Reference Values Matter: Fewer Patients With Malnutrition Using American Compared to More Recent German Growth Charts

Area of Science:

• Pediatric Endocrinology
• Clinical Nutrition
• Biostatistics

Background:

• Accurate anthropometric reference values are essential for evaluating child growth and comparing data across institutions and countries.
• Growth charts provide critical benchmarks for assessing patient health and identifying potential growth abnormalities.

Purpose of the Study:

• To compare the anthropometric reference data from the US Centers for Disease Control (CDC) growth charts and the German Health Interview and Examination Survey for Children and Adolescents Study (KiGGS) percentiles.
• To evaluate the impact of using different reference datasets on the assessment of children with cystic fibrosis.

Main Methods:

• Comparative analysis of two established anthropometric reference datasets: CDC growth charts and KiGGS percentiles.
• Z-score calculations for weight and height in a cohort of children with cystic fibrosis using both datasets.
• Statistical comparison of the proportion of children with decreased z scores (<-2) and median z scores between the two reference groups.

Main Results:

• A significantly smaller proportion of children with cystic fibrosis exhibited decreased z scores (<-2) for weight (5.0% vs. 7.4%) and height (3.0% vs. 6.3%) when using CDC growth charts compared to KiGGS percentiles (P < 0.0001).
• Median z scores for both weight and height were higher when assessed against the CDC reference data.
• The choice of growth reference significantly influenced the interpretation of anthropometric status.

Conclusions:

• The selection of an appropriate growth reference dataset is critical and can influence clinical management decisions for children, particularly those with chronic conditions like cystic fibrosis.
• Discrepancies in growth assessment highlight the importance of considering the reference data used when comparing patient outcomes between different healthcare settings or countries.