Distorções no diagnóstico nutricional de crianças relacionadas ao uso de múltiplas curvas de crescimento em um país em desenvolvimento

Abstract

Objective: Since many health facilities still use different versions of growth references, this study aimed to estimate the diagnostic agreement of nutritional status and its possible distortions in the prevalence of nutritional disorders in children by using the growth curves of the National Center for Health Statistics (NCHS, 1977), and of the Centers for Disease Control and Prevention (CDC, 2000), considering the World Health Organization charts (WHO, 2006) as gold-standard. Methods: A cross-sectional study developed with 646 children aged 12 to 60 months attending day care centers in Rio de Janeiro, Brazil. Weight-for-age, weight-for-height, height-for-age, and body mass index-for-age were evaluated. The cut-off values +2 Z-score for weight-for-height e body mass index-for-age were used to classify overweight. Results: The frequencies of height-for-age deficits were underestimated when NCHS, and CDC curves were applied. The frequency of weight-for-age and weight-for-height deficits was overestimated when using CDC reference, particularly among females and children aged 12 to 23 months for weight-for-age, and among boys and children aged 24 to 60 months for weight-for-height. The use of NCHS resulted in deficit frequencies similar to WHO curve for weight-for-age and weight-for-height. Diagnosis of obesity by weight-for-height and body mass index-for-age was underestimated by using both NCHS and CDC curves particularly among children aged 24 to 60 months. Conclusions: Since distortions in the estimated nutritional disorders may be collectively and individually harmful, it is recommended that only WHO 2006 standards be used for monitoring nutritional status of preschool age children, in order to obtain a reliable diagnosis.