Comparison of International Growth Standards for Assessing Nutritional Status in Cystic Fibrosis: The GreeCF Study
Dimitrios Poulimeneas1,2, Maria G Grammatikopoulou3, Argyri Petrocheilou4
1Department of Public Health Policy, University of West Athens.
Insights
Comparing three growth references for school-aged children with cystic fibrosis (CF) revealed significant variations in weight status classification. No single reference proved superior for assessing growth in CF patients, as all body mass index (BMI) z-scores showed similar associations with lung function.
Area of Science:
- Pediatrics
- Growth Monitoring
- Cystic Fibrosis Research
Background:
- Accurate growth assessment is crucial for managing pediatric chronic conditions like cystic fibrosis (CF).
- International growth references provide benchmarks for evaluating child development, but their applicability can vary across populations.
Purpose of the Study:
- To compare the performance of three international growth references: Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and International Obesity Task Force (IOTF).
- To explore differences in classifying growth status among Greek school-aged children with CF using these references.
Main Methods:
- Study included 114 Greek school-aged patients with CF.
- Anthropometrics and lung function (FEV1%) were measured.
- Body mass index (BMI) and height z-scores were calculated using CDC, WHO, and IOTF references.
- Statistical analyses included kappa statistics, ANOVA, and Bland-Altman analysis to assess agreement and bias.
Main Results:
- Significant differences were observed in BMI z-scores across the three references (P≤0.001).
- The CDC and WHO references showed high agreement for weight status and stunting, unlike other comparisons which exhibited lower agreement and bias.
- The CDC reference classified more children in lower weight categories compared to WHO and IOTF.
Conclusions:
- Employing different growth standards leads to substantial variations in classifying weight status for school-aged children with CF.
- Despite classification differences, all studied body mass index (BMI) z-score references demonstrated comparable associations with pulmonary function (FEV1%).
- No single international growth reference was found to be superior for assessing growth in this cohort of CF patients.
Objective:
The aim of the study was to compare 3 international growth references and explore their differences in assessing growth in Greek school-aged patients with cystic fibrosis (CF).
Methods:
Sample included 114 patients (50 boys, age 11.5 ± 3.9 years), provided care at Aghia Sofia Children's Hospital, Greece. Anthropometrics and predicted forced expiratory volume in 1 second (FEV1%) were measured. Body mass index (BMI) and height z scores were computed according to the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and International Obesity Task Force (IOTF) references. Agreement between methods was analyzed with kappa statistics, repeated-measures analysis of variance, and Bland-Altman analysis. The relationship between FEV1% and BMI was explored with linear regression.
Results:
Mean CDC BMI z score was the lowest (0.06 ± 1.08), followed by WHO (0.17 ± 1.14) and IOTF (0.35 ± 1.05) (P ≤ 0.001 for all). The CDC and WHO growth references highly agreed for most weight status strata and stunting; all other comparisons produced lower agreements. Except for CDC and IOTF BMI z scores, all other comparisons produced wide levels of agreement and proportional bias. CDC reference classified more children as attaining low or normal weight, against WHO or IOTF (P ≤ 0.001 for all). Lowest prevalence of ideal and excess weight was recorded by CDC, compared to all other standards (P ≤ 0.001 for all). All BMI z scores provided moderate associations with FEV1%.
Conclusion:
Large variations across weight status classification were present when employing 3 growth standards in school-aged patients . Given than BMI z-scores from all references provided comparable associations with pulmonary function, our data indicate that no studied reference is better than others in assessing growth in CF.
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