Ziegler Ekhard E, Nelson Steven E
Fomon Infant Nutrition Unit, Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
Nestle Nutr Workshop Ser Pediatr Program. 2010;65:197-210; discussion 210-2. doi: 10.1159/000281166. Epub 2010 Feb 1.
Growth assessment of children requires comparison of growth measurements with normative references, usually in the form of growth charts. Traditionally growth charts (growth references) have described the growth of children who were considered normal and were living in a defined geographic area. The new WHO growth charts, on the other hand, are growth standards that aim to represent growth as it occurs worldwide. Moreover, they represent growth as it occurs under optimal circumstances and is thought to be conducive to optimal long-term health. Most growth references are single-country references, exemplified here by charts from the UK, the Netherlands and the USA. By contrast, the Euro-Growth reference and the WHO standard are based on multinational samples. Comparison of these five charts reveals surprisingly large differences that are for the most part unexplained. Differences between the WHO charts and other charts are only partially explained by the use of a prescriptive approach and by the data truncation employed. The large differences between charts probably are of merely trivial consequence when charts are used in monitoring individual children. When charts are used in health assessment of groups of children, the impact of the differences, however, is substantial.
儿童生长评估需要将生长测量值与标准参考值进行比较，通常采用生长图表的形式。传统上，生长图表（生长参考值）描述的是被认为正常且生活在特定地理区域的儿童的生长情况。另一方面，新的世界卫生组织生长图表是生长标准，旨在呈现全球范围内的生长情况。此外，它们呈现的是在最佳环境下发生的生长情况，并且被认为有利于最佳的长期健康。大多数生长参考值是单一国家的参考值，这里以英国、荷兰和美国的图表为例。相比之下，欧洲生长参考值和世界卫生组织标准是基于多国样本的。对这五张图表的比较揭示出惊人的巨大差异，在很大程度上这些差异无法解释。世界卫生组织图表与其他图表之间的差异仅部分地由规定性方法的使用和所采用的数据截断来解释。当图表用于监测个体儿童时，图表之间的巨大差异可能仅具有微不足道的影响。然而，当图表用于儿童群体的健康评估时，这些差异的影响则相当大。
