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Evaluación del Estado Nutricional

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Presentación del tema: "Evaluación del Estado Nutricional"— Transcripción de la presentación:

1 Evaluación del Estado Nutricional
Dr. Jaime Alberto Bueso Lara Programa de Atención Materno Infantil Hospital Roosevelt, viernes, 24 de marzo de 2017 The CDC Growth Charts, released in May 2000, consist of revised versions of the growth charts developed by the National Center para Health Statistics (NCHS) in 1977 and the addition of the Body Mass Index (BMI)- para-age charts. The development of the growth charts was a collaborative efparat between the Division of Health Examination Statistics in the National Center para Health Statistics (NCHS) and the Division of Nutrition and Physical Activity (DNPA) in the National Center para Chronic Disease Prevention and Health Promotion (NCCDPHP) at the Centers para Disease Control and Prevention (CDC). Revisado en agosto 2006

2 OBJETIVO ESPECÍFICO Evalúa correctamente el estado nutricional de niños y adolescentes, utilizando criterios antropométricos, clínicos y bioquímicos. The objectives of this training are to present general inparamation about the new growth charts, the science behind the development of the growth charts, the rationale para using IMC-para-edad and the advantages of using the IMC-para-edad charts as a screening tool.

3 OBJETIVO ESPECÍFICO Evalúa correctamente el estado nutricional de niños y adolescentes, utilizando criterios antropométricos, clínicos y bioquímicos. The objectives of this training are to present general inparamation about the new growth charts, the science behind the development of the growth charts, the rationale para using IMC-para-edad and the advantages of using the IMC-para-edad charts as a screening tool.

4 OBJETIVOS DE APRENDIZAJE
Al finalizar la actividad el (la) estudiante Argumenta las bases científicas del desarrollo de las tabla de crecimiento. Justifica la inclusión de IMC para edad. Utiliza el IMC para edad como instrumento de tamizaje. The objectives of this training are to present general inparamation about the new growth charts, the science behind the development of the growth charts, the rationale para using IMC-para-edad and the advantages of using the IMC-para-edad charts as a screening tool.

5 Terminología

6 Terminología Índices: Son combinaciones de medidas, es un concepto biológico:

7 Terminología Índices: Son combinaciones de medidas, es un concepto biológico: Necesarios para interpretar medidas

8 Terminología Índices: Son combinaciones de medidas, es un concepto biológico: Necesarios para interpretar medidas Necesarios para resumirlas

9 Terminología Índices: Son combinaciones de medidas, es un concepto biológico: Necesarios para interpretar medidas Necesarios para resumirlas Indicador: Construido a partir de índices, es un concepto social.

10 Terminología Índices: Son combinaciones de medidas, es un concepto biológico: Necesarios para interpretar medidas Necesarios para resumirlas Indicador: Construido a partir de índices, es un concepto social. Índice e Indicador a veces son sinónimos

11 ¿Qué es un percentil? Son el indicador clínico más comúnmente usado para determinar los patrones de crecimiento de niños individuales.

12 ¿Qué es un percentil? Son el indicador clínico más comúnmente usado para determinar los patrones de crecimiento de niños individuales. Determinan la posición de la medida de un individuo indicando a qué por ciento de la población de referencia iguala o excede.

13 ¿Qué es un percentil? Son el indicador clínico más comúnmente usado para determinar los patrones de crecimiento de niños individuales. Determinan la posición de la medida de un individuo indicando a qué por ciento de la población de referencia iguala o excede. Ejemplo: Una niña de 5 años de edad cuyo peso está en el 25 percentil, pesa igual o más que el 25% de las niñas de la población de referencia, por ende pesa menos que el 75% de la misma población de referencia.

14 Indices e Indicadores Antropométricos

15 Indices e Indicadores Antropométricos
Peso/Edad: Estado de nutrición global, sirve de base para la clasificación de Dr. F. Gómez. Peso/Edad alto: Poca utilidad en Salud Pública. Peso/Edad bajo: Mal nutrición global.

16 Indices e Indicadores Antropométricos
Peso/Edad: Estado de nutrición global, sirve de base para la clasificación de Gómez. Peso/Edad alto: Poca utilidad en Salud Pública. Peso/Edad bajo: Mal nutrición global. Peso/Talla: Estado nutricional actual Peso/Talla bajo: Indicador de desgaste Peso/Talla alto: Indicador de sobrepeso y obesidad.

17 Indices e Indicadores Antropométricos
Peso/Edad: Estado de nutrición global, sirve de base para la clasificación de Gómez. Peso/Edad alto: Poca utilidad en Salud Pública. Peso/Edad bajo: Mal nutrición global. Peso/Talla: Estado nutricional actual Peso/Talla bajo: Indicador de desgaste Peso/Talla alto: Indicador de sobrepeso y obesidad. Talla/Edad: Crecimiento lineal alcanzado. Talla/Edad bajo: Indicador de achicamiento Talla/Edad alto: Escaso valor en salud pública.

18 ¿Qué es el Puntaje Z? El puntaje z es la desviación de un valor de un individuo en relación a la mediana de la población de referencia, dividida entre la desviación estándar de esa población.-

19 Z = X1 - X DE Fórmula para determinar la Z X1 = Medida observada
X = Mediana de la población de referencia DE = Desviación Estándar de la población de referencia.

20 Curva de Distribución Normal
97% de la población Curva de Distribución Normal y Valores de Z

21 Interpretación Nutricional
Niveles críticos para distintas categorías de los indicadores de Peso/Edad, Talla/Edad y Peso/Talla Niveles Críticos Interpretación Nutricional Peso para edad Talla para edad Peso para talla Más de 2 DE * ** Riesgo alto de obesidad Entre +1 DE y +2 DE Riesgo leve de obesidad Entre +1 DE y -1 DE Normal Entre -1 DE y - 2 DE Deficiencia leve Retardo leve Entre -2 DE y – 3 DE Deficiencia moderada Retardo moderado Debajo de -3 DE Deficiencia severa Retardo severo * El exceso en peso/edad se debe evaluar analizando la talla del niño. A nivel de población se podrían usar los mismos puntos de corte que en peso/talla. ** No se han definido valores excesivos de talla/edad Tomado de Diplomado a Distancia: Salud de la niñez, módulo I, Unidad 1 Índices e indicadores antropométricos, pp Guatemala 1997.

22 Ejemplo de cálculo de Z Niña de 3 meses de edad con longitud de 55 cm y peso de 3.9 Kg. ¿Cuál es el valor de Z Peso/Talla de esta niña? ¿Cuál es su interpretación?

23 Cuadro 28. Peso (Kg) por longitud de Niñas de 45 a 61 cm
Talla DE DE DE MEDIANA DE DE DE There are several new features of the growth charts. These include The addition of the IMC-para-edad chart para Niños and adolescents 2 to 20 Años; The addition of the 85th Percentilo to identify at risk of Sobrepeso on the IMC-para-edad chart and weight-para-stature chart; The addition of the 3rd and 97th Percentilos. Pediatric endocrinologists and others providing services to special populations may choose to use these charts when caring para Niños growing at the outer Percentilos; The limits para length and height were extended: On the Peso/Talla chart para Niños from birth to 36 months , length was extended from 49 to 45 cm. On the optional weight-para-stature chart, the extension from 90 to 77 cm allows almost all 2-year- Niños to be plotted on the chart; The agreement of smoothed Percentilo curves and z-scores; Correction in the disjunction that occurred between 24 and 36 months de edad when switching from length to stature using the 1977 NCHS growth charts;

24 Calculamos primero la DE
Cuadro 28. Peso (Kg) por longitud de Niñas de 45 a 61 cm Talla DE DE DE MEDIANA DE DE DE There are several new features of the growth charts. These include The addition of the IMC-para-edad chart para Niños and adolescents 2 to 20 Años; The addition of the 85th Percentilo to identify at risk of Sobrepeso on the IMC-para-edad chart and weight-para-stature chart; The addition of the 3rd and 97th Percentilos. Pediatric endocrinologists and others providing services to special populations may choose to use these charts when caring para Niños growing at the outer Percentilos; The limits para length and height were extended: On the Peso/Talla chart para Niños from birth to 36 months , length was extended from 49 to 45 cm. On the optional weight-para-stature chart, the extension from 90 to 77 cm allows almost all 2-year- Niños to be plotted on the chart; The agreement of smoothed Percentilo curves and z-scores; Correction in the disjunction that occurred between 24 and 36 months de edad when switching from length to stature using the 1977 NCHS growth charts; Calculamos primero la DE

25 Cuadro 28. Peso (Kg) por longitud de Niñas de 45 a 61 cm
Talla DE DE DE MEDIANA DE DE DE Como el valor del peso de la niña está por debajo de la mediana, la DE= DE= 0.19 There are several new features of the growth charts. These include The addition of the IMC-para-edad chart para Niños and adolescents 2 to 20 Años; The addition of the 85th Percentilo to identify at risk of Sobrepeso on the IMC-para-edad chart and weight-para-stature chart; The addition of the 3rd and 97th Percentilos. Pediatric endocrinologists and others providing services to special populations may choose to use these charts when caring para Niños growing at the outer Percentilos; The limits para length and height were extended: On the Peso/Talla chart para Niños from birth to 36 months , length was extended from 49 to 45 cm. On the optional weight-para-stature chart, the extension from 90 to 77 cm allows almost all 2-year- Niños to be plotted on the chart; The agreement of smoothed Percentilo curves and z-scores; Correction in the disjunction that occurred between 24 and 36 months de edad when switching from length to stature using the 1977 NCHS growth charts;

26 Cuadro 28. Peso (Kg) por longitud de Niñas de 45 a 61 cm
Talla DE DE DE MEDIANA DE DE DE El Valor de Z sería: /0.19 Z= -2.52 There are several new features of the growth charts. These include The addition of the IMC-para-edad chart para Niños and adolescents 2 to 20 Años; The addition of the 85th Percentilo to identify at risk of Sobrepeso on the IMC-para-edad chart and weight-para-stature chart; The addition of the 3rd and 97th Percentilos. Pediatric endocrinologists and others providing services to special populations may choose to use these charts when caring para Niños growing at the outer Percentilos; The limits para length and height were extended: On the Peso/Talla chart para Niños from birth to 36 months , length was extended from 49 to 45 cm. On the optional weight-para-stature chart, the extension from 90 to 77 cm allows almost all 2-year- Niños to be plotted on the chart; The agreement of smoothed Percentilo curves and z-scores; Correction in the disjunction that occurred between 24 and 36 months de edad when switching from length to stature using the 1977 NCHS growth charts;

27 Interpretación Nutricional
Niveles críticos para distintas categorías de los indicadores de Peso/Edad, Talla/Edad y Peso/Talla Niveles Críticos Interpretación Nutricional Peso para edad Talla para edad Peso para talla Más de 2 DE * ** Riesgo alto de obesidad Entre +1 DE y +2 DE Riesgo leve de obesidad Entre +1 DE y -1 DE Normal Entre -1 DE y - 2 DE Deficiencia leve Retardo leve Entre -2 DE y – 3 DE Deficiencia moderada Retardo moderado Debajo de -3 DE Deficiencia severa Retardo severo * El exceso en peso/edad se debe evaluar analizando la talla del niño. A nivel de población se podrían usar los mismos puntos de corte que en peso/talla. ** No se han definido valores excesivos de talla/edad Tomado de Diplomado a Distancia: Salud de la niñez, módulo I, Unidad 1 Índices e indicadores antropométricos, pp Guatemala 1995.

28 Tablas de Crecimiento CDC 2000
Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition and Physical Activity Maternal and Child Nutrition Branch The CDC Growth Charts, released in May 2000, consist of revised versions of the growth charts developed by the National Center para Health Statistics (NCHS) in 1977 and the addition of the Body Mass Index (BMI)- para-age charts. The development of the growth charts was a collaborative efparat between the Division of Health Examination Statistics in the National Center para Health Statistics (NCHS) and the Division of Nutrition and Physical Activity (DNPA) in the National Center para Chronic Disease Prevention and Health Promotion (NCCDPHP) at the Centers para Disease Control and Prevention (CDC). Revisado en Junio de 2002

29 Nuevos Aspectos en las Tablas de Crecimiento
Tablas de IMC para edad (2-20 años) 85 percentilo (riesgo de sobrepeso) Disponiblidad de los percentilos 3 y 97 Ampliación de los limites inferiores de longitud de 45 a 49 cm y de talla de 77 a 90 cm. Suavizamiento para coincidencia en los percentilos y puntajes Z. Correción de la disyunción There are several new features of the growth charts. These include The addition of the IMC-para-edad chart para Niños and adolescents 2 to 20 Años; The addition of the 85th Percentilo to identify at risk of Sobrepeso on the IMC-para-edad chart and weight-para-stature chart; The addition of the 3rd and 97th Percentilos. Pediatric endocrinologists and others providing services to special populations may choose to use these charts when caring para Niños growing at the outer Percentilos; The limits para length and height were extended: On the Peso/Talla chart para Niños from birth to 36 months , length was extended from 49 to 45 cm. On the optional weight-para-stature chart, the extension from 90 to 77 cm allows almost all 2-year- Niños to be plotted on the chart; The agreement of smoothed Percentilo curves and z-scores; Correction in the disjunction that occurred between 24 and 36 months de edad when switching from length to stature using the 1977 NCHS growth charts;

30 Disyunción: Suavizamiento en las nuevas tablas
120 120 110 1977 2000 110 100 100 90 90 Longitud/talla en cm 80 Ongitud/talla en cm 80 70 70 In the 1977 charts, the infant and child curves para Talla para edad and Estatura para edad did not exactly join at the usual junction of 24 to 36 months. This disjunction occurred in part because recumbent length was obtained from the 1977 Fels data set consisting of upper middle-class infants in Ohio. Stature was from the 1977 NCHS data sets. When changing from recumbent length to stature in a clinical setting, usually between 24 and 36 months, there appeared to be a downward shift in the child's placement on the charts. In the new CDC growth charts, there is no longer a disjunction between length and stature because the same reference population of Niños 2 to 3 Años de edad was measured para both length and height. (Note that the average difference between recumbent length and stature in national survey data is approximately 0.8 cm.) 60 60 50 50 40 40 6 12 18 24 30 36 42 48 54 60 6 12 18 24 30 36 42 48 54 60 Edad en meses Edad en meses

31 Referencias Poblacionales en las Tablas de los CDC
Diversidad étnica y racial. Infantes: Nacimiento a los 36 meses Niños y Adolescentes: 2 a 20 años. Niños alimentados al pecho y con fórmulas. The reference population used to construct the CDC Growth Charts is a nationally representative sample. Data were obtained from a series of national health examinations and surveys conducted by NCHS from and from supplemental data. The racial and ethnic distribution in the reference population represents that of the U.S. population at the time each of the National Health Examination Survey (NHES) and National Health and Nutrition Examination Survey (NHANES) surveys were conducted. para the first time, nationally representative data were used to construct the growth charts para infants — birth to 36 months de edad. Nationally representative data were used to create the growth charts para Niños and adolescents 2 to 20 Años de edad and were obtained from 5 national survey data sets. The new reference represents the combined growth pattern of breast- and paramula-fed infants in the U.S. Approximately 50 percent of the infants were reported to breastfeed with about 33 percent breastfeeding para 3 months or longer.

32 Datos de Referencia: Nacimiento a 36 meses
para the first time, data used to construct growth charts para infants from birth to 36 months de edad is nationally representative. The new infant growth charts were developed using data from several sources. NHANES III provided weight, length, and head circumference data beginning at 2 months de edad. NHANES II provided data beginning at 6 months de edad and NHANES I provided data beginning at 12 months de edad. Because national surveys did not collect data between birth and 2 months de edad, supplemental data was used. These data included 1) birth data from U. S. vital statistics; 2) length and Peso/Talla data from Missouri and Wisconsin birth certificates; 3) length data from infants between 0.5 and 4.5 months de edad in the Pediatric Nutrition Surveillance System; and 4) head circumference measurements at birth from the Fels Longitudinal Study.

33 Datos de Referencia: 2 a 20 Años
Data used to create the growth charts para Niños and adolescents 2 to 20 Años de edad were nationally representative and obtained from 5 national survey data sets. The new growth charts para Niños and adolescents aged 2 to 20 were developed using data from various sources. NHES - Cycle II, included weight and stature data from Niños and adolescents from 6 through 11 Años de edad. Data from Cycle III of NHES represented Niños and adolescents from 12 through 17 Años de edad. NHANES I, II, and III provided weight and stature data para Niños from 2 to 20 Años de edad. However, the NHANES III weight measures were excluded para Niños 6 Años de edad and er

34 Exclusiones en los Datos de Referencia
Infantes de Muy Bajo Peso (MBP) al (<1,500 g) porque tienen un patrón de crecimiento difrerente. Los datos del peso de NHANES III para > 6 años fueron excluidos para evitar una cambio ascendente en curvas de peso-para-edad y de a BMI-para-edad Two groups were excluded from the reference population: Very low birth weight (VLBW) infants were excluded from the reference data because the growth pattern of VLBW infants, who are almost always born premature, is markedly different from that of term infants weighing 2500 g or more. The number of VLBW infants in the reference data was small resulting in the exclusion of less than 1 percent of the data from birth through 35 months . NHANES III weight data para Niños 6 Años and er were excluded to avoid the influence of an increase in body weight that occurred between the previous national surveys and the NHANES III survey. If these data would have been included an upward shift in the weight-para-age and IMC-para-edad curves would have resulted.

35 Ajuste por edad para sobrepeso
NHANES I to III 2 Porcentaje This graph shows the considerable increase in the Prevalencia of Sobrepeso in NHANES III (green bar) para boys and girls ages 6 to 11 and 12 to 19 when compared to NHANES I (purple bar) and II (white bar). If data from NHANES III had been included, the resulting 95th Percentilo curve would have been Más. Consequently, weight data para Niños 6 Años and er were excluded. Grupos por edad y sexo 1>95th percentil IMC para edad 2

36 Las Tablas de los CDC son para todos los grupos étnicos y raciales combinados
Influencias ambientales parecen contribuir a las variaciones del crecimiento más que las influencias genéticas. Muestras inadecuadas en las tablas específicas para raza y etnicidad. El efecto de raza y etnia sobre el IMC/Edad es incierto. CDC promotes one set of growth charts para all racial and ethnic groups. Racial- and ethnic-specific charts are not recommended because studies support the premise that differences in growth among various racial and ethnic groups are the result of environmental rather than genetic influences. Also, the reference population lacked sufficient numbers of specific racial/ethnic groups to consider separate charts. Although some studies using IMC-para-edad to evaluate at risk of Sobrepeso and Sobrepeso have found differences by ethnic and racial groups, factors that affect differences in growth among racial and ethnic groups, if they truly exist, remain unclear and more research is needed to clarify the issue.

37 Prevalencia ajustada a edad de talla baja para edad por grupo etnico, niños de 0-5 años1
Porcentaje A study by Mei et al., illustrates the effect of environmental factors on growth. This graph shows the trend of the Prevalencia of low height-para-age or stunting of recently immigrated refugee Niños from Southeast Asia to the United States in the early 1980s (yellow line) compared to white Niños (red line) living in the United States. By the 1990s, the Prevalencia of low height-para-age had declined among Asian Niños and height-para-age was almost identical to that of white Niños in the United States. Changing socioeconomic status often is associated with improved growth. Año de visita 1 Mei, Yip and Trowbridge, Asia Pacific J Clin Nutr 1998; 7(2):

38 Alimentación al Pecho versus Fórmula
El modo de alimentación puede influenciar el crecimiento. La nuevas tablas representan una combinación de los patrones de crecimiento de ambos grupos. El grupo de trabajo de la OMS desarrolló tablas para infantes y niños hasta los 5 años de edad, colectado en niños siguiendo las indicaciones de alimentación de la OMS. Another characteristics of the reference population that needs to be considered is that the growth patterns of breast-fed infants differ from those of paramula-fed infants. Generally, breast-fed infants grow more rapidly in the first 2 months of life and not as rapidly at 3 to 4 months. Breast-fed infants continue to grow less rapidly up to 12 months compared with the 1977 reference data, which were based on mainly paramula-fed infants. The new reference represents the combined growth patterns of both breast- and paramula- fed infants in the United States. About 50 percent of the infants born were reported to have been breast-fed and about 33 percent of those were breast-fed 3 months or longer. Because the patterns of growth para exclusively breast-fed and paramula-fed infants differ, caution must be used when interpreting growth of exclusively breast-fed infants. The American Academy of Pediatrics (AAP) recommends exclusively breastfeeding para the first 6 months and continuing para at least 12 months. Currently, a reference para exclusively breast-fed infants is not available. However, CDC is collaborating with the World Health Organization (WHO) to develop a set of international growth charts para infants and Niños through 5 Años de edad based on the growth of infants and Niños fed according to WHO recommendations (breast-fed at least 12 months and complementary food introduced sometime between 4 and 6 months).

39 Indicadores del Estado Nutricional
<5th Percentilo >95th Percentilo Circunferencia craneana/edad Detención/Talla Corta Longitud o talla por edad <5th Percentilo Peso bajo Peso/Talla IMC/Edad There are several common measures para monitoring a child’s growth. These include head circumference, length or height, and body weight. The most common indices to compare weight and stature measurements with reference curves are length or Estatura para edad, weight-para-age, Peso/Talla para Niños < 2 Años de edad, and IMC-para-edad para Niños 2 to 20 Años de edad. Head circumference reflects brain size and is often used to screen para potential developmental problems among infants at birth to 24 months . Niños with a head circumference less than the 5th Percentilo or above the 95th Percentilo have health or developmental risks that need further medical assessment. Infants and Niños whose length- or Estatura para edad is less than the 5th Percentilo may be short because their parents are short or they may be stunted because of long-term malnutrition, delayed maturation, chronic illness, or genetic disorder. Bajo Peso defined as Peso/Talla or IMC-para-edad less than the 5th Percentilo may be indicative of recent malnutrition, dehydration, or a genetic disorder. The cutoff values of less than the 5th Percentilo and above the 95th Percentilo are used to screen para potential health or nutrition problems and identify Niños who may need further medical assessment. <5th Percentilo

40 Indicadores del Estado Nutricional
Sobrepeso Peso/Talla IMC/Edad >95th Percentilo Riesgo de Sobrepeso IMC/Edad 85th to 95th Percentilo “Sobrepeso” rather than obesity is the term preferred para describing infants or Niños greater than or equal to the 95th Percentilo of Peso/Talla or IMC-para-edad. The 85th Percentilo is included on the IMC-para-edad and the weight-para-stature charts. Expert committees have indicated that Niños and adolescents aged 2 to 20 Años between the 85th and 95th Percentilos are at risk of Sobrepeso. Evaluating a child’s pattern of growth over time is more important than a single measure of size. The pattern of growth is based on periodic measurements which are tracked on a Percentilo line as a child grows.

41 Prevalencia de Indicadores de Estado Nutricional Curvas Nuevas Comparadas con Curvas*
< 2 Años Indicador Nutricional Cambios en la prevalencia Detención/Talla Corta Talla para edad <5th 1% a 2% menor Bajo Peso Peso/Talla <5th 1% a 2% Más Practitioners have asked about the impact of the new reference population on the Prevalencia of Indicador Nutricionals including stunting or shortness, Bajo Peso, and Sobrepeso. To answer this question, data from NHANES III were used to compare the 2000 (new) reference with the 1977() reference. There are only slight differences in the Prevalencia rates of shortness, Bajo Peso, and Sobrepeso when using the new reference. Fewer Niños will be classified as short or stunted, but a few more will be classified as Bajo Peso. Specifically, among Niños < 2 Años :  the Prevalencia of stunting or shortness, defined as Talla para edad less than the 5th Percentilo, is 1% to 2% menor;  Bajo Peso, defined as Peso/Talla less than the 5th Percentilo, is 1% to 2% Más; and  Sobrepeso, defined as equal to or greater than the 95th Percentilo, is 2% menor para mujeres and 2% menor para hombres. Sobrepeso Peso/Talla >95th 2% menor para mujeres 2% Más para hombres * NHANES III

42 Prevalencia de Indicadores de Estado Nutricional, Curvas nuevas comparadas con Curvas*
Niños 2 a 5 Años de edad Indicador Nutricional Cambios en la prevalencia Detención/Talla Corta Estatura para edad <5th 1% menor 3% a 4% Más Bajo Peso** <5th Among Niños 2 to 5 Años, the greatest difference is found in an increase in the Prevalencia of Bajo Peso by 3 – 4 percent in 2 to 5 year- girls and boys. In er Niños, little change in the Prevalencia of Indicador Nutricionals was found. Sobrepeso** 95th No cambia para mujeres 1% Más para hombres * NHANES III **IMC-para-edad, peso-para-talla

43 ¿Qué es el IMC? Indice de Masa Corporal (IMC) = Peso (kg)/Talla (m)2
IMC es una herramienta de tamizaje efectiva, no es una herramienta diagnóstica. Para Niños, IMC es específica para edad y sexo, IMC-para-edad es la medida recomendada. Body Mass Index (BMI) is an anthropometric index of weight and height (stature) that is defined as body weight in kilograms divided by height in meters squared. IMC is the commonly accepted index para classifying adiposity in adults and it is recommended para use with Niños and adolescents. Like weight-para-height, IMC is a screening tool used to identify individuals who are Bajo Peso or Sobrepeso. IMC is not a diagnostic tool. para example, a child who is relatively heavy may have a high IMC para his or her age or high weight-para-stature. To determine whether the child has excess fat, further assessment needed might include triceps skinf measurements. To determine a counseling strategy, assessments of diet, health, and physical activity are needed. IMC is gender specific and age specific para Niños. IMC-para-edad is the measure used para ages 2 to 20 Años since IMC changes substantially as Niños get er. Whereas para adults, IMC is neither age nor gender specific and nutritional status is defined by fixed cut points.

44 Ventajas del IMC-para-edad
Provee una referencia para adolescentes, que no estaba disponible antes. Es consistente con el índice del adulto, por lo que puede ser usada desde los dos años a la edad adulta. Da indicios de sobrepeso infantil hacia la adultez. There are several advantages to using IMC-para-edad as a screening tool para Sobrepeso and Bajo Peso. IMC-para-edad provides a reference para adolescents that was not previously available. When the 1977 NCHS growth charts were developed, weight-para-height Percentilos were provided only para prepubescent girls up to 10 Años and para boys up to 11.5 Años. IMC-para-edad is the only indicator that allows us to plot a measure of weight and height with age on the same chart. Age and stage of sexual maturation are highly related to body fatness. IMC-para-edad was not available in the 1977 charts. Another advantage is that IMC-para-edad is the measure that is consistent with the adult index so IMC can be used continuously from 2 Años de edad to adulthood. IMC can be used to track body size beginning at 2 Años de edad and continue throughout the life cycle. This is important since IMC in childhood is a determinant of adult BMI.

45 Carriles de IMC-para-edad del Nacimiento a 18 Años con Porcentaje de Sobrepeso de Niños quienes son Obesos a los 25 años1 The tracking of IMC that occurs from childhood to adulthood is clearly shown in data from a study by Robert Whitaker (Niños’s Hospital Medical Center in Cincinnati) and colleagues. They examined the probability of obesity in young adults in relation to the presence or absence of Sobrepeso at various times during childhood. para example, in Niños 10 to 15 Años , 10% of those with IMC-para-edad < 85th Percentilo were obese at age 25 whereas 75% of those with a IMC-para-edad > 85th Percentilo were obese as adults and 80% of those with a IMC-para-edad > 95th Percentilo were obese at age 25. (The sample size para the study was 854.) This study clearly shows that an Sobrepeso child is more likely than a child of normal weight to be obese as an adult. Other studies have shown this same trend of tracking occurring from childhood to adulthood. 1 Whitaker et al. NEJM: 1997;337:

46 Ventajas del IMC-para-edad
IMC-para-edad relacionado con riesgos en salud Correlación con riesgos clínicos para enfermedad cardiovascular, incluyendo hiperlipidemia, hiperinsulinemia e hipertensión. IMC-para-edad durante la pubertad se relaciona con niveles de lípidos e hipertensión en la edad media. Another advantage of using IMC-para-edad to screen para Sobrepeso or at risk of Sobrepeso in Niños is that it correlates with clinical risk factors para cardiovascular disease including hyperlipidemia, elevated insulin, and high blood pressure. Freedman and colleagues* used data from the Bogalusa Heart Study and found that approximately 60% of 5- to 10 year- Niños who were Sobrepeso had at least one biochemical or clinical risk factor para cardiovascular disease such as those just mentioned, and 20% had two or more risk factors.* We know that risk factors in Niños become chronic diseases in adults. IMC-para-edad during pubescence is related to lipid and lipoprotein levels and blood pressure in middle age. *Freedman et al., The relation of Sobrepeso to cardiovascular risk factors among Niños and adolescents: the Bogalusa Heart Study. Pediatrics 1999;103:

47 IMC-para-edad se compara bien con:
Mediciones de Peso-para-Talla1 Mediciones de grasa corporal IMC-para-edad compares well with both weight-para-stature measurements and measures of body fat. A study completed by researchers at CDC compared the perparamance of IMC-para-edad and weight-para-stature with fatness measured by dual energy x-ray absorptometry (DXA), a direct measure of adiposity. NHANES III data were used to test how well IMC-para-edad predicts Bajo Peso (below 15th Percentilo) and Sobrepeso (>85th Percentilo) relative to the traditional weight-para-stature in Niños 2 to 19 Años . Both IMC-para-edad and weight-para-stature perparamed equally well in screening para Bajo Peso and Sobrepeso among Niños 3 to 5 Años de edad. para school-aged Niños (6 to 11 and 12 to 19 age groups), IMC-para-edad was slightly better than weight-para-stature in predicting Bajo Peso and Sobrepeso. Ratios of weight relative to stature such as IMC-para-edad and weight-para-stature may be used as indirect measures of Sobrepeso that correlate with more direct measures. IMC-para-edad is significantly correlated with subcutaneous and total body fatness in adolescents. It is not a measure of body fatness but rather a proxy para body fat. Mei et al., Am J Clin Nutr 2002;75:

48 ¿Por qué usar el IMC-para-edad?
Recomendada por el Comité de Expertos para evaluar Sobrepeso Guía para Sobrepeso en los Servicios Preventivos para Adolescentes (Am J Clin Nutr 1994;59: ) Evaluación y Tratamiento de Obesidad: Recomendaciones del Comité de Expertos (Pediatrics 1998 Sept;(102)3:e 29) Valoración de obesidad en niños y adolescentes: International Obesity Task Force (Am J Clin Nutr 1999, 70,suppl) Because of the numerous advantages of using IMC-para-edad para assessing Sobrepeso in Niños and adolescents, expert committees and advisory groups have recommended IMC-para-edad as the accepted measure. Published references are listed on the slide. Briefly, the background on recommendations to use IMC-para-edad follow: In 1994, an expert committee on Clinical Guidelines para Sobrepeso in Adolescent Preventive Services was convened to provide advice on the development of Bright Futures: National Guidelines para Health Supervision of Infants, Niños and Adolescents and Guidelines para Adolescent Preventive Services (GAPS). The committee recommended that IMC-para-edad be used to routinely screen para Sobrepeso in adolescents. In 1997, a consensus panel recommended that IMC para age be used routinely to screen Niños para Sobrepeso. They also recommended cutpoints of between the 85th and 95th Percentilos to identify Niños and adolescents as at risk of Sobrepeso and at or above the 95th Percentilo to identify Niños and adolescents as Sobrepeso. (Barlow and Dietz, 1998). Also, in 1997, an international conference convened by the International Obesity Task parace concluded that IMC is a reasonable measure para assessing Sobrepeso in Niños and adolescents worldwide. (Dietz and Bellizzi, 1999; Bellizzi and Dietz, 1999).

49 Forma de la Curva Peso/Talla versus Curva de IMC-para-edad
5 10 15 20 25 30 35 80 90 100 110 120 130 Talla (cm) Peso (kg) 10 15 20 25 30 35 24 72 120 168 216 Edad (meses) IMC 95th 95th 50th 5th 50th 5th The shapes of the weight-para-stature and the IMC-para-edad growth curves differ, as you can see. The weight-para-stature curve shows how weight increases in relation to stature. The IMC-para-edad chart shows age-related changes in growth and can be used up to age 20. With the IMC-para-edad chart weight, stature and age of a child are considered whereas with the weight-para-stature chart, only weight and stature are used. 

50 OK135S059

51 Cambios de IMC con la edad (Niños)
BMI BMI Ejemplo: Carril del 95th Percentilo Edas IMC 2 años 4 años 9 años 13 años Niños: 2 a 20 Años IMC changes substantially with age. After about 1 year de edad, IMC-para-edad begins to decline and it continues falling during the preschool Años until it reaches a minimum around 4 to 6 Años de edad. Here you see IMC-para-edad tracking on the 95th Percentilo. BMI BMI

52 Figura de IMC-para-edad, Curva de Crecimiento: Rebote de“Adiposidad” (AR)
Ejemplo: AR temprano Edad (meses) IMC Niños: 2 a 20 Años BMI IMC Here you see a section of the IMC-para-edad chart para boys enlarged to show the shape of the curve in more detail. After 4 to 6 Años de edad, IMC-para-edad begins a gradual increase through adolescence and most of adulthood. The rebound or increase in IMC that occurs after it reaches its lowest point is referred to as "adiposity" rebound. This is a normal pattern of growth that occurs in all Niños. Recent research has shown that the age when the "adiposity" rebound occurs may be a critical period in childhood para the development of obesity as an adult. An early "adiposity" rebound, occurring beparae ages 4 to 6, is associated with obesity in adulthood. In the example shown here, adiposity rebound occurred at around age 3. IMC reached the lowest point at 32 months (2 Años 8 months) and then began to increase. However, studies have yet to determine whether the Más IMC in childhood is truly adipose tissue versus lean body mass or bone. Additional research is needed to further understand the impact of early adiposity rebound on adult obesity. (Note that we put the word adiposity in quotations when using it in this context since we do not know if it is truly adipose tissue.) IMC

53 IMC-para-edad Puntos de corte
> 95th Percentilo Sobrepeso 85th a < 95th Percentilo Riesgo de Sobrepeso < 5th Percentilo Bajo Peso The expert committees’ recommendations are to classify IMC-para-edad at or above the 95th Percentilo as Sobrepeso and between the 85th and 95th Percentilo as at risk of Sobrepeso. The 85th Percentilo is included on the IMC-para-edad and the weight-para-stature charts to identify those at risk of Sobrepeso. The cutoff para Bajo Peso of less than the 5th Percentilo is based on recommendations by the World Health Organization Expert Committee on Physical Status.1 1 The World Health Organization Expert Committee on Physical Status. The Use and Interpretation of Anthropometry. Physical Status: Report of a WHO Expert Committee: WHO Technical Report Series 854, WHO, Geneva, 1996.

54 Rendimiento del IMC-para-edad como tamizador
Usando el 85o y 95o Percentilos como puntos de corte, pocos niños son incorrectamente identificados como sobrepeso, pero algunos con sobrepeso pueden no ser identificados. Es deseable la correcta identificación de aquellos niños con riesgo de sobrepeso o bajo peso. “The validity of selected cutoff points to identify adolescents with the highest percentage of body fat has been investigated. In general, common cutoff points para IMC and relative weight have low sensitivities but high specificities. para example, BMIs > 85th Percentilo has a sensitivity of 29% and 23% para identifying adolescent hombres and mujeres, respectively, who are above the 90th Percentilo para percentage body fat; corresponding specificities are 99% and 100%. In screening para adolescent Sobrepeso, specificity may be more important than sensitivity. Maximizing specificity minimizes the proportion of adolescents who will be incorrectly considered Sobrepeso by the screen.” 1 Recently it has been shown that cardiovascular risk factors are associated with the established IMC-para-edad cutoffs. Freedman et al., (1999) found that approximately 60% of 5- to 10 year- Niños with IMC-para-edad values > the 95th Percentilo had at least one biochemical or clinical risk factor para cardiovascular disease such as hypertension, elevated insulin levels, and hyperlipidemia. Twenty percent of Niños had two or more risk factors. 1 Himes and Dietz, Guidelines para Sobrepeso in adolescent preventive services: Recommendations from an expert committee. Am J Clin Nutr 1994;59:

55 An alternate method to obtain IMC is to use the CDC Table para Calculated Body Mass Index Values para Selected Heights and Weights para Ages 2 to 20. This is available in an 8.5 x 11 inch paramat or a checkbook size paramat that you see here. These can be printed from the growth chart Web site. (http://www.cdc.gov/growthcharts) Selected BMIs are calculated from heights that range 29 to 78 in. and the corresponding centimeters; and from weights ranging from 18 to 250 pounds and the corresponding kilograms.

56 Here you see a page from the checkbook size CDC Table para Calculated Body Mass Index Values para Selected Heights and Weights para Ages 2 to 20. To find the IMC of a child who is 33.5 inches tall with a weight of 28.0 pounds, find the height of 33.5 inches in the left column (circled in red) and the weight of 28 pounds on the top row (circled in red). The intersection of these two is the IMC (circled in red). In this example, the IMC is 17.5.

57 ¿Puede ver el Riesgo? Esteban tiene 3 años 3 semanas .
¿Cómo “estima” su estado nutricional? Normal Delgado Riesgo de sobrepeso Sobrepeso In the next three slides, we want you to do a self-test to see how well you can screen para risk of Sobrepeso in Niños by looking. We want you to try to identify Niños with a IMC-para-edad equal to or greater than the 85th Percentilo and less than the 95th Percentilo. It has been said that “few medical conditions can be diagnosed as confidently by untrained individuals as gross obesity.” Yet it is very difficult to distinguish Niños who are at risk of Sobrepeso from normal Niños. In childhood, the distinction is made more difficult by age-related physiological variations. So, see how you do with the three photos. This first one is a boy who is 3 Años . Does he appear at risk of Sobrepeso? Foto: UC Berkeley Longitudinal Study, 1973

58 ¿Puede ver el Riesgo? Estefanía tiene 4 Años .
¿Cómo “estima” su estado nutricional? Normal Delgado Riesgo de sobrepeso Sobrepeso This is another 4-year- girl. Does she appear at risk of Sobrepeso? Photo from UC Berkeley Longitudinal Study, 1973

59 ¿Puede ver el Riesgo? Estela tiene 4 Años, 4 semanas .
¿Cómo “estima” su estado nutricional? Normal Delgada Riesgo de sobrepeso Sobrepeso Here is 4-year- girl. Is she at risk para Sobrepeso? Photo from UC Berkeley Longitudinal Study, 1974

60 Ploteando IMC-para-edad
Niños: 2 a 20 Años BMI Medidas de Esteban: Edad=3 años 3 s. Talla=100.8 cm (39.7 pulgadas) Peso=18.6 kg (41 lb) IMC=18.3 IMC-para-edad= >95th Percentilo Sobrepeso This boy’s height is 39.7 inches and his weight is 41 pounds. Using his height and weight, his calculated IMC is 18.3. Plotted on the IMC-para-edad chart para boys, his IMC-para-edad falls above the 95th Percentilo. Likewise, when plotted on the weight-para stature grid, it falls above the 95th Percentilo.

61 Ploteando IMC-para-edad
Niñas: 2 a 20 Años Medidas de Estefanía: Edad=4 años Talla=99.2 cm (39.2 in) Peso=17.55 kg (38.6 lb) IMC=17.8 IMC/edad= entre 90th –95th Percentilo Tiene riesgo para Sobrepeso This girl’s height is 39.2 inches and her weight is 38.6 pounds. Using her height and weight we calculated IMC to be 17.8. Plotted on the IMC-para-edad chart para girls, her IMC-para-edad falls between the 90th and 95th Percentilos. She is classified as at risk of Sobrepeso. The point of this exercise is to demonstrate the difficulty of making a consistently accurate visual assessment of at risk of Sobrepeso. IMC-para-edad needs to be obtained and plotted on the appropriate growth chart to determine risk of Sobrepeso.

62 Ploteando IMC-para-edad
Medidas de Estela: Edad= 4 años 4 s. Talla=106.4 cm (41.9 in) Peso=15.7 kg (34.5 lb) IMC=13.9 IMC-para-edad= th Percentilo Normal Niñas: 2 a 20 Años BMI This girl’s height is 41.9 inches and her weight is 34.5 pounds. Using her height and weight we calculated IMC to be 13.9. Plotted on the IMC-para-edad chart para girls, her IMC-para-edad falls on the 10th Percentilo. Likewise, when plotted on the weight-para stature chart, it falls on the 10th Percentilo.

63 Exactitud de la medición es CRÍTICA
Niños: 2 a 20 Años BMI 5 1/2 años, niño Peso: 41.5 lb Talla: 43 in IMC= 15.8 IMC/edad=50th percentilo Inexactitud en la medición de la tallat: 42.25 BMI=16.3 IMC-para-edad=75th %tile Measurements must be obtained and recorded accurately if they are to be used as an effective screening tool. Stature and weight should be measured following recommended protocols. To illustrate the importance of accurate data, we used the case of a 5.5-year- boy, weighing 41.5 lb with a height of 43 inches. His calculated IMC-para-edad is When plotted on the IMC-para-edad chart para boys, his IMC is on the 50th Percentilo. If his height were measured or recorded inaccurately at (3/4-inch below his actual height of 43 inches), his IMC-para-edad would be 16.3 and would fall on the 75th Percentilo (orange dot). A measurement error of 3/4-inch in height resulted in a change of 25 Percentilos. In this example, the measurement error did not cause a change in classification because growth remained within the normal range but you see what could happen.

64 “Puntos de corte”: IMC/edad
> 95th Percentilo Sobrepeso 85th a < 95th Riesgo de Sobrepeso Percentilo < 5th Percentilo Bajo Peso Interpretation of IMC plotted on a IMC-para-edad chart is based on the established cutoff values.   These Percentilos indicate the rank of IMC in a group of 100 Niños of the same gender and age. para example, in a group of 100 Niños, you would expect: 5 Niños to have a IMC-para-edad that is at or above the 95th Percentilo 10 to have a IMC-para-edad that is between the 85th and 95th Percentilos 5 to have a IMC-para-edad less than the 5 Percentilo, 80 Niños will have a IMC-para-edad that is within the normal range. Note that there are no recognized standards to satisfactorily define the menor limits of IMC-para-edad para Niños and adolescents; however, it is reasonable to use IMC-para-edad to identify Niños and adolescents as Bajo Peso. Research is needed to determine the validity of using IMC-para-edad to screen para Bajo Peso.

65 Interpretación de la curva de IMC/Edad
IMC-para-edad indica su peso en relación con su talla para una edad y sexo específico. Es necesario una serie de ploteos para determinar la tendencia de crecimiento. Indices desviados de los patrones normales de crecimiento, hacen necesario valoraciones posteriores. para Niños, IMC is age and gender specific When assessing physical growth, it is desirable to have a series of accurate measurements to establish an observed growth pattern. Having a series of measurements takes into consideration short- and longer-term conditions and provides a context para individual measurements in interpretation. To obtain a clear understanding of the growth pattern observed on the IMC-para-edad chart, plot the weight-para-age and Estatura para edad charts to determine the pattern of weight and stature separately. Growth patterns that fall outside the established parameters, the 5th and 95th Percentilo para any given anthropometric indices, suggest the need to recheck measurements, plots, and calculations and make any necessary corrections or adjustments. If measurements are correct, further evaluation may be needed to determine the cause.

66 Ejemplo: Nombre: Samuel Peso: 37 lb 4 oz (16.9 kg)
Talla: pulgadas (105 cm) Edad: 3.5 Años IMC: 15.2 Here is an example of interpretation of IMC-para-edad: Sam weighs 37 pounds and 4 ounces and is 41.5 inches tall. He is 3 1/2 Años and his calculated IMC is 15.2.

67 Muchachos: 2 a 20 Años BMI Interpretación: El IMC/edad de Samuel está ligeramente por debajo del 25o percentilo, lo que hace que caiga dentro del rango normal. De 100 niños de la misma edad de Sam, poco menos de 25 tienen un IMC/Edad menor que el de Sam. On the IMC-para-edad chart, find Sam’s age on the horizontal axis and visually draw a vertical line up from that point, then find his IMC on the vertical axis and visually draw a horizontal line across from that point. The point where the two intersect represents Sam’s IMC-para-edad. When plotted on the growth chart, Sam’s IMC-para-edad falls just below the 25th Percentilo curve. Percentilo indicates the rank of a measure in a group of This means that of 100 Niños the same sex and age as Sam, fewer than 25 Niños will have a IMC menor than his. Sam is neither Sobrepeso, Bajo Peso nor at risk of Sobrepeso. When a child’s plotted measurement falls between the 5th and 95th Percentilos it is considered to be in the normal range. Sam’s IMC-para-edad is in the normal range. When a child’s Percentilo rank falls outside the normal range (i.e., outside the 5th or 95th Percentilos), further evaluation is needed.

68 Sumario del uso del IMC-para-edad
IMC-para-edad es el método recomendado para tamizar Sobrepeso y Bajo Peso Para niños el IMC es específico para edad y sexo. Para adultos es un punto de corte fijo. Mediciones periódicas y exáctas son elementos importantes para cualquier tamizaje antropométrico. IMC-para-edad is the method recommended para screening Sobrepeso and Bajo Peso in Niños and adolescents from 2 to 20 Años de edad. IMC-para-edad is a screening tool that may lead to further assessment to diagnose a specific health condition. para Niños, IMC is age and gender specific and nutritional status is determined based on Percentilos. This is different para adults as IMC is neither age nor gender specific and nutritional status is defined by fixed cut points para adults. Periodic, accurate measurements and growth records are important elements of growth screening. An accurate interpretation of growth depends on the accuracy of weighing and measuring. 

69 Visite el sitio: http://www.cdc.gov/growthcharts/
para materiales educativos adicionales relacionados con las tablas de crecimiento. para herramientas relacionadas con las tablas de crecimiento. Para “bajar” las tablas de crecimiento. Please visit the growth chart Web site at (http://www.cdc.gov/growthcharts) to access additional training materials including web-based interactive training modules and tools related to the growth charts including the IMC tables and the instruction sheet para the growth charts. The clinical growth charts can be downloaded or printed from this Web site.

70 Here is the CDC Web site. All materials related to the growth charts can be accessed at this site.


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