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IAP charts to screen for metabolic risk in children more appropriate than WHO: study

The IAP growth chart committee recommends growth charts for height, weight and body mass index for assessment of growth of 5-18 years old Indian children.

Written by Anuradha Mascarenhas | Pune |
Updated: October 19, 2021 8:53:36 am
The researchers said IAP 2015 may be preferred owing to increased prevalence of obesity and high risk of development of metabolic syndrome in Indians. (File photo)

Researchers have made a strong case for the use of Indian Academy of Paediatrics (IAP )charts to screen for metabolic risk in children. IAP 2015 charts (as against the WHO 2007 references) had a higher sensitivity in identifying metabolic risk and are likely to be more suitable in Indian children and adolescents, a multi-centric study has found.

The study, ‘Predictive value of WHO vs IAP BMI charts for identification of metabolic risk in Indian children and adolescents’, was published in the September issue of the peer-reviewed Journal of Paediatric Endocrinology Metabolism.

The study was conducted among 1,418 healthy school-going children of age 9-18 years. The study’s specific aims were to compare the prevalence of overweight/obesity and metabolic risk, using random blood glucose, blood pressure and waist circumference by the WHO 2007 versus the IAP 2015 references, and to assess the predictive value of the two growth references for identifying metabolic risk.

The WHO and IAP BMI for age charts estimated a prevalence of overweight/obese as 15.7 per cent and 19.1 per cent respectively. The IAP charts had better sensitivity and negative predictive value, while WHO charts fared better in positive predictive value. The prevalence of overweight/obesity as judged by IAP charts was higher and a higher percentage of children with waist circumference more than the 90th centile was classified as overweight/obese by IAP as against the WHO charts, researchers said.

The difference in specificity was not statistically significant. As the IAP 2015 BMI for age charts use lower cut-offs than WHO charts (23kg/m 2 and 27kg/m 2 versus 25kg/m 2 and 30kg/m 2 ), they yield better sensitivity with drawback of higher number of false positives, Pune-based Dr Vaman Khadilkar told The Indian Express. Khadilkar had led a committee of experts that designed the IAP chart in 2015 and is one of the study authors.

WHO cut-offs have better positive predictive value but there are higher numbers of false negatives, leading to risk of missing evaluation in individuals at risk of development of metabolic syndrome by labelling them as having normal BMI.

The IAP growth chart committee recommends growth charts for height, weight and body mass index (BMI) for assessment of growth of 5-18 years old Indian children. This chart is updated every ten years. There are no updates on these WHO growth standard charts presently. But given the rising prevalence of obesity and metabolic syndrome (risk factors that could lead to heart disease and other health problems) in adolescents, assessing metabolic risk early is critical. BMI is recommended for diagnosis of obesity in children and adolescents.

“Growth patterns differ amongst different populations, especially in children above the age of five years. This is due to nutritional, environmental, genetic factors and timing of puberty, which play a major role not only in the attainment of final height but also in the characteristics of the growth curve. So, it is necessary to have country-specific growth charts to monitor growth of children between 5 and 18 years of age,” Khadilkar said.

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Dr Anuradha Khadilkar, consultant paediatrician and deputy director of Hirabai Cowasji Jehangir Medical Research Institute, who is one of the study authors, told the Indian Express, “As Asians and in general Indians are at higher risk of development of metabolic syndrome and consequent cardiometabolic consequences due to the same, as compared to people of other ethnicities, it is apt to evaluate a greater number of at-risk children and begin an early intervention.”

The researchers, who also include Dr Chirantap Oza, Dr Neha Kajale and Ketan Gondhalekar, said IAP 2015 may be preferred owing to increased prevalence of obesity and high risk of development of metabolic syndrome in Indians.

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