Transcript An Italian survey on school children: antropometric

A pilot study of the “Healthy
Growth Charter”
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
Seven points:
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•
•
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Abstract
Introduction
Subjects and Methods
Results
Discussion and Conclusions
Noopolis “Healthy Growth Charter” project,
with related campaigns
• References
2
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 Charter”
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 …
3
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 …
4
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% …
5
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 Charter” and
suggests that, after appropriate refining, it
could become part of the educational career of
young people.
6
Introduction
Growth charters 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 charters, however, are not currently used
to monitor the growth of the whole population.
Another information about anthropometric
parameters and some other items of …
7
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
Charter” project, which to our knowledge is the
first, consistent attempt to fill the above two
gaps.
8
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 …
9
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 …
10
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.
11
Subjects and methods:
the questionnaire
• Gender, weight, height
• Dental problems
– Did you experience toothache?
– Have you ever been visited by a
dentist?
– Do you use orthodontic devices?
…
12
Subjects and methods:
the 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?
…
13
Subjects and methods:
the questionnaire
• Mediterranean anemia
– Are you aware of this condition?
• Sport
– Do you practice sports?
– Which one?
14
Results
•
•
•
•
•
Self explanatory Figure 1
Response rate by Regions
Self explanatory Figures 2 - 6
Definition of obesity
Self explanatory Figures 7 - 28
15
1. Geographic distribution
600
500
400
North
Center
South
300
200
100
0
Boys
Girls
16
Response rate by Regions
1.
2.
3.
4.
5.
6.
7.
8.
9.
Lombardia
Veneto
Campania
Emilia-Romagna
Piemonte
Toscana
Sicilia
Puglia
Others
17
2. Age and sex
450
400
350
300
250
Boys
Girls
200
150
100
50
0
8
9
10
11
12
Age years
18
3. Weight (Kg) by age and gender
60
50
40
30
Boys
Girls
20
10
0
8
9
10
11
12
Age years
19
4. Mean weight, 5th and 95th
centiles. Boys and girls
60
90
80
70
60
50
40
30
20
10
0
50
40
30
20
10
0
8
9
Mean
10
5th centile
11
95th centile
12
Age years
8
9
Mean
10
5th centile
11
12
95th centile
20
5. Height (cm) by age and gender
160
155
150
145
Boys
Girls
140
135
130
125
120
8
9
10
11
12
Age years
21
6. Mean height, 5th and 95th centiles.
Boys and girls
170
180
160
170
160
150
150
140
140
130
130
120
120
110
110
100
100
8
9
Mean
10
5th centile
11
95th centile
8
12
9
10
11
12
Age years
Mean
5th centile
95th centile
22
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
23
7. Obesity (%) by age and gender
20
18
16
14
12
10
8
6
4
2
0
Boys
Girls
8
9
10
11
12
Age years
24
8. Obesity (%) by gender and area
of residence
20
18
16
14
12
10
8
6
4
2
0
North
Center
South
Boys
Girls
25
9. Dental problems (%) by sex
90
80
70
60
Toothache
Visited by a dentist
Orthodontic devices
50
40
30
20
10
0
Boys
Girls
26
10. Toothache by gender and age
80
70
60
50
Boys
Girls
40
30
20
10
0
8
9
10
11
12
Age years
27
11. Visited by a dentist by age and
gender
100
90
80
70
60
50
40
30
20
10
0
Boys
Girls
8
9
10
11
12
Age years
28
12. Use of orthodontic devices by
age and gender
40
35
30
25
Boys
Girls
20
15
10
5
0
8
9
10
11
12
Age years
29
13. Dental problems and obesity
90
80
70
60
50
40
30
20
10
0
Obese
Non obese
Toothache
Visited by a
dentist
Use of
orthodontic
devices
30
14. Visual problems by gender
30
25
20
Both eyes
Right eye
Left eye
Use of lenses
Possible amblyopia
15
10
5
0
Boys
Girls
31
15. Visual problems (binocular) by
age and gender
14
12
10
8
Boys
Girls
6
4
2
0
8
9
10
11
12
Age years
32
16. Possible amblyopia by age and
gender
40
35
30
25
Boys
Girls
20
15
10
5
0
8
9
10
11
12
Age years
33
17. Use of lenses by age and gender
50
45
40
35
30
25
20
15
10
5
0
Boys
Girls
8
9
10
11
12
Age years
34
18. Knowledge of Mediterranean
anemia by age and gender
50
45
40
35
30
25
20
15
10
5
0
Boys
Girls
8
9
10
11
12
Age years
35
19. Sport practice by age and gender
90
80
70
60
50
Boys
Girls
40
30
20
10
0
8
9
10
11
12
Age years
36
20. Mean weight and sport. Boys
50
45
40
35
30
25
20
15
10
5
0
not
yes
8
9
10
11
12
Age years
37
21. Mean weight and sport. Girls
60
50
40
not
yes
30
20
10
0
8
9
10
11
12
Age years
38
22. Mean height and sport. Boys
165
160
155
150
145
not
yes
140
135
130
125
120
8
9
10
11
12
Age years
39
23. Mean height and sport. Girls
160
155
150
145
not
yes
140
135
130
125
120
8
9
10
11
12
Age years
40
24. Obesity and sport
25
20
15
yes
not
10
5
0
Boys
Girls
41
25. Obesity and sport by age
30
25
20
not
yes
15
10
5
0
8
9
10
11
12
Age years
42
26. Sport disciplines by gender
250
200
150
100
50
0
Boys
Girls
Athletics
Football
Dance
Swimming
Bicycle
Ski
Basket
Volley
Tennis
Gymnastic
No sport
43
27. Obesity and sport disciplines
in boys
25
25
20
20
15
15
10
10
5
5
0
0
Other sports
Football
No sport
Other sports
Swimming
No sport
25
20
15
10
5
0
Other sports
Basket
No sport
44
28. Obesity and sport disciplines
in girls
18
18
16
14
16
14
12
12
10
10
8
8
6
6
4
4
2
2
0
0
Other sports
Dance
No sport
18
Other sports
Swimming
No sport
18
16
14
16
14
12
12
10
10
8
8
6
6
4
4
2
2
0
Other sports
Volley
No sport
0
Other sports
Gymnastic
No sport
45
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).
46
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.
47
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 widespread knowledge in children, probably
connected with current educational campaigns
in schools.
48
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.
49
Noopolis “Healthy Growth Charter”
Project
This study confirms the potential value of an
extended growth charter 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.
50
Noopolis “Healthy Growth Charter”
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 Charter”
Project
• To cover the whole young population, the
survey has to become a duty, within the
scholastic curriculum.
• In other words, the “Healthy Growth Charter”
ought to become a State issue.
52
Noopolis “Healthy Growth Charter”
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 Charter, which
provides a unique opportunity to interact with
the whole young population.
53
References
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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. 2002;75:761-766
Nader P.R., O’Brien 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
54
the United Kingdom. Arch Dis Child. 2002; 86(1): 11-14