SPEC IAL ART IC L E
New Growth Charts for Taiwanese Children and Adolescents Based on World Health Organization Standards and Health-related Physical Fitness Walter Chen1*, Mei-Hwei Chang2
Department of Pediatrics, China Medical University Beigang Hospital, Yulin and China Medical University College of Medicine, Taichung, Taiwan 2 Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
1. Growth Charts
Received: Jul 19, 2009 Revised: Aug 12, 2009 Accepted: Aug 17, 2009 KEY WORDS: body mass index; growth charts; health-related physical fitness; Taiwanese children; World Health Organization standards
Children are not small adults. Growth (changes in size of the body as a whole or of its separate parts) and development (changes of function) consist of unique processes from birth to adulthood. Growth charts for height, weight and body mass index (BMI) are indispensable tools for both pediatricians and healthcare providers. They constitute not only the basic tools required for clinical evaluation, but are also useful for the purposes of public health and preventive medicine. On May 8, 2009 the Bureau of Health Promotion, Department of Health (DOH), officially launched new growth charts for infants and pre-school children in Taiwan.1 These new growth charts, unlike previous population-based ones, were adapted from the World Health Organization (WHO) Child Growth Standards for 0−5 years of age.2 This report briefly describes the new methods (criterion-based approach) used to construct these standards and compares the new growth charts with the old ones. We also propose growth charts for children and adolescents over 5 years of age in Taiwan.
2. Old Growth Curves
Previous measurements of height and weight were generally conducted by sampling the entire population. Following the rapid economic development in Taiwan and the associated increases in the standard of living and social wellbeing of its people, survey results have shown that child growth trends have also gradually increased each year. The reference growth charts previously
*Corresponding author. Department of Pediatrics, China Medical University Beigang Hospital, Yulin and China Medical University College of Medicine, 91 Hsueh-Shih Road, Taichung 40402, Taiwan. E-mail: email@example.com ©2010 Taiwan Pediatric Association
70 used in Taiwan were based on the combined data from two population-based surveys: the DOH (survey by stratified sampling of children from 0−6 years of age) and the Ministry of Education (nationwide survey of students).3 When these data were compared with those from the 2000 National Center for Health Statistics (NCHS), USA, it was found that the weight of boys aged 7−15 years in Taiwan was higher by an average of 1.6 kg, while the height was lower by 2.3 cm.3 These differences have raised several questions: (1) Is the method of sampling from the entire population acceptable, especially when the prevalence of childhood obesity has rapidly increased in recently years, (2) does the socalled “reference” agree with the real standard?
W. Chen, M.H. Chang morbidity rates. These approaches not only differ significantly from the previous population-based approach (also known as the descriptive approach),9 but also focus on how children should grow, rather than on how they grew in a particular time and place.
4. Growth Standards and References
In April 2006, the WHO released new standards for assessing the growth of children from birth to 5 years of age.10 These new standards were the product of a previous project that included a longitudinal followup of 882 infants from birth to 24 months and a cross-sectional component of 6669 children aged 18−71 months in six countries from diverse geographical regions, including Brazil, Ghana, India, Norway, Oman and the United States. The eligibility criteria were: single-term birth...