Objectives - The high incidence of obesity registered among children worldwide urgently requests
the identification of simple, shared instruments for early diagnosis and treatment. The
aims of our study were to illustrate how the choice of growth curves can influence this objective
and to evaluate the opportunity of using the growth curves proposed by World Health
Organization (WHO) for subjects 5-19 years of age.
Methods - Using anthropometric data from a nutritional survey conducted on 2,804 children
from preschools, primary, and secondary schools in Bologna, we calculated BMIz-scores
according to the Center for Disease Control and Prevention, Luciano’s, the Italian Society
of Pediatric Endocrinology and Diabetology (SIEDP) and the WHO growth curves.
Results - The percentage of overweight or moderate/severe obese children varied according
to the different growth curves. It is higher with WHO growth standards, especially in preschool
and primary school children. The discordance is more significant between SIEDP
and WHO growth curves.
Conclusions - Recent Italian SIEDP growth curves underestimate the incidence of overweight/
obesity in our population and therefore do not meet the goal of early identifying patients
for preventive/therapeutic programmes. The WHO growth curves may be more
helpful, although this also means treating a higher number of children with presumably efficacious
and safe programmes.
1. Kimm SY, Obarzanek E. Childhood obesity:
a new pandemic of the new millennium. Pediatrics
2002;110:1003-7.
2. Tanas R, Albertini A, Casarini T, Armari S,
Bottazzi M. Prevalence and trends in overweight
and obesity among children and adolescents
in Bologna, Italy: 1974-2002. Rivista Italiana di
Medicina dell’Adolescenza 2006;4:38-40.
3. Barlow SE; Expert Committee. Expert committee
recommendations regarding the prevention,
assessment, and treatment of child
and adolescent overweight and obesity: summary
report. Pediatrics. 2007;120(suppl 4):
S164-92.
4. Smith SM, Gately P, Rudolf M. Can we recognise
obesity clinically? Arch Dis Child
2008;93;1065-6.
5. Pietrobelli A, Faith MS, Allison DB, Gallagher
D, Chiumello G, Heymsfield SB. Body
mass index as a measure of adiposity among
children and adolescents: a validation study. J
Pediatr 1998;132:204-10.
6. Ezzati M, Friedman AB, Kulkarni SC, Murray
CJ. The reversal of fortunes: trends in
county mortality and cross-county mortality
disparities in the United States. PLoS Med
2008;5:e66.
7. Rolland-Cachera MF, Cole TJ, Sempè M, Tichet
J, Rossignol C, Charroud E. Body mass
index variations: centiles from birth to 87
years. Eur J Nutr 1991;45:13-21.
8. Luciano A, Bressan F, Zoppi G. Body mass index
curves for children aged 3-19 years from Verona,
Italy. Eur J Clin Nutr 1997;51:6-10.
9. Cole TJ, Freeman JV, Preece MA. British
1990 growth reference centiles for weight, height,
body mass index and head circumference
fitted by maximum penalized likelihood. Stat
Med 1998;17:407-29.
10. Kuczmarski RJ, Ogden CL, Grummer-
Strawn LM, et al. CDC growth charts: United
States. Adv Datazvol 2000;314:1-27.
11. Cacciari E, Milani S, Balsamo A, et al. Italian
cross-sectional growth charts for height,
weight and BMI (6-20y). Eur J Clin Nutr 2002;
56:171-80.
12. Cacciari E, Milani S, Balsamo A, et al. Italian
cross-sectional growth charts for height,
weight and BMI (2-20y). J Endocrinol Invest
2006;29:581-93.
13. Mei Z, Ogden CL, Flegal KM, Grummer-
Strawn LM. Comparison of the prevalence of
shortness, underweight, and overweight
among US children aged 0 to 59 months by
using the CDC 2000 and the WHO 2006
growth charts. J Pediatr 2008;153:622-8.
14. Huang JS, Donohue M, Golnari G, et al. Pediatricians’
weight assessment and obesity management
practices. BMC Pediatr 2009;9: 19.
15. Cole TJ, Bellizzi MC, Flegal KM, Dietz
WH. Establishing a standard definition for
child overweight and obesity worldwide: international
survey. BMJ 2000;320:1240-3.
16. WHO Multicentre Growth Reference
Study Group. WHO child growth Standards
based on length/height, weight and age. Acta
Paediatr 2006;(suppl 450):76-85.
17. Tamburlini G. Le nuove curve di crescita
dell’OMS.
Medico e Bambino 2006;25:315-6.
18. Wright C, Lakshman R, Emmett P, Ong
KK. Implications of adopting the WHO 2006
Child Growth Standard in the UK: two prospective
cohort studies. Arch Dis Child 2008;
93:549-51.
19. van Dijk CE, Innis SM. Growth-curve standards
and the assessment of early excess weight
gain in infancy. Pediatrics 2009;123:102-8.
20. Hui LL, Schooling CM, Cowling BJ, Leung
SS, Lam TH, Leung GM. Are universal standards
for optimal infant growth appropriate?
Evidence from a Hong Kong Chinese birth
cohort. Arch Dis Child 2008;93:549-51.
21. Caroli M. New standard growth curves of
WHO: rationale, project and validation. Minerva
Pediatr 2007;59:510-1.
22. Butte NE, Garza C, de Onis M. Evaluation
of the feasibility of international growth standards
for school-aged children and adolescents.
Food Nutr Bull 2006;27(4 Suppl
Growth Standard):S169-74.
23. De Onis M, Onyango AW, Borghi E, Siyam
A, Nishida C, Siekmann J. Development of a
WHO growth reference for school-aged children
and adolescents. Bull World Health Organ
2007;85:660-7.
24. Albertini A, Tripodi A, Fabbri A, et al. Prevalence
of obesity in 6- and 9-year-old children
living in Central-North Italy. Analysis of determinants
and indicators of risk of overweight.
Obes Rev 2008;9:4-10.
25. Krebs NF, Himes JH, Jacobson D, Nicklas
TA, Guilday P, Styne D. Assessment of child
and adolescent overweight and obesity. Pediatrics.
2007;120 (suppl 4):S193-228.
26. Spinelli A, Baglio G, Cattaneo C, Fontana
G, Lamberti A; Gruppo OKkio alla SALUTE;
Coorte PROFEA anno 2006. Promotion of
healthy life style and growth in primary
school children (OKkio alla SALUTE). Ann Ig
2008;20:337-44. http://www.ministerosalute.
it/imgs/C_17_primopianoNuovo_188_docum
enti_itemDocumenti_1_fileDocumento.pdf.
27. Davis MM, Gance-Cleveland B, Hassink S,
Johnson R, Paradis G, Resnicow K. Recommendations
for prevention of childhood obesity.
Pediatrics 2007;120(suppl 4):S229-53.
28. Evans A, He M. Are parents aware that
their children are overweight or obese? Do
they care? Can Fam Physician 2007;53:1493-9.
29. Spear BA, Barlow SE, Ervin C, et al. Recommendations
for treatment of child and
adolescent overweight and obesity. Pediatrics
2007;120(suppl 4):S254-88.
30. Lazzeri G, Rossi S, Pammolli A, Pilato V,
Pozzi T, Giacchi MV. Underweight and
overweight among children and adolescents
in Tuscany (Italy). Prevalence and short-term
trends. J Prev Med Hyg 2008;49:13-21.
31. Neumark-Sztainer D, Palti H, Butler R.
Weight concerns and dieting behaviors
among high school girls in Israel. J Adolesc
Health 1995;16:53-9.
32. Patton GC, Selzer R, Coffey C, Carlin JB,
Wolfe R. Onset of adolescent eating disorders:
population based cohort study over 3 years.
BMJ 1999;318:765-8.
33. Caprio S. Treating child obesity and associated
medical conditions. Future Child 2006;
16:209-24.
34. Oude Luttikhuis H, Baur L, Jansen H, et
al. Interventions for treating obesity in children.
Cochrane Database Syst Rev 2009;21(1):
CD001872.
35. Whitlock EP, O’Connor EA, Williams SB,
Beil TL, Lutz KW. Effectiveness of weight management
interventions in children: a targeted
systematic review for the USPSTF. Pediatrics
2010;125:e396-418.
36. Golley RK, Magarey AM, Baur LA, Steinbeck
KS, Daniels LA. Weight-Management
Program for Prepubertal Children: A Randomized,
Controlled Trial. Pediatrics 2007;119:
517-25.
37. Kalavainen MP, Korppi MO, Nuutinen
OM. Clinical efficacy of group-based treatment
for childhood obesity compared with
routinely given individual counseling. Int J
Obes (Lond) 2007;31:1500-8.
38. Reinehr T, Temmesfeld M, Kersting M, de
Sousa G, Toschke AM. Four-year follow-up of children and adolescents participating in an
obesity intervention program. Int J Obes
(Lond) 2007;31:1074-7.
39. Schwartz RP, Hamre R, Dietz WH, et al. Office-
based motivational interviewing to prevent
childhood obesity: a feasibility study. Arch
Pediatr Adolesc Med 2007;161:495-501.
40. Tanas R, Marcolongo R, Pedretti S, Gilli G.
A family-based education program for obesity:
a three-year study. BMC Pediatr 2007;7:33.
41. Tanas R, Marcolongo R, Pedretti S, Gilli G.
L’educazione terapeutica familiare nel trattamento
dell’obesità.
Medico e Bambino 2007;
26:393-6. pagine elettroniche 10(6) http://
www.medicoebambino.com/index.php?id=RI
0706_10.html.
42. Johnson SS, Paiva AL, Cummins CO, et al.
Transtheoretical model-based multiple behavior
intervention for weight management: effectiveness
on a population basis. Prev Med
2008;46:238-46.
43. Prochaska JO, Butterworth S, Redding
CA, et al. Initial efficacy of MI, TTM tailoring
and HRI’s with multiple behaviors for employee
health promotion. Prev Med 2008;46:
226-31.
44. Weigel C, Kokocinski K, Lederer P, Dötsch
J, Rascher W, Knerr I. Childhood obesity:
concept, feasibility, and interim results of a local
group-based, long-term treatment program.
J Nutr Educ Behav 2008;40:369-73.
45. Pelletier-Fleury N, Le Vaillant M, Franc C,
Rosman S. Prevention of obesity in daily practice:
a telephone survey among pediatricians
in France. Am J Prev Med 2006;31:533.
46. Schwartz RP, Hamre R, Dietz WH, et al. Office-
based motivational interviewing to prevent
childhood obesity: a feasibility study. Arch
Pediatr Adolesc Med 2007;161:495-501.
L'accesso agli ultimi 12 mesi non è disponibile on line.