A pilot study of the

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A pilot study of the Healthy Growth Chart

• B. Silvestrini1, M. Arpino1, 2, M. Ferrante1, 2,
  M. Musicco1, 3, 4 and G. Santilli1, 2
• 1Noopolis, Rome 2CONI, Rome 3ITB-CNR, Milan
  4IRCCS-Fondazione Santa Lucia, Rome

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Seven points

• Abstract
• Introduction
• Subjects and Methods
• Results
• Discussion and Conclusions
• Noopolis Healthy Growth Chart project,
  
• with related campaigns
• References

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Abstract

• This pilot study was supported by CONI within a
  campaign against doping. It was aimed at
  preliminarily assessing the value and feasibility
  of the Noopolis Healthy Growth Chart project,
  designed to check at regular intervals the whole
  young population for various items of statistical
  and medical interest.
• 1500 children of both sexes, 8-12 yrs, from

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• 18 Italian regions out of 20, fulfilled a
  questionnaire on height, weight, dental and sight
  problems, knowledge of Mediterranean anemia,
  sport practice.
• The Body Mass Index (BMI) distribution was in
  line with that reported by Cacciari et al.
  (2006). 60 of children had experienced
  toothache, 80 underwent a dental visit

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• and up to 15 used orthodontic devices.The
  blackboard test indicated visual problems in 24
  of children, suggesting in 8 of cases a possible
  amblyopic defect. 12 used lenses. The knowledge
  of Mediterranean anemia increased with age,
  approaching 50 at 12 years.
• Children practicing sport were over 80

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• at 9 years and 70 at 11 years. Football was the
  favorite discipline in male and dance in female.
  Obesity occurrence was minimal in association
  with football practice.
• This study stresses the potential value of the
  Noopolis Healthy Growth Chart and suggests
  that, after appropriate refining, it could become
  part of the educational career of young people.

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Introduction

• Growth charts for children are derived from
  large, representative cross sectional surveys in
  US (Flegal et al., 2002), Canada (Anonymous,
  2004), UK (Wright et al., 2002), Italy (Cacciari
  et al., 2006) and other areas (de Onis et al.,
  1996).
• These charts, however, are not currently used to
  monitor the growth of the whole population.
• Another information about anthropometric
  parameters and some other items of

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• medical interest was collected in occasion of the
  obligatory enrollment army visit. This
  information, however, was limited to males and in
  Italy and some other countries the obligatory
  army service has been abolished.
• The present study was supported by CONI within a
  campaign against doping. It was aimed at
  assessing the Noopolis Healthy Growth Chart
  project, which to our knowledge is the first,
  consistent attempt to fill the above two gaps.

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Subjects and methods

• The study involved 4000 primary schools in 18 out
  of 20 Italian regions, with an average of 70
  students each. Hence the potential sample was of
  279.580 subjects from 6 to 12 years .
• The Directors of the schools were contacted by
  mail with a personal letter. They were sent
  booklets with an illustrated story on doping a
  questionnaire situated on the back cover

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• of the booklet 3 public notices a DVD
  containing all the above material. They were
  asked to adhere to the campaign, distribute the
  booklets and return back the filled
  questionnaires.
• 2776 Directors out of 4000 expressed their
  interest, which corresponded to about 190.000
  students out of 279.580. The questionnaire

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• was administered only to students of 8-12 yrs,
  amounting roughly to 100.000 subjects. The filled
  questionnaires sent back were 1500, corresponding
  to about 1.5 of the involved sample.
• The agency entrusted with the campaign and
  related tests was Angelicum Film SrL, Milan.

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Subjects and methodsthe questionnaire

• Gender, weight, height
• Dental problems
• Did you experience toothache?
• Have you ever been visited by a dentist?
• Do you use orthodontic devices?

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Subjects and methodsthe questionnaire

• Visual problems
• Can you see a word on the blackboard from the
  back of the room?
• Can you see it with a single eye?
• Do you use glasses?

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Subjects and methodsthe questionnaire

• Mediterranean anemia
• Are you aware of this condition?
• Sport
• Do you practice sports?
• Which one?

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Results

• Self explanatory Figure 1
• Response rate by Regions
• Self explanatory Figures 2 - 6
• Definition of obesity
• Self explanatory Figures 7 - 28

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1. Geographic distribution
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Response rate by Regions

• Lombardia
• Veneto
• Campania
• Emilia-Romagna
• Piemonte
• Toscana
• Sicilia
• Puglia
• Others

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2. Age and sex
Age years
19
3. Weight (Kg) by age and gender
Age years
20
4. Mean weight, 5th and 95th centiles. Boys and
girls
Age years
21
5. Height (cm) by age and gender
Age years
22
6. Mean height, 5th and 95th centiles.Boys and
girls
Age years
23
Obesity

• We defined obese the children with a body mass
  index (BMI) equal to or greater than
• the value of 95th centile of the corresponding
  age and sex according to WHO standards

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7. Obesity () by age and gender
Age years
25
8. Obesity () by gender and area of residence
26
9. Dental problems () by sex
27
10. Toothache by gender and age
Age years
28
11. Visited by a dentist by age and gender
Age years
29
12. Use of orthodontic devices by age and gender
Age years
30
13. Dental problems and obesity
31
14. Visual problems by gender
32
15. Visual problems (binocular) by age and gender
Age years
33
16. Possible amblyopia by age and gender
Age years
34
17. Use of lenses by age and gender
Age years
35
18. Knowledge of Mediterranean anemia by age and
gender
Age years
36
19. Sport practice by age and gender
Age years
37
20. Mean weight and sport. Boys
Age years
38
21. Mean weight and sport. Girls
Age years
39
22. Mean height and sport. Boys
Age years
40
23. Mean height and sport. Girls
Age years
41
24. Obesity and sport
42
25. Obesity and sport by age
Age years
43
26. Sport disciplines by gender
44
27. Obesity and sport disciplines in boys
45
28. Obesity and sport disciplines in girls
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Discussion and Conclusions

• Height and weight values in line, despite less
  accurate measures, with previously reported
  values (Cacciari et al., 2006).
• Obesity also in line, deserving attention both
  by itself and in connection with the
  corresponding, related condition in the adult
  (Nader et al., 2006).

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Discussion and Conclusions

• Dental problems quite common, earlier in
  females, high frequency of medical control and
  orthodontic devices. Some inverse relation
  between the latter two and obesity, which might
  be indirect, due to cultural or psychological
  reasons.

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Discussion and Conclusions

• Visual problems quite common as well, use of
  lenses averaging 25 . The consistent indication
  of possible undiagnosed amblyopic defects
  deserves careful attention.
• Mediterranean anemia a surprisingly wide-spread
  knowledge in children, probably connected with
  current educational campaigns in schools.

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Discussion and Conclusions

• Sports widely practiced, probably mostly out of
  schools, football and dance being the preferred
  ones in males and females respectively.
• A clear-cut inverse relation was found between
  sport practice and obesity, football being the
  most effective one.

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Noopolis Healthy Growth Chart Project

• This study confirms the potential value of an
  extended growth chart in the prevention and
  treatment of some common conditions. At the same
  time it points out some substantial adjustments
• Other items should be considered, such as
  hearing, color-blindness, dyslexia and additional
  clues of learning and behavioral problems.

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Noopolis Healthy Growth Chart Project

• The survey must be anticipated as much as
  possible and repeated at least two more times,
  around puberty and after adolescence.
• To accomplish the above goals, the questionnaire
  should be adapted to each age, with particular
  reference to the first one.

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Noopolis Healthy Growth Chart Project

• To cover the whole young population, the survey
  has to become a duty, within the scholastic
  curriculum.
• In other words, the Healthy Growth Chart ought
  to become a State issue.

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Noopolis Healthy Growth Chart Project , with
associated campaigns

• Last but not least, this pilot study was
  associated with a campaign against doping,
  designed and conducted with the active
  involvement of young people. This positive
  experience should be renewed with the extended
  Healthy Growth Chart, which provides a unique
  opportunity to interact with the whole young
  population.

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References
Anonymous - The use of growth charts for
assessing and monitoring growth in Canadian
infants and children. Revue canadienne de la
pratique et de la recherche en diététique, 2004
65(1) Cacciari E., Milani S., Balsamo A., Spada
E., Bona G., Cavallo L., Cerutti F., Gargantini
L., Greggio N., Tonini G., and Cicognani A.
Italian cross-sectional growth charts for height,
Weight and BMI (2 to 20 yr). J.Endocrinol.Invest.,
2006 29 581-593 de Onis M., Habicht J.P. -
Anthropometric reference data for international
use recommendations from a World Health
Organization Expert Committee. Am J Clin Nutr.
1996 64 (650-8) Flegal K.M., Wei R., and Ogden
C. - Weight-for-stature compared with body mass
index-for-age growth charts for the United
States from the Centers for Disease Control and
Prevention. Am.J.Clin.Nutr. 200275761-766 Nader
P.R., OBrien M., Houts R., Bradley, R., Belsky
J., Crosnoe R., Friedman S., Mei Z.,Susman E.J.,
Identifying Risk for Obesity in Early Childhood .
Pediatrics, 2006, 118 e594-601 Wright C.M.,
Booth I.W., Buckler J.M., Cameron N., Cole T.J.,
Healy M.J., Hulse J.A., Preece M.A., Reilly J.J.,
Williams A.F. - Growth reference charts for the
use in the United Kingdom. Arch Dis Child. 2002
86(1) 11-14