World Health Organization growth standards: How do Canadian children measure up?. Issue 5 (18th July 2020)

• Record Type: Journal Article
• Authors: Rodd, Celia; Feely, Allison; Becker, Allan B; Moraes, Theo J; Subbarao, Padmaja; Mandhane, Piushkumar J; Turvey, Stuart E; Lefebvre, Diana L; Sears, Malcolm R; Azad, Meghan B; Sharma, Atul
• Is Part Of: Paediatrics & Child Health. Volume 26:Issue 5(2021)
• Page Start: e208
• Page End: e214
• Publication Date: 2020-07-18
• Subjects: Adiposity -- Bottle feeding -- Breastfeeding -- Growth; Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/pxaa053
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: Background: World Health Organization (WHO) growth standards for children aged 0 to 5 years describe growth under optimal conditions and were adopted for use in Canada in 2012. We are seeking to validate these charts in a well-characterized, longitudinal cohort of healthy, Canadian youngsters, assess tracking over time, and evaluate the prognostic implications of early growth. Methods: Data from 2, 795 mother–infant dyads from the CHILD birth cohort were classified by feeding modality at 6 months as exclusively breastfed, partially breastfed, or formula-fed. WHO z-scores (z) were calculated at birth, 3 months, 1 year, and 3 years. Receiver operator characteristics (ROC) assessed the predictive performance of early weight (WT), weight-for-length (WfL), or body mass index (BMI) z-scores for overweight/obesity at 3 years. Results: Compared to WHO standards, Canadian children at birth had lower median WfLz (−0.73) and BMIz (−0.29), with more positive scores by 3 years (WfLz=BMIz=0.58). At both 1 and 3 years, formula feeding was associated with higher scores than breastfeeding, even after regression adjustment for covariates. Head circumference z-score was typically positive at all times and regardless of feeding modality. At 1 year, ROC area under the curve was 0.79 for WTz, WfLz, and BMIz, and BMIz>0.88 identified children with increased risk of overweight/obesity (BMIz >2) at age 3 years (20.3% versus 3.0%, P<0.001). Conclusions: Compared to WHO growth charts, Canadian children at 3 years show an upward shift in BMIz and WfLz, particularly when formula-fed. Infant growth parameters may identify infants with increased risk of overweight/obesity at age 3 years; early recognition may allow targeting infants at higher risk.