference BMI values: the revised growth charts of the Centers for Disease Control and Prevention (CDC-US growth charts), international standards proposed by Cole et al, and values developed by Must et al.Design: Data for children and adolescents came from cross-sectional nationally representative US surveys: cycles II and III of the National Health Examination Survey (1963\u20131965 and 1966\u20131970) and the first, second, and third National Health and Nutrition Examination Surveys: NHANES I (1971\u20131974), II (1976\u20131980), and III (1988\u20131994). The reference values of Cole et al equivalent to a BMI of 25 were compared with the 85th percentiles from the other 2 methods; the values equivalent to a BMI of 30 were compared with the 95th percentiles.Results: The 3 methods gave similar but not identical results. The reference values of Cole et al gave lower estimates than did the CDC-US growth charts for young children but higher estimates for older children. The reference values of Must et al gave much higher prevalences for younger girls than did the other 2 methods.Conclusions: Differences between methods were related to differences in data sets, smoothing methods, and theoretical approaches. All 3 methods are based on statistical criteria and incorporate arbitrary assumptions. These methods should be used cautiously, with awareness of the possible limitations.", "author" : [ { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "Cynthia L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "Rong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuczmarski", "given" : "Robert L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "Clifford L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Clinical Nutrition", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2001", "6", "1" ] ] }, "page" : "1086-1093", "title" : "Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "18", "plainTextFormattedCitation" : "18", "previouslyFormattedCitation" : "18" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18 compared the IOTF and CDC standards in a population of U.S. children aged between 2 and 19 years. They found that the IOTF produced lower prevalence estimates for overweight and obesity than did the CDC in younger children, but higher estimates for older children. These results may be indicative of systematic differences in the distribution of BMI with age between the US and other countriesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Background: Several different sets of reference body mass index (BMI) values are available to define overweight in children.Objective: The objective of this study was to compare the prevalence of overweight in US children calculated with 3 sets of reference BMI values: the revised growth charts of the Centers for Disease Control and Prevention (CDC-US growth charts), international standards proposed by Cole et al, and values developed by Must et al.Design: Data for children and adolescents came from cross-sectional nationally representative US surveys: cycles II and III of the National Health Examination Survey (1963\u20131965 and 1966\u20131970) and the first, second, and third National Health and Nutrition Examination Surveys: NHANES I (1971\u20131974), II (1976\u20131980), and III (1988\u20131994). The reference values of Cole et al equivalent to a BMI of 25 were compared with the 85th percentiles from the other 2 methods; the values equivalent to a BMI of 30 were compared with the 95th percentiles.Results: The 3 methods gave similar but not identical results. The reference values of Cole et al gave lower estimates than did the CDC-US growth charts for young children but higher estimates for older children. The reference values of Must et al gave much higher prevalences for younger girls than did the other 2 methods.Conclusions: Differences between methods were related to differences in data sets, smoothing methods, and theoretical approaches. All 3 methods are based on statistical criteria and incorporate arbitrary assumptions. These methods should be used cautiously, with awareness of the possible limitations.", "author" : [ { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "Cynthia L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "Rong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuczmarski", "given" : "Robert L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "Clifford L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Clinical Nutrition", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2001", "6", "1" ] ] }, "page" : "1086-1093", "title" : "Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "18", "plainTextFormattedCitation" : "18", "previouslyFormattedCitation" : "18" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18. Within the Australian context, this may be an important consideration given that Australia is not included within any of the three international growth standard’s sample populations. Monasta and colleaguesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00748.x", "ISSN" : "1467-789X", "abstract" : "Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24\u201360 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24\u201360 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.", "author" : [ { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "295-300", "publisher" : "Blackwell Publishing Ltd", "title" : "Defining overweight and obesity in pre-school children: IOTF reference or WHO standard?", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "4" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 compared the IOTF and WHO standards in a Czech population of children aged 2 to 5 years and reported that the WHO standards produced much lower estimates of overweight than did the IOTF standards, these differences were particularly marked in girls. Conversely, a study of Canadian pre-schoolers ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1471-2431-11-21", "ISSN" : "1471-2431", "abstract" : "Childhood obesity is a public health problem in Canada. Accurate measurement of a health problem is crucial in defining its burden. The objective of this study is to compare the prevalence estimates of overweight and obesity in preschool children using three growth references.", "author" : [ { "dropping-particle" : "", "family" : "Twells", "given" : "Laurie K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newhook", "given" : "Leigh A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Pediatrics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "1-6", "title" : "Obesity prevalence estimates in a Canadian regional population of preschool children using variant growth references", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "20", "plainTextFormattedCitation" : "20", "previouslyFormattedCitation" : "20" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }20 (mean age of 4.5 years) found that WHO classified a higher prevalence of children as overweight than either CDC or IOTF. Yet the CDC standards yielded higher obesity prevalence than both the WHO and IOTF standards, with similar results observed for both boys and girls. Discrepant prevalence estimates identifypresent a problem; the choice of standard can result in substantially different individual, group, and population estimates of overweight and obesity, with attendant effects on research findings, public health interventions, and clinical practice. In the current paper we examine these potential biases in two studies. In Study 1, we applied all three international reference standards for BMI-for-age to a single population to assess differences in prevalence estimates of overweight and obesity. Our focus sample, a cohort of 1,926 Australian preschool children, is drawn from a Western developed economy but one that is not part of any of the current international reference populations. In Study 2, we examined all research studies relating to paediatric obesity (3 – 5 years) in Australia conducted between 2006 and 2017, the period when all three standards were available, to assess the patterns ofin the standards used to report overweight and obesity prevalence in pre-school populations. Our aim is to inform the rationale for selection of growth standards in defining the extent and nature of the obesity problem in child populations.Study 1 – Prevalence Estimates in an Australian Population MethodParticipantsA total of 2,489 children were recruited into the Effective Early Educational Experiences (E4Kids) Study, an Australian longitudinal cohort. Recruitment and sampling was designed to capture a representative sample of Australian children attending licensed Early Childhood Education and Care (ECEC) environments. These methods have been detailed elsewhere ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/s12889-016-2985-1", "ISBN" : "1288901629851", "ISSN" : "1471-2458", "PMID" : "27098954", "author" : [ { "dropping-particle" : "", "family" : "Tayler", "given" : "Collette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cloney", "given" : "Daniel Scott", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Adams", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ishimine", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thorpe", "given" : "Karen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nguyen", "given" : "Thi Kim Cuc", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Public Health", "id" : "ITEM-1", "issue" : "April", "issued" : { "date-parts" : [ [ "2016" ] ] }, "publisher" : "BMC Public Health", "title" : "Assessing the effectiveness of Australian early childhood education and care experiences: study protocol", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "21", "plainTextFormattedCitation" : "21", "previouslyFormattedCitation" : "21" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }21. Briefly, the E4Kids Study is a 5-year longitudinal study that commenced in 2010. To represent the diversity of licensed ECEC provision in Australia, a random sampling frame, stratified by service type (Long Day Care, Kindergarten and Family Day Care) and socioeconomic status (SES) was used to recruit 140 licensed ECEC services in the states of Queensland and Victoria. Within each service, any room with children in the year prior to school (aged 3-5 years) were identified for recruitment. All children and their families in these rooms were invited to participate. Written informed consent to participate was provided by each child’s parent or legal guardian. Ethics approval for the study was granted by both The University of Melbourne and Queensland University of Technology Human Research Ethics Committees. Measures Trained research staff measured each child’s height and weight at their ECEC service using calibrated stadiometers (SECA Leicester Portable Height Measure) and floor scales (HD-316, Wedderburn Scales; Tanita Corporation, Tokyo, Japan). Children were dressed in light clothing and without shoes, in accordance with the standardised procedures outlined by the World Health OrganisationADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0803-5326", "PMID" : "16817681", "abstract" : "AIM: To describe the methods used to construct the WHO Child Growth Standards based on length/height, weight and age, and to present resulting growth charts. METHODS: The WHO Child Growth Standards were derived from an international sample of healthy breastfed infants and young children raised in environments that do not constrain growth. Rigorous methods of data collection and standardized procedures across study sites yielded very high-quality data. The generation of the standards followed methodical, state-of-the-art statistical methodologies. The Box-Cox power exponential (BCPE) method, with curve smoothing by cubic splines, was used to construct the curves. The BCPE accommodates various kinds of distributions, from normal to skewed or kurtotic, as necessary. A set of diagnostic tools was used to detect possible biases in estimated percentiles or z-score curves. RESULTS: There was wide variability in the degrees of freedom required for the cubic splines to achieve the best model. Except for length/height-for-age, which followed a normal distribution, all other standards needed to model skewness but not kurtosis. Length-for-age and height-for-age standards were constructed by fitting a unique model that reflected the 0.7-cm average difference between these two measurements. The concordance between smoothed percentile curves and empirical percentiles was excellent and free of bias. Percentiles and z-score curves for boys and girls aged 0-60 mo were generated for weight-for-age, length/height-for-age, weight-for-length/height (45 to 110 cm and 65 to 120 cm, respectively) and body mass index-for-age. CONCLUSION: The WHO Child Growth Standards depict normal growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socio-economic status and type of feeding.", "author" : [ { "dropping-particle" : "", "family" : "WHO Multicentre Growth Reference Study Group", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta paediatrica. Supplementum", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "76-85", "title" : "WHO Child Growth Standards based on length/height, weight and age.", "type" : "article-journal", "volume" : "450" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "7", "plainTextFormattedCitation" : "7", "previouslyFormattedCitation" : "7" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }7. Children were measured twice; if measurements differed (weight >0.1kg; height >0.5cm), a third measurement was taken by the researcher with the mean of these measurements used to calculate BMI. The main caregiver of the participating child also completed a questionnaire which provided details about the child and family demographics. Defining overweight and obesity BMI for each child was calculated (weight (kg) / height (m) 2) from anthropometric data. Children were then classified according to the published WHO, CDC and IOTF cut-points.The World Health Organisation: The WHO’s Anthro program (version 3.2.2) was used to transform raw anthropometric data into sex- and age-specific z scores. In accordance with WHO standards, overweight for children under 5 years of age is classified as a BMI z-score ≥2 standard deviations above the mean, and a classification of obese given to children with a BMI z-score ≥3 standard deviations above the mean. The Center for Disease Control: Using the SAS (version 9.5) macro for the 2000 CDC Growth Charts, children’s raw anthropometric data were also transformed into sex- and age- specific z-scores. With children classified as overweight if their BMI z-score was ≥ 85th percentile and obese, if their BMI z-score was ≥ 95th percentile.The International Obesity Task Force: Using the guidelines published by Cole and LobsteinADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.2047-6310.2012.00064.x", "ISSN" : "2047-6310", "abstract" : "Background: The international (International Obesity Task Force; IOTF) body mass index (BMI) cut-offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based on data from six countries fitted by the LMS method, they link BMI values at 18\u2009years (16, 17, 18.5, 25 and 30\u2009kg\u2009m\u22122) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. the World Health Organization (WHO) standard, these cut-offs cannot be expressed as centiles (e.g. 85th). \nMethods: To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut-offs defined in terms of the centiles at 18\u2009years corresponding to each BMI value. These new cut-offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data.\nResults: The new cut-offs were virtually identical to the originals, giving prevalence rates differing by <0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5.\nConclusions: Defining the international cut-offs in terms of the underlying LMS curves has several benefits. New cut-offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity\u2009=\u200998.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction.", "author" : [ { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatric Obesity", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012", "8", "1" ] ] }, "note" : " - the short cut to the actual website", "page" : "284-294", "title" : "Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "22", "plainTextFormattedCitation" : "22", "previouslyFormattedCitation" : "22" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }22 children were classified as overweight or obese by age (rounded to the nearest whole month i.e., 38.6 = 39 months old) and gender specific BMI score which corresponds to a BMI of ≥25 and ≥30 at age 18, respectively. AnalysisInitial data cleaning and checks were conducted to remove all children labelled as having biologically implausible values on height, weight, and BMI-for-age measurements. Height and weight measurements were available for 2,038 children (81.9%). Children who were considered age outliers were removed from the sample; 50 aged < 3 years, and 36 children aged > 5.1 years were removed from analyses. The WHO and CDC exclusion ranges were utilised and any children identified as having implausible biological values (i.e. likely the result of a recording or calculation error) were examined for possible exclusions; 26 children were subsequently excluded. Applying the WHO criteria there were 12 exclusions. More stringent criteria from the CDC resulted in an additional 14 children being flagged and excluded as having biologically implausible values. Eleven of the 12 children identified in the WHO flags were also identified in the CDC analysis. Our final sample consisted of 1,926 children (985 [51.1%] boys; Mean age = 48.65 months ± 6.21 [SD]; Age range: 36.00 – 60.95 months). Differences in prevalence estimates for each weight status category were tested for statistical significance using a z-test for difference in proportions. We then calculated the odds ratio of being classified as overweight/obese when using one reference standard compared to another. We also examined if there were any gender differences using the same methods. ResultsDemographic information about the final sample is provided in Table 2. Over 90% of participating children had been breastfed at some point in infancy and 1.9% of children were identified as being of Aboriginal and/or Torres Strait Islander origin. The majority of respondents were born in Australia. Of the responding main caregivers 53.3% held university degrees and 28% held a technical qualification. These figures (81.3%) are slightly higher than national statistics that show 59% of Australians (aged between 15 and 64 years) have a post-school qualification ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Provides selected information on participation in education, highest educational attainment, transition from education to work and current labour force and demographic characteristics for the civilian population aged 15-74 years. Characteristics reported on include: type of educational institution attended or attending; level and main field of education of current study and highest level and main field of educational attainment.", "author" : [ { "dropping-particle" : "", "family" : "Australian Bureau of Statistics", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "Canberra, Australia", "title" : "6227.0 - Education and Work, Australia, May 2015", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "23", "plainTextFormattedCitation" : "23", "previouslyFormattedCitation" : "23" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }23 however, it isbut consistent with recruitment in childcare, where most caregivers are employed or studying ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Australian Bureau of Statistics", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "publisher-place" : "Canberra, Australia", "title" : "4402.0 - Childhood Education and Care, Australia, June 2014", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "24", "plainTextFormattedCitation" : "24", "previouslyFormattedCitation" : "24" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }24., Aas such our sample were is highly educated. Table 3 shows the crude prevalence estimates of normal weight, overweight, and obese children resulting from application of each of the three international reference standards. The proportion of children classified as overweight or obese significantly differed across each of the three reference values. Using the WHO reference values, significantly fewer children were classified as overweight compared to the CDC or IOTF cut-points. There were significantly more children classified as obese when using the CDC reference, than either the IOTF or WHO. Odds ratio analyses indicated that when CDC is used to classify child weight status over IOTF, a child was 1.78 times greater odds (95% CI: 1.54 – 2.06) of being classified as either overweight or obese. Commensurately, if IOTF is used in favour of WHO, a child was 2.66 times greater odds (95% CI: 2.20 – 3.20) of being classified as overweight/obese. Finally, if the CDC cut-points are used instead of the WHO, a child is 4.72 times greater odds (95% CI: 3.96 – 5.67) of being classified as overweight/obese. Prevalence rates were also examined by gender (Table 3). For males, there were significantly fewer children classified as overweight using the WHO standards than when using the CDC standards. When using the CDC standards, male children were 4.43 times greater odds (95% CI: 3.49 – 5.62) of being classified as overweight or obese than when using WHO. For females there were significantly fewer children classified as overweight when using the WHO reference versus either IOTF or CDC standards. For females, if the IOTF cut-points are used instead of the WHO cut-points, a child was 3.61 times greater odds (95% CI: 2.72 – 4.78) of being classified as overweight/obese. Alternatively, if using CDC in place of WHO cut-points, females were 5.22 times greater odds (95% CI: 3.96 – 6.88) of being classified as overweight or obese. Study 2 – Systematic ReviewMethodSearch strategyWe conducted a systematic search of research literature published between 2006 and 2017 relating to paediatric obesity (children (3-5 years) in Australia. This search is current as of 30th of January 2017 and used the following international databases: PubMed, Embase, PsycINFO [via EBSCOhost], CINAHL, Web of Science, SCOPUS, Science Direct, PROQUEST, The Cochrane library database, and JSTOR. The reference lists from identified review articles and papers were also examined to identify potential papers for inclusion. Key words included ‘Australia AND BMI AND Obesity AND Overweight AND Pre-school’ and where possible date limit from 2006 – 2017 OR last 11 years. Search strategy in PsycINFO (AB: Australia*) AND (AB: BMI OR “Body Mass Index” OR BMIz-score OR Obesity OR Overweight OR Anthropometry OR prevalence) Limited by Age: Pre-school Age (2-5 yrs) AND Publication Year 2006 – 2017. Searches in other databases were based on these terms (see Table S1). Inclusion and exclusion criteriaStudies were included if they were intervention studies, case control, observational studies, cross-sectional, longitudinal or national data analyses that report prevalence of overweight and obesity in a 3-5 year old cohort. The inclusion criteria specified that study participants needed to be aged between 3 and 5 years (<72 months) and recruited in Australia. Studies that included children outside of the specified age range where allowable, only if the prevalence of overweight and obesity for children within the 3-5-year old age range was identifiable. Studies were excluded if they were case studies, letters, commentaries, review articles, or conference abstracts with full text unavailable. Studies that examined sub-populations of Australians (e.g. ethnic minorities, children with specific health problems which are related to increased BMI, and studies specifically targeting groups with high BMI) were excluded. Intervention studies were included in the final pool only if baseline measurements of weight status were provided or able to be sourced. Further, if intervention and control groups differed in baseline weight status, only the control group was reported to limit bias in weight status categories. Adopting the PRISMA approach, after the initial search was conducted, two authors (E.S., C.L.P.) examined the title and abstracts of all records to determine if they met the inclusion criteria. Then, full-text versions of identified studies were reviewed for consistency with inclusion criteria (C.L.P.). Any concerns about inclusion or exclusion of articles were discussed with three members of the research team (K.J.T., S.L.S., S.S.S.). Full details of the number of articles identified and included at each stage are provided in Fig. S1. Where multiple studies reporting on the same study sample were found, the publication that identified overweight/obesity prevalence in the closest age (or age range) according to our criteria or the publication with the largest sample size was retained. As a result, out of the total of 39 studies identified as meeting the inclusion criteria, 19 studies were then excluded from the final analysis due to duplication of the study sample. The representative studies included in the final analysis are identified in Table 4.ResultsThe systematic review of Australian pre-school cohort studies identified 20 articles. These are summarised in Table 4. The studies had a wide range of sample sizes (from 84 to 114,925 children). Nineteen out of the 20 studies directly measured child weight and height, thus reducing the error associated with self-report data. Most studies (8079%) used the IOTF standards to describe the prevalence of overweight and obesity. Three studies used the CDC standards and oneno studyies used the WHO standards to determine prevalence. It is important to note that one study ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.5694/mja11.11080", "ISBN" : "0025-729X\r1326-5377", "abstract" : "Objective: To determine the nutrient intakes and status of preschool children from a representative population sample in Adelaide. Design, setting and participants: Cross-sectional survey of children aged 1-5 years, using a stratified random sampling method and a doorknocking strategy, between September 2005 and July 2007. Main outcome measures: Dietary intake, assessed using a 3-day weighed-food diary; anthropometrics, biomarkers of iron, zinc and vitamin B12, and fatty acid profiles assessed using standard methods. Results: Median energy intakes were within dietary recommendations for the age group. Overall energy contributions from carbohydrate, protein, fat and saturated fat intakes were 50%, 17%, 33% and 16%, respectively. The rates of inadequate intake of iron, zinc, calcium and vitamin C were low, as was the prevalence of iron deficiency (5%). Only a minority of children achieved the adequate intake for n-3 long-chain polyunsaturated fatty acids (32%) and dietary fibre (18%). There was no association between socioeconomic status and intakes of macronutrients and key micronutrients. Fourteen per cent of children were obese (BMI, > 95th percentile); no association between BMI and energy intake was shown. Conclusions: The dietary intake of children in the study was adequate for macronutrients and the majority of micronutrients. However, low intakes of fibre and n-3 long-chain polyunsaturated fatty acids and high saturated fat intakes have raised concerns that this dietary pattern may be associated with adverse long-term health effects.", "author" : [ { "dropping-particle" : "", "family" : "Zhou", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gibson", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gibson", "given" : "R S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Makrides", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Journal of Australia", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "696-700", "title" : "Nutrient intakes and status of preschool children in Adelaide, South Australia", "type" : "article-journal", "volume" : "196" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "25", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "25" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 reported using the WHO software to obtain BMI z-scores and percentiles, however, when it came to classifying children as overweight and obese they used cut-points of 85th and 95th percentiles respectively, which indicates that the authors elected to use the lower CDC recommended percentiles for overweight and obeseOW and OB, instead of the WHO recommended 2SD and 3SD z-scores. This would have contributed to the high prevalence of overweight/obesity (33%) reported in their 4- to 5-year old children. In general, the proportion of children in each weight category varied. For the studies which that used the IOTF standards, the weighted average of overweight/obese prevalence was 18.3% (Range: 13.0 to 29.6%). From the three studies that used the CDC standards, the weighted average of children classified as overweight/obese was 25.5% (Range: 14.8 to 33.0%). As only one study utilised the WHO standards weighted averages were unable to be computed. However, the authors report that 38% of children participating were classified as overweight/obese.DiscussionOur results indicate that the estimates of overweight and obesity in preschool children vary significantly based on application of the different standards to a single population. Specifically, in our sample, the WHO and IOTF identified 1.6% and 4.0% of children as obese, respectively. In contrast, the CDC standards identified 13.1% of children as obese. Our findings, like those of several other international comparisons, show that international standards do not produce equivalent estimates ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00748.x", "ISSN" : "1467-789X", "abstract" : "Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24\u201360 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24\u201360 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.", "author" : [ { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "295-300", "publisher" : "Blackwell Publishing Ltd", "title" : "Defining overweight and obesity in pre-school children: IOTF reference or WHO standard?", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Background: Several different sets of reference body mass index (BMI) values are available to define overweight in children.Objective: The objective of this study was to compare the prevalence of overweight in US children calculated with 3 sets of reference BMI values: the revised growth charts of the Centers for Disease Control and Prevention (CDC-US growth charts), international standards proposed by Cole et al, and values developed by Must et al.Design: Data for children and adolescents came from cross-sectional nationally representative US surveys: cycles II and III of the National Health Examination Survey (1963\u20131965 and 1966\u20131970) and the first, second, and third National Health and Nutrition Examination Surveys: NHANES I (1971\u20131974), II (1976\u20131980), and III (1988\u20131994). The reference values of Cole et al equivalent to a BMI of 25 were compared with the 85th percentiles from the other 2 methods; the values equivalent to a BMI of 30 were compared with the 95th percentiles.Results: The 3 methods gave similar but not identical results. The reference values of Cole et al gave lower estimates than did the CDC-US growth charts for young children but higher estimates for older children. The reference values of Must et al gave much higher prevalences for younger girls than did the other 2 methods.Conclusions: Differences between methods were related to differences in data sets, smoothing methods, and theoretical approaches. All 3 methods are based on statistical criteria and incorporate arbitrary assumptions. These methods should be used cautiously, with awareness of the possible limitations.", "author" : [ { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "Cynthia L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "Rong", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuczmarski", "given" : "Robert L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "Clifford L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Clinical Nutrition", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2001", "6", "1" ] ] }, "page" : "1086-1093", "title" : "Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index", "type" : "article-journal", "volume" : "73" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1080/03014460802014625", "ISBN" : "0301-4460", "abstract" : "Background: Various charts based on body mass index (BMI) and per cent body fat (%BF) are used to classify childhood body composition but outcomes may vary. Aim: The study investigated variation in incidences of childhood obesity as depicted by four classification charts. Subjects and methods: BMI and DXA-derived %BF were assessed in 741 children. Incidences of overweight and obesity were compared between two BMI charts and two bioelectrical impedance (BIA)-based %BF charts. Results: The International Obesity Task Force (IOTF)-adopted BMI chart designated 21%, 6% (boys), and 26%, 9% (girls) as overweight and obese, respectively. Corresponding figures using the USA CDC BMI chart were 27%, 11 % (boys) and 27%, 12% (girls). Using a USA-derived %BF chart incidences were 17%, 2% (boys) and 21%, 8% (girls) and using a UK-derived %BF chart 51%, 24% (boys) and 53%, 36% (girls). Sensitivity of BMI varied according to the %BF reference chart. Conclusions: In contrast to the BMI-based charts, there were considerable variations in depicted incidences of obesity between the %BF-based charts. These discordances were considered to result from previously reported variation within and between BIA and DXA %BF assessments underlying the charts. The present study highlights the need for valid, reliable, unchanging BIA and DXA procedures.", "author" : [ { "dropping-particle" : "", "family" : "Telford", "given" : "R D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cunningham", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daly", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reynolds", "given" : "G J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lafferty", "given" : "A R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gravenmaker", "given" : "K J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Budge", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Javaid", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bass", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Telford", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of Human Biology", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "language" : "English", "page" : "334-341", "title" : "Discordance of international adiposity classifications in Australian boys and girls - The LOOK study", "type" : "article-journal", "volume" : "35" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Grummer-Strawn", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reinold", "given" : "C R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Krebs", "given" : "N F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Morbidity and Mortality Weekly Report (MMWR), CDC", "id" : "ITEM-4", "issue" : "RR-9", "issued" : { "date-parts" : [ [ "2010" ] ] }, "number-of-pages" : "1-20", "publisher-place" : "Atlanta, GA", "title" : "Use of World Health Organization and CDC Growth Charts for Children Aged 0 \u2013 59 Months in the United States", "type" : "report", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4,13,18,19", "plainTextFormattedCitation" : "4,13,18,19", "previouslyFormattedCitation" : "4,13,18,19" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4,13,18,19. Figure 1 illustrates how an individual child from the E4Kids data set, aged 3-.5-years of 103.5cm height and 19.3kg weight was classified using the three standards. There are several reasons why each of the standards would yield different results. Specifically, each of the international standards are based on different sample populations and employ different statistical methodologies to derive their cut-points for categorization. The CDC is based on a normative US population; the WHO from a population specifically chosen for optimal development characteristics, free from economic constraints; and the IOTF which backward maps from overweight and obesity cut-points in adulthood. Furthermore, the prevalence estimates differ due to the choice of cut-points or percentiles which correspond to overweight and obesity used by each of the three standards. The WHO uses more stringent cut-points of overweight (2 SD = 97.7th percentile) and obesity (3 SD = 99.9th percentile) for children aged between birth and 5 years than those recommended by the CDC (85th and 95th percentile, respectively). The IOTF centiles for obesity at age 18 (BMI of ≥30), corresponds to the 97th and 96th percentile for US boys and girls, respectively ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.2047-6310.2012.00064.x", "ISSN" : "2047-6310", "abstract" : "Background: The international (International Obesity Task Force; IOTF) body mass index (BMI) cut-offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based on data from six countries fitted by the LMS method, they link BMI values at 18\u2009years (16, 17, 18.5, 25 and 30\u2009kg\u2009m\u22122) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. the World Health Organization (WHO) standard, these cut-offs cannot be expressed as centiles (e.g. 85th). \nMethods: To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut-offs defined in terms of the centiles at 18\u2009years corresponding to each BMI value. These new cut-offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data.\nResults: The new cut-offs were virtually identical to the originals, giving prevalence rates differing by <0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5.\nConclusions: Defining the international cut-offs in terms of the underlying LMS curves has several benefits. New cut-offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity\u2009=\u200998.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction.", "author" : [ { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatric Obesity", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012", "8", "1" ] ] }, "note" : " - the short cut to the actual website", "page" : "284-294", "title" : "Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "22", "plainTextFormattedCitation" : "22", "previouslyFormattedCitation" : "22" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }22. These differences are also dependent on the sample that is being examined, i.e. the IOTF cut-point for overweight corresponds with the 85th percentile in US children, but around the 90th percentile in children from the UK ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "978-1-4051-8226-3", "author" : [ { "dropping-particle" : "", "family" : "Must", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "Sarah E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "28", "container-title" : "Clinical Obesity in Adults and Children", "edition" : "Third", "editor" : [ { "dropping-particle" : "", "family" : "Kopelman", "given" : "Peter G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caterson", "given" : "Ian D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dietz", "given" : "William H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "375 - 392", "publisher" : "Wiley-Blackwell Publishing Ltd.", "publisher-place" : "Singapore", "title" : "Childhood Obesity: Definition, classification and assessment", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/978-1-4419-1788-1_2", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Youfa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chen", "given" : "Hsin-Jen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "2", "container-title" : "Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease", "editor" : [ { "dropping-particle" : "", "family" : "Preedy", "given" : "V. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "29-48", "publisher" : "Springer Science & Business Media", "publisher-place" : "London", "title" : "Use of Percentiles and Z-scores in Anthropometry", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "", "ISSN" : "03070565", "abstract" : "OBJECTIVE: To assess the ability of simple definitions of BMI to successfully screen for children with high body fatness. DESIGN: We determined the sensitivity and specificity of the body mass index (BMI) by testing its ability to correctly identify children with high body fat percentage. Receiver operator characteristic (ROC) analyses were carried out using the top 5% of body fat percentage to define children as obese (true positives). SUBJECTS: Representative sample of 4175 7 y-old (88-92 month-old) children (2120 boys; 2055 girls) participating in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). RESULTS: The current obesity definition based on BMI (95th centile) had moderately high sensitivity (88%) and high specificity (94%). Sensitivity and specificity did not differ significantly between boys and girls. The ROC analysis showed that lower cut-offs applied to the BMI improved sensitivity with no marked loss of specificity: the optimum combination of sensitivity (92%) and specificity (92%) was at a BMI cut-off equivalent to the 92nd centile. Sensitivity of BMI using the new International Obesity Task Force (IOTF) cut-off for obesity was much lower, and differed significantly (P<0.001) between boys (46%) and girls (72%). CONCLUSIONS: Screening for childhood obesity using the BMI is specific, and can have moderately high sensitivity if an appropriate cut-off is chosen. New recommendations based on the IOTF approach to defining childhood obesity are associated with lower sensitivity, and sensitivity differs between boys and girls. INTERNATIONAL JOURNAL OF OBESITY: (2000) 24, 1623-1627", "author" : [ { "dropping-particle" : "", "family" : "Reilly", "given" : "J. 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It is evident that in the current sample, the IOTF cut-points for overweight align closely with the CDC’s 85th percentile, yet the IOTF obesity cut-points align more closely with WHO’s 3SD. Therefore, our findings emphasise the concern that studies reporting prevalence of overweight and obesity in child populations might have very different results based on which standards are used.We then assessed the use of each of the standards in all published literature relating to preschool aged children in Australia in the period when all three international standards were available for selection (2006-2017). We found a distinct preference among the research outputs, with 16 of the 2019 papers identified employing the IOTF standards. Furthermore, the weighted averages from papers using IOTF gave much lower estimates in comparison to the paper’s employing the CDC standards. Only one studyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/oby.21544", "ISSN" : "1930739X", "PMID" : "27380909", "author" : [ { "dropping-particle" : "", "family" : "Hayes", "given" : "Alison", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chevalier", "given" : "Anna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "D'Souza", "given" : "Mario", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baur", "given" : "Louise", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wen", "given" : "Li Ming", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simpson", "given" : "Judy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1752-1758", "title" : "Early childhood obesity: Association with healthcare expenditure in Australia", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "26", "plainTextFormattedCitation" : "26" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }26 reported weight status using the WHO standards, therefore weighted averages were unable to be computed, however the prevalence of overweight and obesity in this study was quite high (38%). However,Notably this study was of low-SES families living in Sydney, Australia, and the higher risk of overweight and obesity in this population may account for the high rates of overweight/obesity prevalence reported in this study. The preference for using the IOTF identified in the Australian studies found may be explained in two ways. First, the rationale may be substantive and based on a concern to use a reference that is based in population health which is internationally comparable. Alternatively, it may be that consensus and publication patterns drive selection. That is, researchers choose a reference standard on the basis that other studies have made a particular choice. The Australian National Health and Medical Research Council guidelines recommend the use of either the CDC or WHO growth charts for children aged 2-18 years in clinical practice ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "National Health and Medical Research Council", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "number-of-pages" : "1-30", "publisher-place" : "Melbourne, AU", "title" : "Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "27", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "27" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27. It is recognized that clinical use may involve other consideration relating to sensitivity and specificity ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0307-0565", "author" : [ { "dropping-particle" : "", "family" : "Reilly", "given" : "J. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Int J Obes", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "595-597", "publisher" : "Nature Publishing Group", "title" : "Diagnostic accuracy of the BMI for age in paediatrics", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "28", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "28" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }28 (e.g. if adopted for screening or for diagnosis), however, differential use of these standards means that interpretation will vary widely, with more or fewer individual children captured, depending on the standard used. For research purposes, there is not a specific guideline, and the selection of the standard is relative to the research aim. Some researchers have advocated for the use of IOTF in epidemiological research based on this standard’s modelling from adult base BMI cut-offs, and the possibilities for international comparison ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0959-8138", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Youfa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "Joanna Q", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-1", "issue" : "7269", "issued" : { "date-parts" : [ [ "2000", "11", "4" ] ] }, "page" : "1158", "publisher" : "BMJ Group", "title" : "Standard definition of child overweight and obesity worldwide: Authors' standard compares well with WHO standard", "type" : "article-journal", "volume" : "321" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Background: Few studies have used the same references across countries to examine the trends of over- and underweight in older children and adolescents.Objective: Using international references, we examined the trends of overweight and underweight in young persons aged 6\u201318 y from 4 countries.Design: Nationally representative data from Brazil (1975 and 1997), Russia (1992 and 1998), and the United States (1971\u20131974 and 1988\u20131994) and nationwide survey data from China (1991 and 1997) were used. To define overweight, we used the sex- and age-specific body mass index cutoffs recommended by the International Obesity Task Force. The sex- and age-specific body mass index fifth percentile from the first US National Health and Nutrition Examination Survey was used to define underweight.Results: The prevalence of overweight increased during the study periods in Brazil (from 4.1 to 13.9), China (from 6.4 to 7.7), and the United States (from 15.4 to 25.6); underweight decreased in Brazil (from 14.8 to 8.6), China (from 14.5 to 13.1), and the United States (from 5.1 to 3.3). In Russia, overweight decreased (from 15.6 to 9.0) and underweight increased (from 6.9 to 8.1). The annual rates of increase in the prevalence of overweight were 0.5% (Brazil), 0.2% (China), \u22121.1% (Russia), and 0.6% (United States).Conclusions: The burden of nutritional problems is shifting from energy imbalance deficiency to excess among older children and adolescents in Brazil and China. The variations across countries may relate to changes and differences in key environmental factors. ", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Youfa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Monteiro", "given" : "Carlos", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Popkin", "given" : "Barry M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Clinical Nutrition ", "id" : "ITEM-2", "issue" : "6 ", "issued" : { "date-parts" : [ [ "2002", "6", "1" ] ] }, "page" : "971-977", "title" : "Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia", "type" : "article-journal", "volume" : "75 " }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1111/j.1467-789X.2010.00748.x", "ISSN" : "1467-789X", "abstract" : "Two international datasets are used to define overweight and obesity in pre-school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24\u201360 months old children. This was done by plotting the IOTF cut-offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut-off for overweight in 24\u201360 months old children goes from 1.7 to 1.1 z-scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z-scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut-offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut-offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.", "author" : [ { "dropping-particle" : "", "family" : "Monasta", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lobstein", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vignerov\u00e1", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cattaneo", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Reviews", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "295-300", "publisher" : "Blackwell Publishing Ltd", "title" : "Defining overweight and obesity in pre-school children: IOTF reference or WHO standard?", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4,29,30", "plainTextFormattedCitation" : "4,29,30", "previouslyFormattedCitation" : "4,29,30" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4,29,30. There are alternative arguments for selection of the CDC and WHO, however, based on health related characteristics that affect growth trajectories and long-term health outcomes of the base population (e.g. breastfeeding) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kuczmarski", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "C L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guo", "given" : "S S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grummer-Strawn", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mei", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtin", "given" : "Lester R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roche", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "Clifford L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Vital Health Stat", "id" : "ITEM-1", "issue" : "246", "issued" : { "date-parts" : [ [ "2002" ] ] }, "number-of-pages" : "1-190", "title" : "2000 CDC growth charts for the United States: Methods and development", "type" : "report", "volume" : "11" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/978-1-4419-1788-1_2", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Youfa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chen", "given" : "Hsin-Jen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "2", "container-title" : "Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease", "editor" : [ { "dropping-particle" : "", "family" : "Preedy", "given" : "V. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "29-48", "publisher" : "Springer Science & Business Media", "publisher-place" : "London", "title" : "Use of Percentiles and Z-scores in Anthropometry", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "5,8", "plainTextFormattedCitation" : "5,8", "previouslyFormattedCitation" : "5,8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }5,8. However, aA recent study comparing the use of the CDC and WHO standards on the height of Australian children (2–16 years), found that neither effectively standardised height and thus argued that there may be a need for the development of local growth charts specifically for Australian children ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/jpc.12672", "ISSN" : "1440-1754", "abstract" : "Aim: (i) To compare the Centers for Disease Control and Prevention (CDC) reference and World Health Organization (WHO) standard/reference for height, particularly with respect to short stature and eligibility for growth hormone (GH) treatment by applying them to contemporary Australian children; (ii) To examine the implications for identifying short stature and eligibility for GH treatment. Methods: Children from the longitudinal Raine Study were serially measured for height from 1991 to 2005 (2\u201315-year-old girls (660) and boys (702) from Western Australia). In the cross-sectional Australian National Children's Nutrition and Physical Activity survey (2\u201316-year-old boys (2415) and girls (2379) from all states), height was measured in 2007. Heights were converted to standard deviation scores (SDSs) based on CDC and WHO. Results: Means and standard deviations of height-SDS varied between CDC and WHO definitions and with age and gender within each definition. However, both identified similar frequencies of short stature (<1st centile for GH eligibility), although these were very significantly less than the anticipated 1% (0.1\u20130.7%) of the Australian cohorts. Mean heights in the Australian cohorts were greater than both the WHO and CDC means. Conclusions: Neither CDC nor WHO height standardisations accurately reflect the contemporary Australian child population. Australian children are taller than the CDC or WHO height means, and significantly less than 1% of Australian children are defined as being short using either CDC or WHO. This study suggests there may be a case for an Australian-specific standard/reference for height.", "author" : [ { "dropping-particle" : "", "family" : "Hughes", "given" : "Ian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "Mark", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cotterill", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garnett", "given" : "Sarah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bannink", "given" : "Ellen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pennell", "given" : "Craig", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sly", "given" : "Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leong", "given" : "Gary M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cowell", "given" : "Chris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ambler", "given" : "Geoff", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Werther", "given" : "George", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hofman", "given" : "Paul", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cutfield", "given" : "Wayne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Choong", "given" : "Catherine S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Paediatrics and Child Health", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "895-901", "title" : "Comparison of Centers for Disease Control and Prevention and World Health Organization references/standards for height in contemporary Australian children: Analyses of the Raine Study and Australian National Children's Nutrition and Physical Activity coho", "type" : "article-journal", "volume" : "50" }, "uris" : [ "", "" ] } ], "mendeley" : { "formattedCitation" : "31", "plainTextFormattedCitation" : "31", "previouslyFormattedCitation" : "31" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }31. In the meantime, in today’s ‘big data’ age, researchers should consider providing raw height, weight, and age data for publications. This will ensure comparability across studies and will assist investigations of the relationship between BMI and health outcomes.In conclusion, paediatric obesity remains a significant public health concern both in Australia and internationally. Accurate classification and assessment of the clinical burden is vital to inform action. The three international standards commonly used produce significantly different prevalence estimates of overweight and obesity when applied to a single population of Australian pre-school children. Furthermore, given the reliance of Australian researchers on the IOTF standards for 3 – 5 year old populations, there is a possibility that we are either under or over-estimating the prevalence of childhood obesity amongst pre-school aged children in Australia, even if all other aspects of the study quality are high. Therefore, researchers need to take care to limit comparisons within metric types and give careful consideration to their research aims and sample population when selecting the growth standard to use. ReferencesADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1.Rokholm, B., Baker, J. L. & S?rensen, T. I. A. The levelling off of the obesity epidemic since the year 1999 – a review of evidence and perspectives. Obes. Rev. 11, 835–846 (2010).2.Ogden, C. L., Carroll, M., BK, K. & KM, F. Prevalence of childhood and adult obesity in the united states, 2011-2012. JAMA 311, 806–814 (2014).3.Australian Bureau of Statistics. 4364.0.55.001 - Australian Health Survey: First Results, 2014–15. (2015). at <, L., Lobstein, T., Cole, T. J., Vignerová, J. & Cattaneo, A. Defining overweight and obesity in pre-school children: IOTF reference or WHO standard? Obes. Rev. 12, 295–300 (2011).5.Wang, Y. & Chen, H.-J. in Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease (ed. 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Assessing the effectiveness of Australian early childhood education and care experiences: study protocol. BMC Public Health (2016). doi:10.1186/s12889-016-2985-122.Cole, T. J. & Lobstein, T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr. Obes. 7, 284–294 (2012).23.Australian Bureau of Statistics. 6227.0 - Education and Work, Australia, May 2015. (2015). at < Features1May 2015?opendocument&tabname=Summary&prodno=6227.0&issue=May 2015&num=&view=>24.Australian Bureau of Statistics. 4402.0 - Childhood Education and Care, Australia, June 2014. (2014). at < Features2June 2014?opendocument&tabname=Summary&prodno=4402.0&issue=June 2014&num=&view=>25.Zhou, S. J., Gibson, R. A., Gibson, R. S. & Makrides, M. Nutrient intakes and status of preschool children in Adelaide, South Australia. Med. J. Aust. 196, 696–700 (2012).26.Hayes, A. et al. Early childhood obesity: Association with healthcare expenditure in Australia. 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Child Health 50, 895–901 (2014).32.Campbell, M. W. C., Williams, J., Hampton, A. & Wake, M. Maternal concern and perceptions of overweight in Australian preschool-aged children. Med. J. Aust. 184, 274–277 (2006).33.Cox, R., Skouteris, H., Dell’Aquila, D., Hardy, L. L. & Rutherford, L. Television viewing behaviour among pre-schoolers: Implications for public health recommendations. J. Paediatr. Child Health 49, E108–E111 (2013).34.Cretikos, M. A., Valenti, L., Britt, H. C. & Baur, L. A. General practice management of overweight and obesity in children and adolescents in Australia. Med. Care 46, 1163–1169 (2008).35.Crouch, P., O’Dea, J. & Battisti, R. Child feeding practices and perceptions of childhood overweight and childhood obesity risk among mothers of preschool children. Nutr. Diet. 64, 151–158 (2007).36.De Silva-Sanigorski, A. M. et al. Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program. Am. J. Clin. Nutr. 91 , 831–840 (2010).37.Franzon, J., Hugo, G., Wittert, G. & Wilson, D. Overweight and obesity in 4-year-old South Australian children and the stability of IOTF cut points in this age group. Obes. Res. Clin. Pract. 2, 247–250 (2008).38.Gopinath, B. et al. Body Mass Index and Waist Circumference Are Associated With Blood Pressure in Preschool-Aged Children. Ann. Epidemiol. 21, 351–357 (2011).39.Jones, R. A., Okely, A. D., Gregory, P. & Cliff, D. P. Relationships between weight status and child, parent and community characteristics in preschool children. Int. J. Pediatr. Obes. 4, 54–60 (2008).40.Kremer, P. J., Bell, A. C., Sanigorski, A. M. & Swinburn, B. A. Overweight and obesity prevalence in children based on 6-or 12-month IOTF cut-points: does interval size matter? Int. J. Obes. 30, 603–605 (2006).41.Nichols, M. S. et al. Decreasing trends in overweight and obesity among an Australian population of preschool children. Int. J. Obes. 35, 916–924 (2011).42.Pettman, T., Magarey, A., Mastersson, N., Wilson, A. & Dollman, J. Improving weight status in childhood: Results from the eat well be active community programs. Int. J. Public Health 59, 43–50 (2014).43.Spurrier, N. J., Magarey, A. A., Golley, R., Curnow, F. & Sawyer, M. G. Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study. Int. J. Behav. Nutr. Phys. Act. 5, 31 (2008).44.Spurrier, N. J., Volkmer, R. E., Abdallah, C. A. & Chong, A. South Australian four-year-old Aboriginal children: residence and socioeconomic status influence weight. Aust. N. Z. J. Public Health 36, 285–290 (2012).45.Tai, A., Volkmer, R. & Burton, A. Association between asthma symptoms and obesity in preschool (4-5 year old) children. J. Asthma 46, 362–365 (2009).46.Tey, C., Wake, M., Campbell, M., Hampton, A. & Williams, J. The light time-use diary and preschool activity patterns: Exploratory study. Int. J. Pediatr. Obes. 2, 167–173 (2007).47.Wake, M., Nicholson, J. M., Hardy, P. & Smith, K. Preschooler obesity and parenting styles of mothers and fathers: Australian National Population Study. Pediatrics 120, E1520–E1527 (2007).48.Wolfenden, L. et al. Prevalence and socio-demographic associations of overweight and obesity among children attending child-care services in rural and regional Australia. Nutr. Diet. 68, 15–20 (2011).49.Zuo, Y., Norberg, M., Wen, L. M. & Rissel, C. Estimates of overweight and obesity among samples of preschool-aged children in Melbourne and Sydney. Nutr. Diet. 63, 179–182 (2006). Table 1. Description of the three international reference values for overweight and obesityADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4419-1788-1_2", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Youfa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chen", "given" : "Hsin-Jen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "2", "container-title" : "Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease", "editor" : [ { "dropping-particle" : "", "family" : "Preedy", "given" : "V. 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METHODS: The WHO Child Growth Standards were derived from an international sample of healthy breastfed infants and young children raised in environments that do not constrain growth. Rigorous methods of data collection and standardized procedures across study sites yielded very high-quality data. The generation of the standards followed methodical, state-of-the-art statistical methodologies. The Box-Cox power exponential (BCPE) method, with curve smoothing by cubic splines, was used to construct the curves. The BCPE accommodates various kinds of distributions, from normal to skewed or kurtotic, as necessary. A set of diagnostic tools was used to detect possible biases in estimated percentiles or z-score curves. RESULTS: There was wide variability in the degrees of freedom required for the cubic splines to achieve the best model. Except for length/height-for-age, which followed a normal distribution, all other standards needed to model skewness but not kurtosis. Length-for-age and height-for-age standards were constructed by fitting a unique model that reflected the 0.7-cm average difference between these two measurements. The concordance between smoothed percentile curves and empirical percentiles was excellent and free of bias. Percentiles and z-score curves for boys and girls aged 0-60 mo were generated for weight-for-age, length/height-for-age, weight-for-length/height (45 to 110 cm and 65 to 120 cm, respectively) and body mass index-for-age. CONCLUSION: The WHO Child Growth Standards depict normal growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socio-economic status and type of feeding.", "author" : [ { "dropping-particle" : "", "family" : "WHO Multicentre Growth Reference Study Group", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta paediatrica. Supplementum", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "76-85", "title" : "WHO Child Growth Standards based on length/height, weight and age.", "type" : "article-journal", "volume" : "450" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "7", "plainTextFormattedCitation" : "7", "previouslyFormattedCitation" : "7" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }7 Children aged between Birth and 5 years (or 60.99 months)BMI-for-age z-score >2 standard deviations above the mean BMI-for-age z-score >3 standard deviations above the meanMulticentre Growth Reference Study from Brazil, Ghana, India, Norway, Oman and the USAStatistical – Ideal “Healthy Child” DevelopmentCDC Growth Charts – 2000 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Kuczmarski", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogden", "given" : "C L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guo", "given" : "S S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grummer-Strawn", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mei", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtin", "given" : "Lester R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roche", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "Clifford L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Vital Health Stat", "id" : "ITEM-1", "issue" : "246", "issued" : { "date-parts" : [ [ "2002" ] ] }, "number-of-pages" : "1-190", "title" : "2000 CDC growth charts for the United States: Methods and development", "type" : "report", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "8", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }8Children aged between 2 and 19 years≥85th percentile≥95th percentileUS NHANES data (1971-1994)Statistical – normative USA population dataIOTF Reference Values – 2000 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.320.7244.1240", "author" : [ { "dropping-particle" : "", "family" : "Cole", "given" : "Tim J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bellizzi", "given" : "Mary C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flegal", "given" : "Katherine M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dietz", "given" : "William H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-1", "issue" : "7244", "issued" : { "date-parts" : [ [ "2000" ] ] }, "page" : "1240", "title" : "Establishing a standard definition for child overweight and obesity worldwide: international survey", "type" : "article-journal", "volume" : "320" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "9", "plainTextFormattedCitation" : "9", "previouslyFormattedCitation" : "9" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }9International BMI cut-points for children aged between 2 to 18 years≥BMI-for-age cut-offs (pass through BMI of 25 at age 18)≥ BMI-for-age cut-offs (pass through BMI of 30 at age 18)Multinational Surveys from Brazil, Britain, Hong Kong, the Netherlands, Singapore and the USCut-points are linked with adult BMI cut-points.Table 2. Demographic information of children and families participating in the E4Kids study.CharacteristicDescriptiveSample Size (n)Child age in years, Mean (SD)4.05 (0.52)1926Child gender (% Female) 48.91926Child ever breastfed? (% Yes) 91.21332Child is Aboriginal and/or Torres Strait Islander origin (%)1.91129Family CharacteristicsMain Caregiver born in Australia (%)80.61120Highest Level of Education of Main Caregiver (%)High school or did not complete high schoolTechnical certificate or diplomaUniversity bachelor degreePostgraduate university degree17.828.033.121.21059188297350224Table 3. Crude prevalence estimates of overweight and obesity in the E4Kids sample according to the three international standards and by gender.CategoryIOTFCDCWHOn%n%n%Overall (n = 1,926)Non-overweight/obese150878.3 a128966.9b174490.6c,bOverweight 34117.7a38520.0a1517.8b,bObese 774.0a25213.1b311.6a,aMale (n = 985)Not overweight/obese78679.8 a63564.5 b87688.9 c,bOverweight 16116.3 a21021.3 a888.9 a,bObese 383.9a14014.2 a212.1 a,aFemale (n = 941)Not overweight/obese72276.7 a65469.5b86892.2 c,bOverweight 18019.1 a17518.6 a636.7 b,bObese 394.1 a11211.9 a101.1 a,aa,b,c Denotes the z-score test of proportional difference. Note: The first set of letters denotes the difference between IOTF (a) and the prevalence estimates of each of the other standards. The second set of letters is a direct comparison between the CDC (a) and the WHO standards. If the letter subscripts differ from ‘a’ this indicates a statistically significant difference at the level of p < .05.Table 4. Selection of weight standard in Australian pre-school samples 2006-2017AuthorSample,Age; Female (%)BMI ReferenceAge BMI reportedNot Overweight%Overweight%Obese%Campbell et al., 2006 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0025-729X", "ISSN" : "0025729X", "PMID" : "16548831", "abstract" : "OBJECTIVE: To assess maternal concern about overweight in Australian preschool-aged children and factors predicting maternal concern about children's current and future weight status. DESIGN: Cross-sectional survey of child's body mass index and parent questionnaire. SETTING: Metropolitan Melbourne, Victoria, 2002. PARTICIPANTS: A community-based cohort of 324 4-year-old children and their parents. MAIN OUTCOME MEASURES: Mothers' reports of concern about the child's current and future weight status, and perceptions of the child's weight, diet and activity relative to their peers were compared with the child's measured weight status, and parent and child characteristics. RESULTS: The prevalence of overweight or obesity was 19%, but only 5% of mothers indicated concern about their child being currently overweight, while 16% worried their child would become overweight. Over 70% of mothers of overweight children saw them as being of similar weight to their peers. Most mothers saw their children as being equally or more active than other children and having a diet at least as healthy as their peers. Overweight daughters were more likely to elicit maternal concern about current weight than overweight sons (relative risk, 4.6; 95% CI, 1.1-19.8). Mothers were more likely to worry about their child's potential for future overweight if they or the child's father were overweight. CONCLUSIONS: Despite mounting public concern about childhood obesity in Australia, most mothers surveyed were not concerned about their child's weight, and many mothers did not perceive their overweight children as different from their peers. This may have implications for interventions that rely on acknowledgement of child overweight as a first step to change.", "author" : [ { "dropping-particle" : "", "family" : "Campbell", "given" : "Michele W C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Williams", "given" : "Joanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hampton", "given" : "Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wake", "given" : "Melissa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Journal of Australia", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "274-277", "title" : "Maternal concern and perceptions of overweight in Australian preschool-aged children", "type" : "article-journal", "volume" : "184" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "32", "plainTextFormattedCitation" : "32", "previouslyFormattedCitation" : "32" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }32Cohort follow-up of subset of the Parent Education And Support [PEAS] (N = 324) 4 yrs; 51.2IOTF M = 4.2 (SD = 0.2)81.017.03.0Cox et al.,2012 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/jpc.12041", "ISSN" : "1440-1754", "abstract" : "The current column explore excessive television (TV) viewing in early childhood has been associated with adverse cognitive and behavioural outcomes. A recent review of the literature revealed that TV viewing in the formative pre-school years has also been linked with other health concerns including sleep difficulties, increased aggression, anxiety and obesity. Given that early childhood is the time in which the foundations for future behaviours and habits are established and evidence shows that TV behaviours track from early childhood to adolescence, it is not surprising that there has been much interest in determining an 'appropriate' amount of screen time for pre-schoolers. The aim of this paper is to review current recommendations around Australian pre-school children\u2019s TV use and the implications of these guidelines when we consider current data pertaining to young children\u2019s TV viewing behaviour. (PsycINFO Database Record (c) 2013 APA, all rights reserved)", "author" : [ { "dropping-particle" : "", "family" : "Cox", "given" : "Rachael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Skouteris", "given" : "Helen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dell'Aquila", "given" : "Daniela", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hardy", "given" : "Lousie L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rutherford", "given" : "Leonie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Paediatrics and Child Health", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2013", "2" ] ] }, "page" : "E108-E111", "publisher" : "Wiley-Blackwell Publishing Ltd.", "publisher-place" : "Skouteris, Helen, School of Psychology, Deakin University 221 Burwood Highway, Burwood, VIC, Australia, 3125, helen.skouteris@deakin.edu.au", "title" : "Television viewing behaviour among pre-schoolers: Implications for public health recommendations.", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "33", "plainTextFormattedCitation" : "33", "previouslyFormattedCitation" : "33" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }33Cross-sectional survey of children and their mothers in Melbourne, Australia (N = 135) 2 – 6 yrs; 60.0CDC?M = 4.5 (SD = 0.84)85.211.13.7Cretikos et al.,a 2008 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/MLR.0b013e318179259a", "ISBN" : "0025-7079\r1537-1948", "abstract" : "Background: Childhood obesity is rapidly increasing in prevalence worldwide, but healthcare capacity to address this problem seems limited. Objective: The purpose of this study was to describe the prevalence and rate of management of childhood overweight and obesity in Australian general practice. Subjects: A cross-sectional study consisting of 3978 general practitioners (GPs), randomly selected using Medicare Australia claims, who recorded 42,515 encounters with children age 2-17 including 12,925 sub-sampled encounters with self or carer-reported height and weight collected. Measures: Prevalence of overweight and obesity, rate of management of overweight and obesity, content of encounters in overweight and nonoverweight children, content of encounters in those managed for overweight and obesity, and management to prevalence ratio. Results: A total of 29.6% of sub-sampled children were classified as overweight (18.3%) or obese (11.4%). GPs managed overweight and obesity during 215 encounters, or once per 200 encounters with children age 2-17 and once per 58 encounters with overweight or obese children. The content of encounters in overweight and non-overweight children did not differ. Children who were managed for overweight or obesity presented with these conditions as reasons for the encounter significantly more often [66.5 (95% confidence interval (CI): 59.7-73.3) vs. 1.2 (95% CI: 1.0-1.3)] and were managed for more problems, particularly depression [4.2 (95% CI: 1.5-6.9) vs. 0.8 (95% CI: 0.7-0.9)], than average per 100 encounters. Consultations for overweight or obesity were significantly longer than average [16.7 (95% CI: 14.7-18.7) vs. 12.4 (95% CI: 12.2-12.5) minutes]. Conclusions: Overweight and obesity are prevalent in children presenting to Australian general practice but GPs do not use most of the available opportunities to manage this problem. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (journal abstract)", "author" : [ { "dropping-particle" : "", "family" : "Cretikos", "given" : "Michelle A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Valenti", "given" : "Lisa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Britt", "given" : "Helena C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baur", "given" : "Louise A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Care", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1163-1169", "publisher" : "Lippincott Williams & Wilkins", "publisher-place" : "US", "title" : "General practice management of overweight and obesity in children and adolescents in Australia", "type" : "article-journal", "volume" : "46" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "34", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "34" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34Sub-sample of the Bettering the Evaluation and Care of Health[BEACH] program (N = 12,925) a2-17 yrs; 71.3IOTF?(CDC and ABS data used to identify BIV)2 – 4(n = 3,015) 71.214.714.1Crouch et al.,2007 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1747-0080.2007.00180.x", "author" : [ { "dropping-particle" : "", "family" : "Crouch", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "O'Dea", "given" : "JA", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Battisti", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nutrition & Dietetics", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "151-158", "title" : "Child feeding practices and perceptions of childhood overweight and childhood obesity risk among mothers of preschool children", "type" : "article-journal", "volume" : "64" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "35", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "35" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35Mothers and their children, attending swim lessonsat a Central Coast swim school in NSW(N = 111) 2 – 6 yrs; 48.6IOTFM = 4.42 (SD = 1.35)78.415.36.3de Silva-Sanigorski et al.,2010 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3945/ajcn.2009.28826", "abstract" : "Background: There is growing evidence that community-based interventions can reduce childhood obesity in older children.Objective: We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0\u20135 y.Design: Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y.Results: After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05).Conclusion: A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young children's diets. This trial was registered with the Australian Clinical Trials Registry at .au as ACTRN12607000374460. ", "author" : [ { "dropping-particle" : "", "family" : "Silva-Sanigorski", "given" : "Andrea M", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bell", "given" : "A Colin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kremer", "given" : "Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nichols", "given" : "Melanie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Crellin", "given" : "Maree", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharp", "given" : "Sharon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Groot", "given" : "Florentine", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carpenter", "given" : "Lauren", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boak", "given" : "Rachel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Robertson", "given" : "Narelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swinburn", "given" : "Boyd A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American Journal of Clinical Nutrition ", "id" : "ITEM-1", "issue" : "4 ", "issued" : { "date-parts" : [ [ "2010", "4", "1" ] ] }, "note" : "10.3945/ajcn.2009.28826", "page" : "831-840", "title" : "Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program", "type" : "article-journal", "volume" : "91 " }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "36", "plainTextFormattedCitation" : "36", "previouslyFormattedCitation" : "36" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }36Romp and Chomp community-based obesity prevention RCT, conducted in Victoria (n = 15,838)3.5 yr cohort; 48.8IOTF(BMIz and BMI used the CDC STATA program)^C group:M = 3.65 (SE = .001)n = 14,64783.613.23.2Franzon et al.,2008 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "", "ISBN" : "1871-403X", "abstract" : "SummaryObjective To assess the validity of internationally accepted mid-year cut points for overweight and obesity in children and their application for ongoing surveillance. Data A large (n = 114,925) state wide administrative data set of preschool children (aged 48\u201360 months) in South Australia including measured height and weight, collected at various points in the fifth year of life by the Children, Youth and Women's Health Service (CYWHS) between 1995 and 2003. Methods Prevalence of overweight and obesity were calculated for each year of the data set between 1995 and 2003. The international mid-year cut points were compared to cut points for each month of age throughout the fifth year of life. Results The prevalence of overweight and obesity in this age group has increased significantly over the period for both males and females. The estimates of overweight and obesity prevalence for both males and females calculated using the mid-year cut points were not significantly different to cut points for each month of age in both genders. Conclusions The body mass index of children does not vary significantly through the fifth year of life and prevalence estimates can be obtained at any point in the fifth or sixth year of age for surveillance purposes.", "author" : [ { "dropping-particle" : "", "family" : "Franzon", "given" : "Julie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hugo", "given" : "Graeme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wittert", "given" : "Gary", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilson", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity Research & Clinical Practice", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "247-250", "title" : "Overweight and obesity in 4-year-old South Australian children and the stability of IOTF cut points in this age group", "type" : "article-journal", "volume" : "2" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "37", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "37" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }37Sate wide administrative data set of preschool children in South Australia [SA] (N = 114,925)4 – 5 yrs; 49.1IOTF4.5*82.912.64.5Gopinath et al.,2011 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.annepidem.2011.02.002", "ISBN" : "1047-2797", "abstract" : "PURPOSE: Population-derived data on the association between body mass index (BMI) and blood pressure (BP) during early childhood are lacking. We investigated the association between BMI, waist circumference, and BP among preschool-aged children. METHODS: A total of 1294 children ages 3 to 6 years were examined in the Sydney Paediatric Eye Disease Study during 2007 to 2009. Height, weight, and waist circumference were collected and BMI calculated. The weight status of each child was classified on the basis of age- and sex-specific BMI percentiles. BP was measured by the use of a standard protocol. RESULTS: A prevalence of 11.0% and 15.1% of children were obese or overweight, respectively. The prevalence of elevated BP was 21.3% among obese children compared with 12.4% of nonoverweight/obese children (p = .03). An increase of 1 BMI unit was independently associated with, on average, a 0.57 and 0.56 mm Hg increase in systolic and diastolic BP, respectively. Each unit increase in waist circumference was associated with a 0.14 and 0.23 mm Hg increase in systolic and diastolic BP, respectively. CONCLUSIONS: A strong and independent association between adiposity and BP was present during early childhood. These data have important public health implications because elevated BP at a young age may be associated with increased cardiovascular risk in later life. Ann Epidemiol 201121:351-357. (C) 2011 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Gopinath", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baur", "given" : "L A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garnett", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pfund", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burlutsky", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mitchell", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of Epidemiology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2011" ] ] }, "note" : "Gopinath, Bamini Baur, Louise A. Garnett, Sarah Pfund, Natalie Burlutsky, George Mitchell, Paul", "page" : "351-357", "title" : "Body Mass Index and Waist Circumference Are Associated With Blood Pressure in Preschool-Aged Children", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "38", "plainTextFormattedCitation" : "38", "previouslyFormattedCitation" : "38" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }38Sydney Paediatric Eye Disease Study [SPEDS] (N = 1,249) 3 – 6 yrs; 47.4CDC3(n = 333) 77.215.37.54(n = 333)72.415.012.65(n = 321)71.716.811.5Hayes et al.,2016ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/oby.21544", "ISSN" : "1930739X", "PMID" : "27380909", "author" : [ { "dropping-particle" : "", "family" : "Hayes", "given" : "Alison", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chevalier", "given" : "Anna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "D'Souza", "given" : "Mario", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baur", "given" : "Louise", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wen", "given" : "Li Ming", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Simpson", "given" : "Judy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Obesity", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1752-1758", "title" : "Early childhood obesity: Association with healthcare expenditure in Australia", "type" : "article-journal", "volume" : "24" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "26", "plainTextFormattedCitation" : "26", "previouslyFormattedCitation" : "26" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }26The Healthy Beginnings Trial [HBT] (N = 350)WHO2-<5 yrs61299Jones et al., 2008 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/17477160802199984", "ISSN" : "1747-7166", "abstract" : "Objective. To examine, using an Ecological Systems Theoretical framework, relationships between weight status and child, parent and community characteristics and risk factors among preschool children. Methods. Cross-sectional data was collected from 140 children and their parents from 11 randomly selected preschools. Outcome variables included: motor development; perceived competence; objectively measured physical activity; time spent in active and quiet play; location and number of televisions; parental rules around physical activity and time spent watching television; availability of sport and physical activity programs; and parks and open spaces and access to footpaths. Results. Overweight children spent more time in quiet play and watching television and less time in active play and physical activity. Perceived competence and motor development were similar for both overweight and non-overweight children. Associations between weight status and several parent and community characteristics were not evident, except for access to footpaths. Overweight children had greater access to footpaths compared with non-overweight children (p=0.046). Conclusion. The results reported here showed little difference between overweight and non-overweight children in relation to a variety of child, parent and community variables. However, for some characteristics, differences in older children have been reported. Longitudinal studies are required to confirm when these characteristics begin to differ, what effects these differences have on behaviour and weight-status, and therefore when targeted treatment should be provided during a child's development.", "author" : [ { "dropping-particle" : "", "family" : "Jones", "given" : "Rachel A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Okely", "given" : "Anthony D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gregory", "given" : "Parriel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cliff", "given" : "Dylan P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Pediatric Obesity", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2008", "1", "1" ] ] }, "note" : "doi: 10.1080/17477160802199984", "page" : "54-60", "publisher" : "Taylor & Francis", "title" : "Relationships between weight status and child, parent and community characteristics in preschool children", "type" : "article-journal", "volume" : "4" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "39", "plainTextFormattedCitation" : "39", "previouslyFormattedCitation" : "39" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }39Pre-school Activity ‘N’ Dietary Adiposity [PANDA] (N = 138)2 – 6 yrs; 48.6IOTFM = 4.3 (0.7)80.419.6Kremer et al.,b2006 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/sj.ijo.0803162", "ISBN" : "0307-0565", "abstract" : "The International Obesity Taskforce (IOTF) recommends using age- and gender-specific body mass index (BMI) cut-points for defining the prevalence of overweight and obesity in children. These are given in both 6- and 12-month age intervals. Since the BMI-for-age curves are nonlinear, a degree of bias will be introduced when age intervals are wide. We aimed to quantify this bias in prevalence estimates in 2178 Australian children aged 4-12 years using 12- versus 6- month age intervals. Using the 12- month interval, the prevalence of overweight and obesity was underestimated by 1.4% compared to the 6- month interval estimates; however, this was age- dependent. It overestimated prevalence for 4-year olds, but underestimated it for older ages by up to 2.6%. Overweight prevalence was generally affected more than obesity prevalence. The use of different age intervals for IOTF cut-points introduces a small but systematic bias in prevalence estimates of overweight and obesity.", "author" : [ { "dropping-particle" : "", "family" : "Kremer", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bell", "given" : "A C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sanigorski", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swinburn", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Obesity", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2006" ] ] }, "language" : "English", "page" : "603-605", "title" : "Overweight and obesity prevalence in children based on 6-or 12-month IOTF cut-points: does interval size matter?", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "40", "plainTextFormattedCitation" : "40", "previouslyFormattedCitation" : "40" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }40Representative sample of children in Barwon-South Western Victoria (N = 2,178) 4 – 12 yrs; 52.1IOTF4*(n = 176)70.523.36.35*(n = 247)75.315.88.9Nichols et al.,2011 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/ijo.2011.64", "ISBN" : "0307-0565\r1476-5497", "abstract" : "Background: After several decades of increasing prevalence, recent evidence suggests a levelling of obesity rates in some groups, although little is known about trends in children under 5 years of age. Aim: To investigate the prevalence, trends and sociodemographic correlates of overweight and obesity in Australian preschool children between 1999 and 2007. Methods: Child anthropometric and demographic data were extracted from records of routine maternal and child health consultations for children aged 2 and 3.5 years in the Australian state of Victoria. Data were analysed for prevalence of overweight and obesity (according to International Obesity Task Force definitions), trends in prevalence from 1999 to 2007 and sociodemographic correlates of prevalence and trends. Results: Complete data were available for 129,266 2-year-old children and 96,164 3.5-year-old children from 41 local government areas across Victoria. Combined prevalence of overweight and obesity decreased significantly between 1999 and 2007 in 3.5-year-old children (by 3.1% points from 18.5 to 15.4%) and in 2-year-old children (1.1% point decrease from 13.5 to 12.4%). There was no accompanying increase in rates of underweight. Decreases were more pronounced in areas of lower socioeconomic status (SES). Prevalence of both overweight and obesity was consistently higher across time in the older group of children, in the lowest quartile of SES and among girls. Conclusions: Prevalence of overweight and obesity in preschool children in Victoria has decreased significantly between 1999 and 2007, whereas socioeconomic disparities have narrowed. Further research is needed to understand the reasons for the decreasing prevalence, and to better evaluate existing and emerging health promotion initiatives. Such evidence will be important to build on the findings of this study and to transfer lessons learnt to other population groups. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (journal abstract)", "author" : [ { "dropping-particle" : "", "family" : "Nichols", "given" : "M S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Silva-Sanigorski", "given" : "A M", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cleary", "given" : "J E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goldfeld", "given" : "S R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Colahan", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swinburn", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Obesity", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2011" ] ] }, "note" : "WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, VIC, Australia. Release Date: 20120402. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Journal Article. Language: English. Major Descriptor: Early Childhood Development; Epidemiology; Obesity; Overweight; Trends. Minor Descriptor: Demographic Characteristics; Preschool Students; Socioeconomic Status. Classification: Eating Disorders (3260). Population: Human (10); Male (30); Female (40). Location: Australia. Age Group: Childhood (birth-12 yrs) (100); Preschool Age (2-5 yrs) (160). Methodology: Empirical Study; Longitudinal Study; Retrospective Study; Quantitative Study. References Available: Y. Page Count: 9. Issue Publication Date: Jul, 2011. Publication History: First Posted Date: Mar 22, 2011; Accepted Date: Feb 11, 2011; Revised Date: Feb 4, 2011; First Submitted Date: Aug 3, 2010. Copyright Statement: All rights reserved. Macmillan Publishers Limited. 2011.", "page" : "916-924", "publisher" : "Nature Publishing Group", "publisher-place" : "United Kingdom", "title" : "Decreasing trends in overweight and obesity among an Australian population of preschool children", "type" : "article-journal", "volume" : "35" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "41", "plainTextFormattedCitation" : "41", "previouslyFormattedCitation" : "41" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }41Maternal and Child Health Services data on Victorian children (N = 96,164) 3.5 yr cohort; 49.1IOTF (WHO growth standards used to attain BIV)M = 3.64 (SD = .16)80.716.13.2Pettman et al.,2014 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00038-013-0455-4", "ISBN" : "1661-8564 (Electronic)\\r1661-8556 (Linking)", "ISSN" : "16618556", "PMID" : "23529384", "abstract" : "OBJECTIVES: The eat well be active Community Programs (ewba) aimed to prevent obesity among children aged 0-18 years in two Australian communities from 2006 to 2010. METHODS: ewba was a multi-strategy intervention in children's settings. The evaluation was quasi-experimental, including a before and after survey with intervention (INT) and non-randomised comparison (COMP) communities. Outcome measures included BMI-z score (zBMI) and overweight/obesity prevalence in children aged 4-5 years; and zBMI, waist circumference (WC) z-score and overweight/obesity prevalence in children aged10-12 years. RESULTS: After 3 years, among the 4-5 years old, mean zBMI was significantly lower in both INT (-0.20, p < 0.05) and COMP (-0.15, p < 0.05), however, changes were not significantly different between INT and COMP. There was a larger reduction in overweight/obesity prevalence in INT (-6.3 %) compared to COMP (-3.7 %) (p < 0.05, chi 2 test). In the 10-12 years old, mean zBMI did not change significantly in INT or COMP. There was a significant reduction in WC z-score in INT (-0.17, p < 0.05) but not in COMP (-0.10, p = NS), although not significantly different between INT and COMP (p = 0.092). CONCLUSIONS: These findings suggest that the ewba community intervention had a moderate impact, showing modest improvements in weight status at 3-year follow-up.", "author" : [ { "dropping-particle" : "", "family" : "Pettman", "given" : "Tahna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magarey", "given" : "Anthea", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mastersson", "given" : "Nadia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilson", "given" : "Annabelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dollman", "given" : "James", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Public Health", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "43-50", "title" : "Improving weight status in childhood: Results from the eat well be active community programs", "type" : "article-journal", "volume" : "59" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "42", "plainTextFormattedCitation" : "42", "previouslyFormattedCitation" : "42" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }42Evaluation of the Eat Well Be Active [EWBA] community program and intervention targeted 0-18yr olds living in SA. (n = 1,005)4-5 yr cohort; NRIOTF^^C group:M = 4.8 (SD = 0.23)(n = 541)77.117.65.4Table 4. (Continued)AuthorSample,Age; Female (%)BMI ReferenceAge BMI reportedNot Overweight%Overweight%Obese%Spurrier et al.,2008 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1479-5868-5-31", "ISBN" : "1479-5868", "ISSN" : "1479-5868", "PMID" : "18513416", "abstract" : "OBJECTIVE: To assess relationships between characteristics of the home environment and preschool children's physical activity and dietary patterns. METHODS: Homes of 280 preschool children were visited and information obtained by direct observation and parent interview regarding physical and nutritional characteristics of the home environment. Children's physical activity, sedentary behaviour and dietary patterns were measured using standardised parent-report questionnaires. Associations were analysed using analysis of variance and correlation. RESULTS: Parental physical activity (p = 0.03-0.008), size of backyard (p = 0.001) and amount of outdoor play equipment (p = 0.003) were associated with more outdoor play. Fewer rules about television viewing (p < 0.001) and presence of playstation (p = 0.02) were associated with more indoor sedentary time. Higher fruit and vegetable intake was associated with restricting children's access to fruit juice (p = 0.02) and restricting high fat/sugar snacks (p = 0.009). Lower intake of non-core foods was associated with restricting children's access to fruit juice (p = 0.007), cordial/carbonated drinks (p < 0.001) and high fat/sugar snacks (p = 0.003). Lower fruit and vegetable intake was associated with reminding child to 'eat up' (p = 0.007) and offering food rewards to eat main meal (p = 0.04). Higher intake of non-core foods was associated with giving food 'treats' (p = 0.03) and offering food rewards to eat main meal (p = 0.04). The availability of food groups in the home was associated with children's intake of these foods (fruit and vegetables, p < 0.001; fat in dairy, p = <0.001; sweetened beverages, p = 0.004-<0.001; non-core foods, p = 0.01-<0.001). CONCLUSION: Physical attributes of the home environment and parental behaviours are associated with preschool children's physical activity, sedentary behaviour and dietary patterns. Many of these variables are modifiable and could be targeted in childhood obesity prevention and management.", "author" : [ { "dropping-particle" : "", "family" : "Spurrier", "given" : "Nicola J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magarey", "given" : "Anthea A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golley", "given" : "Rebecca", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curnow", "given" : "Fiona", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sawyer", "given" : "Michael G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The international journal of behavioral nutrition and physical activity", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "31", "title" : "Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study.", "type" : "article-journal", "volume" : "5" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "43", "plainTextFormattedCitation" : "43", "previouslyFormattedCitation" : "43" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }43Families recruited through preschools, in the southern region Adelaide, SA(280) 4.1 – 5.4 yrs; 50.0IOTFM = 4.8 (SD = .21)79.015.06.0Spurrier et al. c,2012 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1753-6405.2012.00872.x", "ISBN" : "1326-0200", "abstract" : "Objective: Obesity rates have increased in children in Australia in the past 15 years. However, there is little available population data describing rates of overweight and obesity in Aboriginal children. Methods: Anthropometric data of four-year-old children (n=11,859) were collected by trained nurses at routine statewide preschool health checks during 2009. Weight status (underweight, healthy weight, overweight and obese) was determined using age and gender specific International Obesity Task Force (IOTF) cut-points. Results: There were 337 Aboriginal children (3%) in the study population. Aboriginal children had significantly higher rates of overweight and obesity compared to non-Aboriginal children (28% compared to 18% respectively, ?2p=0.0001). A statistically significant association between BMIz score and identifying as Aboriginal remained after controlling for rural/urban residence and socioeconomic status using multiple regression analyses. Conclusions: Aboriginal children have higher rates of overweight and obesity compared to their non-Aboriginal peers by the time they are four years of age. Aboriginal children have higher BMIz scores compared to non-Aboriginal children after controlling for rural/urban residence and socioeconomic status. Implications: A significant investment is required to optimise the health of Aboriginal women before pregnancy and throughout pregnancy. A rethink may be necessary in the approach to dietary management and catch-up growth of Aboriginal children of low birth weight or having growth failure in early childhood.", "author" : [ { "dropping-particle" : "", "family" : "Spurrier", "given" : "N J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Volkmer", "given" : "R E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abdallah", "given" : "C A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chong", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Australian and New Zealand Journal of Public Health", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Spurrier, Nicola J. Volkmer, Robert E. Abdallah, Christina Abi Chong, Alwin", "page" : "285-290", "title" : "South Australian four-year-old Aboriginal children: residence and socioeconomic status influence weight", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "44", "plainTextFormattedCitation" : "44", "previouslyFormattedCitation" : "44" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }44The Children, Youth, Women’s Health Service [CYWHS] school entry health assessment in SA in 2009 (N = 11,025) 3.5 - 5.9 yrs; 48.7IOTF (Also used BMIz – 1990 British Growth Reference Data) M = 4.76 (SD = .24)75.414.24.4Tai et al.,2009 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/02770900902759260", "author" : [ { "dropping-particle" : "", "family" : "Tai", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Volkmer", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burton", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Asthma", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "362-365", "title" : "Association between asthma symptoms and obesity in preschool (4-5 year old) children", "type" : "article-journal", "volume" : "46" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "45", "plainTextFormattedCitation" : "45", "previouslyFormattedCitation" : "45" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }45The Children, Youth, Women’s Health Service [CYWHS] school entry health assessment in SA in 2006 (N = 1,509)4 – 5 yrs; 49.0IOTFM = 4.6 (SD = .04)(n = 1,457 with anthropometric data)80.613.75.7Tey et al.,2007 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/17477160701369274", "ISBN" : "1747-7166", "abstract" : "Aim. To conduct an exploratory study of time-use patterns in Australian 5-year-old children, and to pilot the novel Children's Light Time-Use Diary as a potential tool for investigating relationships between children's time-use and weight status. Methods. Subjects for the present cross-sectional study were drawn from an established longitudinal cohort and included eighty-four 5-year-old Australian children (36 males) originally recruited as infants in three local government areas of Melbourne. Children were weighed and measured, and body mass index (BMI; kg/m(2)) calculated. Over three to four complete 24-hour periods, parents completed the Children's Light Time-Use Diary to record their child's activities in 15-minute blocks and details about the context in which the activities took place, selecting from a list of predetermined options. Results. The children studied were largely sedentary, with television viewing the most time-consuming activity outside sleep. Only 49% of children spent any time walking for transport or pleasure. Children spent a median of 71% of their time in activities that were likely to be physically active when outdoors, compared with 3% when indoors, but averaged only 110 minutes/day outdoors (excluding passive transport). The 11 overweight/obese children watched significantly more television than non-overweight children. Conclusion. The Children's Light Time-Use Diary appears to be a practical and informative tool, which may complement accelerometry as a tool relevant to future studies of the determinants of child overweight/obesity. Further validation studies and larger research trials seem warranted.", "author" : [ { "dropping-particle" : "", "family" : "Tey", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wake", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Campbell", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hampton", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Williams", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Pediatric Obesity", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Tey, Corinne Wake, Melissa Campbell, Michele Hampton, Anne Williams, Joanne", "page" : "167-173", "title" : "The light time-use diary and preschool activity patterns: Exploratory study", "type" : "article-journal", "volume" : "2" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "46", "plainTextFormattedCitation" : "46", "previouslyFormattedCitation" : "46" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }46Subset of ‘PEAS Study’ re-enrolled into the PEAS Kids Growth Study (N = 84)M = 5.1 yrs; 57.0IOTFM = 5.1 (SD = 0.1)8776Wake et al., d2007 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1542/peds.2006-3707", "ISBN" : "0031-4005", "abstract" : "OBJECTIVE. The purpose of this work was to determine relationships between BMI status at ages 4 to 5 years and mothers' and fathers' parenting dimensions and parenting styles. PARTICIPANTS AND METHODS. Participants were composed of all 4983 of the 4- to 5-year-old children in wave 1 of the nationally representative Longitudinal Study of Australian Children with complete BMI and maternal parenting data. Mothers and fathers self-reported their parenting behaviors on 3 multi-item continuous scales ( warmth, control, and irritability) and were each categorized as having 1 of 4 parenting styles ( authoritative, authoritarian, permissive, and disengaged) using internal warmth and control tertile cut points. Using a proportional odds model, odds ratios for children being in a higher BMI category were computed for mothers and fathers separately and together, after adjustment for factors associated with child BMI, including mothers' and fathers' BMI status. RESULTS. The sample was composed of 2537 boys and 2446 girls with a mean age 56.9 months; 15% were overweight and 5% were obese ( International Obesity Task Force criteria). Mothers' parenting behaviors and styles were not associated in any model with higher odds of children being in a heavier BMI category, with or without multiple imputation to account for missing maternal BMI data. Higher father control scores were associated with lower odds of the child being in a higher BMI category. Compared with the reference authoritative style, children of fathers with permissive and disengaged parenting styles had higher odds of being in a higher BMI category. CONCLUSIONS. This article is the first, to our knowledge, to examine the parenting of both parents in relation to preschoolers' BMI status while also adjusting for parental BMI status. Fathers' but not mothers' parenting behaviors and styles were associated with increased risks of preschooler overweight and obesity. Longitudinal impacts of parenting on BMI gain remain to be determined.", "author" : [ { "dropping-particle" : "", "family" : "Wake", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicholson", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hardy", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatrics", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Wake, Melissa Nicholson, Jan M. Hardy, Pollyanna Smith, Katherine", "page" : "E1520-E1527", "title" : "Preschooler obesity and parenting styles of mothers and fathers: Australian National Population Study", "type" : "article-journal", "volume" : "120" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "47", "plainTextFormattedCitation" : "47", "previouslyFormattedCitation" : "47" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }47Longitudinal Study of Australian Children [LSAC](n = 4,934; wave 1)4 – 5yr; 49.1IOTF4-579.315.25.5Wolfenden et al.,2011 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1747-0080.2010.01487.x", "ISBN" : "1446-6368", "abstract" : "To describe the prevalence and socio-demographic characteristics associated with body mass index among children attending child-care services in New South Wales, Australia. Cross-sectional study of parent-reported socio-demographic characteristics and objectively measured height and weight among children aged two to five years attending 40 randomly selected long day care centres and preschools. Seven hundred and sixty-four children, 11% of whom were Indigenous, participated in the study (response rate = 66%). Overall, 16.7% of children and 24.6% of Indigenous children were overweight or obese. Overweight and obesity was higher among children whose mothers did not have a university education (OR 1.91: 95% CI 1.15, 3.12) and who were Indigenous (OR 1.74: 95% CI 1.05, 2.90). No differences in prevalence were found between geographic areas. Multivariate analysis indicated that after adjusting for age, child-care service hours and other demographic covariates, only maternal education remained a significant predictor of weight status (OR 2.06: 95% CI 1.16, 3.66). The high prevalence of overweight and obesity among children attending child-care services underscores the importance of obesity prevention interventions in early child-care settings, and particularly those catering for Indigenous children.", "author" : [ { "dropping-particle" : "", "family" : "Wolfenden", "given" : "Luke", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hardy", "given" : "Louise L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wiggers", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Milat", "given" : "Andrew J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bell", "given" : "Colin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sutherland", "given" : "Rachel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nutrition & Dietetics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "15-20", "title" : "Prevalence and socio-demographic associations of overweight and obesity among children attending child-care services in rural and regional Australia", "type" : "article-journal", "volume" : "68" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "48", "plainTextFormattedCitation" : "48", "previouslyFormattedCitation" : "48" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }48Data collected as part of Good for Kids, Good for Life, NSW (N = 764) 2 – 5 yrs; 50.0IOTFM = 3.89 (SD = 0.79)83.312.74.0Zhou et al.,2012 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.5694/mja11.11080", "ISBN" : "0025-729X\r1326-5377", "abstract" : "Objective: To determine the nutrient intakes and status of preschool children from a representative population sample in Adelaide. Design, setting and participants: Cross-sectional survey of children aged 1-5 years, using a stratified random sampling method and a doorknocking strategy, between September 2005 and July 2007. Main outcome measures: Dietary intake, assessed using a 3-day weighed-food diary; anthropometrics, biomarkers of iron, zinc and vitamin B12, and fatty acid profiles assessed using standard methods. Results: Median energy intakes were within dietary recommendations for the age group. Overall energy contributions from carbohydrate, protein, fat and saturated fat intakes were 50%, 17%, 33% and 16%, respectively. The rates of inadequate intake of iron, zinc, calcium and vitamin C were low, as was the prevalence of iron deficiency (5%). Only a minority of children achieved the adequate intake for n-3 long-chain polyunsaturated fatty acids (32%) and dietary fibre (18%). There was no association between socioeconomic status and intakes of macronutrients and key micronutrients. Fourteen per cent of children were obese (BMI, > 95th percentile); no association between BMI and energy intake was shown. Conclusions: The dietary intake of children in the study was adequate for macronutrients and the majority of micronutrients. However, low intakes of fibre and n-3 long-chain polyunsaturated fatty acids and high saturated fat intakes have raised concerns that this dietary pattern may be associated with adverse long-term health effects.", "author" : [ { "dropping-particle" : "", "family" : "Zhou", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gibson", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gibson", "given" : "R S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Makrides", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Journal of Australia", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "696-700", "title" : "Nutrient intakes and status of preschool children in Adelaide, South Australia", "type" : "article-journal", "volume" : "196" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "25", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "25" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25Cross-sectional survey of children aged living in Adelaide, SA (N = 300) 1 – 5 years; (1) 40.0 (2) 53.0CDC(1) 3 – 4(n = 70)711613(2) 4 – 5(n = 68)671518Zuo et al.,2006 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1747-0080.2006.00085.x", "author" : [ { "dropping-particle" : "", "family" : "Zuo", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norberg", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wen", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rissel", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nutrition and Dietetics", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "179-182", "title" : "Estimates of overweight and obesity among samples of preschool-aged children in Melbourne and Sydney", "type" : "article-journal", "volume" : "63" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "49", "plainTextFormattedCitation" : "49", "previouslyFormattedCitation" : "49" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }49Two cross-sectional surveys of children attending pre-school in Melbourne (M) and Sydney (S). The data sets were collected independently both focus on preschool children (M, N = 196) (S, N = 325) 2.0 - 5.4 yrs; M 50.0, S 53.8IOTFMelbourne4.0 – 4.4(n = 51)78.419.62.04.5 – 4.9(n = 83)72.316.910.85.0 – 5.4(n = 62) 79.012.98.1Sydney3.0 – 3.4(n = 58)74.119.06.93.5 – 3.9(n = 37)70.821.18.14.0 – 4.4(n = 18)72.222.25.6?Parent reported weight and height in this study. aThis study is representative, as one other paper was identified using the same BEACH data-set. bThis study is representative, as one other paper was identified using the same Victorian data-set. cThis study is representative, as one other paper was identified using data from the same year as this study. dThis study is representative, as 16 other papers were identified using the same LSAC data-set.^Reported here is the Baseline data from comparison (C) group only in the 3.5 year - old sample.^^Reported here is the Baseline data from the comparison (C) group of the pre-school aged children.*Mean of the 6-month cut-points reported hereNR – Not Reported/not able to be determined Figure 1. Differential classification of one child depending on the standard applied. ................
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