Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, SE 405 30, Gothenburg, Sweden.
Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMC Pediatr. 2022 Apr 30;22(1):238. doi: 10.1186/s12887-022-03304-3.
Despite inter-individual variations in pubertal timing, growth references are conventionally constructed relative to chronological age (C-age). Thus, they are based on reference populations containing a mix of prepubertal and pubertal individuals, making them of limited use for detecting abnormal growth during adolescence. Recently we developed new types of height and weight references, with growth aligned to age at onset of the pubertal growth spurt (P-age). Here, we aim to develop a corresponding reference for pubertal BMI.
The QEPS-height and weight models were used to define a corresponding QEPS-BMI model. QEPS-BMI was modified by the same individual, constitutional weight-height-factor (WHF) as computed for QEPS-weight. QEPS-BMI functions were computed with QEPS weight and height functions fitted on longitudinal measurements from 1418 individuals (698 girls) from GrowUpGothenburg cohort. These individual BMI functions were used to develop BMI references aligned for height at AgeP5; when 5% of specific puberty-related (P-function) height had been attained. Pubertal timing, stature at pubertal onset, and childhood BMI, were investigated in subgroups of children from the cohort GrowUpGothenburg using the new references.
References (median, standard deviation score (SDS)) were generated for total BMI (QEPS-functions), for ongoing prepubertal growth (QE-function) vs C-age, and for total BMI and separated into BMI specific to puberty (P-function) and BMI gain from ongoing basic growth (QES-functions), allowing individual growth to be aligned based on P-age. Growth in basic BMI was greater than average for children categorized as tall and/or with high-BMI at puberty-start. In children categorized as short at puberty-start, P-function-related-BMI was greater than average.
Use of these new pubertal BMI references will make it possible for the first time to consider individual variations owing to pubertal timing when evaluating BMI. This will improve the detection of abnormal changes in body composition when used in combination with pubertal height and weight references also abnormal growth. Other benefits in the clinic will include improved growth monitoring during treatment for children who are overweight/obese or underweight. Furthermore, in research settings these new references represent a novel tool for exploring human growth.
尽管青春期开始时间存在个体差异，但生长参考值通常是相对于年龄（C 年龄）来构建的。因此，它们基于包含青春期前和青春期个体混合的参考人群，因此对于检测青春期生长异常的用途有限。最近，我们开发了新型身高和体重参考值，其生长与青春期突增开始时的年龄（P 年龄）相匹配。在这里，我们旨在开发相应的青春期 BMI 参考值。
使用 QEPS-身高和体重模型来定义相应的 QEPS-BMI 模型。通过与 QEPS 体重相同的个体构建的体重身高因素（WHF）来修改 QEPS-BMI。使用从 1418 名个体（698 名女孩）的纵向测量值拟合的 QEPS 体重和身高函数来计算 QEPS-BMI 函数。这些个体 BMI 函数用于开发与身高在 AgeP5 时对齐的 BMI 参考值；当达到特定青春期相关（P 函数）身高的 5%时。使用新的参考值研究了哥德堡成长队列中的儿童亚组的青春期开始时间、青春期开始时的身高和儿童期 BMI。
生成了总 BMI（QEPS 函数）、持续青春期前生长（QE 函数）与 C 年龄以及总 BMI 并分为特定于青春期的 BMI（P 函数）和基本生长期间的 BMI 增益（QES 函数）的参考值（中位数、标准偏差分数（SDS）），允许根据 P 年龄对齐个体生长。在青春期开始时被归类为高个子和/或高 BMI 的儿童中，基础 BMI 的增长大于平均水平。在青春期开始时被归类为矮个子的儿童中，与 P 函数相关的 BMI 大于平均水平。
使用这些新的青春期 BMI 参考值，首次有可能在评估 BMI 时考虑由于青春期时间引起的个体差异。当与青春期身高和体重参考值一起使用时，这将改善对身体成分异常变化的检测，也异常生长。在临床实践中的其他好处包括改善超重/肥胖或体重不足儿童的生长监测。此外，在研究环境中，这些新的参考值代表了探索人类生长的新工具。
