Silveira C R M, Beghetto M G, Carvalho P R A, Mello E D
Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brasil.
Nutr Hosp. 2011 May-Jun;26(3):465-71. doi: 10.1590/S0212-16112011000300006.
This study evaluated the agreement of growth charts proposed by the National Center for Health Statistics (NCHS/1977), Centers for Disease Control and Prevention (CDC/2000) and World Health Organization (WHO/2006).
Were assessed children between 0 and 5 years old, hospitalized in the pediatric wards of a Brazilian school hospital. Z-score indexes: stature/age (S/A), weight/age (W/A) and weight/stature (W/S) was evaluated, in each of the three references (NCHS, CDC and WHO). ANOVA and test Bland & Altman and Lin plots were used in the comparison of the 3 charts. The agreement of the nutritional state categories was also evaluated, through kappa coefficient. The study was approved by the Institution's Research Ethics Committee.
The study analyzed 337 children, whose median age was 0.52 (IQR: 0.21-1.65) years, 65.3% of them were below 1 year old, 60.2% were male and 50% hospitalized due to acute respiratory disease. Lower Z-scores of W/A and S/A were obtained with the WHO charts and lower W/S with the CDC chart. High correlation and agreement were observed among the criteria, but more patients were classified as presenting shortness through the WHO criteria. CDC and WHO criteria were more rigorous than the NCHS criteria for the diagnosis of underweight (W/A) and malnutrition (W/S).
Despite the strong agreement of the 3 charts, the adoption of the WHO charts seems to be more helpful for the children's nutritional screening for admission, as it enables to detect a higher number of malnourished children or at nutritional risk, who will benefit from an early intervention.
本研究评估了美国国家卫生统计中心（NCHS/1977）、疾病控制与预防中心（CDC/2000）和世界卫生组织（WHO/2006）提出的生长图表的一致性。
对一家巴西教学医院儿科病房收治的0至5岁儿童进行评估。在三个参考标准（NCHS、CDC和WHO）中，分别评估身高/年龄（S/A）、体重/年龄（W/A）和体重/身高（W/S）的Z评分指数。使用方差分析、布兰德-奥特曼检验和林氏图对这三个图表进行比较。还通过kappa系数评估营养状况分类的一致性。该研究获得了机构研究伦理委员会的批准。
该研究分析了337名儿童，他们的中位年龄为0.52（四分位间距：0.21 - 1.65）岁，其中65.3%年龄小于1岁，60.2%为男性，50%因急性呼吸道疾病住院。WHO图表得出的W/A和S/A的Z评分较低，而CDC图表得出的W/S较低。各标准之间观察到高度相关性和一致性，但通过WHO标准被归类为身材矮小的患者更多。在诊断体重不足（W/A）和营养不良（W/S）方面，CDC和WHO标准比NCHS标准更严格。
尽管这三个图表具有很强的一致性，但采用WHO图表似乎对儿童入院时的营养筛查更有帮助，因为它能够检测出更多营养不良或有营养风险的儿童，这些儿童将受益于早期干预。
