Original articleCentile values for anthropometric variables in Colombian adolescentsPercentiles antropométricos para adolescentes de Cali, Colombia
Introduction
Several authors have postulated that adults’ health status and quality of life are defined from very early ages.1, 2 Prenatal, nutritional, and life-style factors during the first years of life affect the onset of non-communicable chronic diseases during adulthood.3, 4 Likewise, changes caused by urbanization in most parts of the world with increased access to goods and services have markedly decreased infant and child mortality, producing a demographic and epidemiological transition in developing nations.5, 6 In the American continent, the first cause of mortality is chronic disease, especially in countries where a small proportion of the population lives in rural areas.7, 8
In Colombia, mortality due to illnesses associated with sedentary life styles currently represents over 40% of the death rate in most predominantly urban areas with high population density.9, 10 Additionally, because of the nutritional changes observed in the American continent, this death rate can by explained by risk factors for chronic disease such as overweight [measured through body mass index (BMI) or waist circumference] and sedentary life styles, given that 56.3% of Colombian children between 5 and 12 years of age spend more than 2 hours daily watching television and 56% perform less than 30 minutes of physical activity per day.9, 11
Determination of fat mass and body fat mass should be considered, given their relationship with the nutritional problems now observed in countries undergoing epidemiological transition. Currently, there is no mention of energy deficit but rather there is an excess of energy in Latin American infants and adolescents.12, 13 Anthropometric evaluation of children and adolescents is important, given the relationship between these parameters and the onset of chronic disease, especially cardio-metabolic diseases. Direct methods such as dual-energy X-ray absorptiometry (DEXA) or underwater weighing provide sensitive and valid evaluation measurements. However, these methods require sophisticated techniques and laboratory environments, limiting their application because of the equipment required and their high costs.
Consequently, in clinical practice and epidemiological studies, simpler anthropometric measurements have been developed such as waist circumference and skin-fold thickness measurements, which have been clearly related to the presence of chronic disease.9, 10, 11, 12, 13 Both methods serve to estimate body fat surplus or deficit and are correlated with BMI. Both childhood and adolescence are decisive periods in human life because of the multiple changes in metabolism, which differ between the sexes. For example, fat mass in female children and adolescents tends to be higher than in males,14 indicating the importance of measuring this parameter. Obtaining population reference values allows criteria for the interpretation of anthropometric scores to be established. This strategy aids the application of measurement instruments, allows a better understanding of the systematic differences among groups (according to ethnicity, age, region of residence, etc.), and permits the magnitude of changes in health status to be evaluated. Thus, reference values are required to interpret the results of anthropometric measurements in clinical and population-based studies and would aid interpretation in our current health system.
Studies describing reference values for body composition in children and adolescents are scarce, especially those evaluating body fat, hampering accurate identification of states of overnutrition or undernutrition. Recently, Mueller et al15 and Moreno et al16 published reference percentiles for the percentage of body fat, lean body mass and fat mass estimated through bioimpedance in adolescents in Spain and the USA, with highly discrepant results. Nevertheless, in Colombia proposals to define such reference percentiles in children and adolescents are rare. Our sample (n = 1,773) consisted of 865 boys and 908 girls from a cross-sectional population-based survey, the IFRECNTEC Study (Identification of Risk Factors for Non-communicable Chronic Diseases in Adulthood in a Population aged 6 to 18 years old attending School in the Municipality of Cali, Colombia)17 in whom data on anthropometric variables were recorded.
Section snippets
Methods
We performed a cross-sectional descriptive study in an ethnically homogeneous population of urban 6-18-year-old boys and girls enrolled in school. We aimed to establish statistically significant comparisons among percentiles. Statistical significance was set at 5% and power at 80%. A sample size of 80 observations for each percentile was chosen in a total of 1,817 individuals.17 For the sample selection, we calculated the total number of students by gender and socioeconomic level from a list of
Results
Fourteen schools were included in the study to achieve the planned sample size. Of the 1,800 students invited to participate, 27 students (1.5%) were not included in the analyses due to loss of information (n = 12) or lack of informed consent (n = 15). The final sample was composed of 1,773 students. The total number of students registered in the urban area of Cali during the study period was 318,916 out of a potential school-aged population of 505,838. For inferences on the city, the number of
Discussion
The objective of this study was to determine the percentile values for BMI, fat percentage, and waist circumference in a sample of children and adolescents in Santiago de Cali, Colombia, aged between 10 and 16 years old. To do this, and because the IFRECNTEC17 is an epidemiological study, we used standardized anthropometric measurements, which were reproducible and easily accessed.14, 15, 16, 17, 18, 19, 20, 21, 22 The sample was representative (baseline) of Colombia's current situation, with a
Conflict of interests
The authors declare they have no conflict of interest.
Funding
This study was supported by the El Instituto Colombiano para el Desarrollo de la Ciencia y la Tecnología “Francisco José de Caldas” – COLCIENCIAS and La Universidad del Valle.
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