Guidelines Dietary - Eat For Health

It is suggested that by 2011, 125 countries representing 75% of the world’s under–5 population had adopted theWHO growth standards and were at varying stages of implementation. 1079 This includes the US, Canada, UK andNew Zealand. The WHO growth standards for 0–19 years were implemented in the Northern Territory in 2009 andVictoria implemented WHO charts for 0–2 years in 2011. In 2012, all Australian jurisdictions agreed to adopt the WHO2006 growth charts as the standard for Australian children aged 0–2 years. They will be phased in by other states andterritories for use at the primary health care level in child health records. Education and training materials to assistAustralian health professionals in using the WHO Charts are being developed and will become available in 2013.Other specialised growth charts may still be used by clinicians for groups with particular needs or characteristics.Care should be taken to consider the differences between charts when assessing the growth of infants. The newWHO growth standards (2006) are heavier than the CDC 2000 growth reference in the first 6 months of life butlighter after 6 months.Table H1: Practical points in the use of growth reference charts in infants aged 0–2 years• Health professionals should use a growth reference chart appropriate to the age and sex of the infant or child and be aware whichchart they are using• In using the WHO growth reference charts, it is important to note that the 2 nd percentile corresponds approximately to the 5 th percentileon the CDC growth chart for infants under 6 months and that lower positions on the growth reference chart are acceptable• In determining whether breast milk production or infant formula consumption is adequate (or for infants fed formula the amount isexcessive), growth trajectory is more important than position on the growth reference chartCDC BMI curvesIn Australia, the NHMRC Overweight and Obesity Guidelines 121 suggest the use of the US CDC growth charts 1046for monitoring growth in children and adolescents aged 2–18 years. 35,1081 Overweight is categorised as betweenthe 85 th and 95 th percentiles in the BMI charts and obesity as above the 95 th percentile.However, use of the CDC charts has been criticised as they are based on US data only, from five national surveysundertaken between 1963 and 1994, the most recent being NHANES 111. The age- and sex-specific CDC growthcharts were last updated in 2000, and do not include weight data (and thus BMI data) from NHANES 111 fromchildren over 6 years of age.BMI using international reference standardsBMI measurement is a low-cost, simple method that has been validated against more direct measures of adiposity. 1082In 1999 an expert committee, on behalf of the IOTF, recommended that BMI be used to assess adiposity in childrenand adolescents and that the adult cut-off points be used as a reference. 1083,1084 However, normal BMI among childrenand adolescents changes with age, so choosing a single cut-off number is not possible.Following on from this recommendation, an international reference for defining overweight and obesity in childrenand adolescents was developed with data from six countries, and provide age- and sex-specific BMI cut-off pointsfor children and adolescents aged 2–18 years that correspond to adult BMI values of 25 kg/m 2 for overweight and30 kg/m 2 for obesity. 122 Designed for epidemiological use, the tables will allow international comparison of theprevalence of overweight and obesity, as well as assessment of trends in children. 1074,1085-1087Other measurementsWaist circumference and waist:height ratio are becoming more common measures of child, adolescent andadult central adiposity, but there is little consensus regarding standard cut-off values to define overweightand obesity. 130,1088-1093 A waist:height ratio equal to or less than half (ratio ≤ 0.5) may be useful in predictingcardiovascular risk in children. 1094-1097Skinfold measurement – an index of subcutaneous adipose tissue – is another method of defining of under- orover-nutrition. 1098 Reliable and accurate measurements depend to a large extent on the use of trained operatorsand properly calibrated instruments.Other methods of body composition assessment, for example dual energy X-ray absorptiometry, can provideaccurate measurements, but cost limits their application to experimental use and to clinical settings where moreaccurate diagnosis is required for management. 1099 The most accurate measure of body composition is providedby using doubly labelled water, but cost limits its use to research.136EAT FOR HEALTH – australian dietary guidelinesNational Health and Medical Research Council