A pilot study of the “Healthy Growth Charter”

1. A pilot study of the “Healthy Growth Charter” B. Silvestrini1, M. Arpino1, 2, M. Ferrante1, 2, M. Musicco1, 3, 4 and G. Santilli1, 2 1Noopolis, Rome; 2CONI, Rome; 3ITB-CNR, Milan; 4IRCCS-Fondazione Santa Lucia, Rome

2. Seven points: • Abstract • Introduction • Subjects and Methods • Results • Discussion and Conclusions • Noopolis “Healthy Growth Charter” project, with related campaigns • References

3. Abstract This pilot study was supported by CONI within a campaign against doping. It was aimed at preliminarily assessing the value and feasibility of the Noopolis “Healthy Growth Charter” project, designed to check at regular intervals the whole young population for various items of statistical and medical interest. 1500 children of both sexes, 8-12 yrs, from …

4. 18 Italian regions out of 20, fulfilled a questionnaire on height, weight, dental and sight problems, knowledge of Mediterranean anemia, sport practice. The Body Mass Index (BMI) distribution was in line with that reported by Cacciari et al. (2006). 60 % of children had experienced toothache, 80 % underwent a dental visit …

5. and up to 15% used orthodontic devices.The blackboard test indicated visual problems in 24% of children, suggesting in 8% of cases a possible amblyopic defect. 12% used lenses. The knowledge of Mediterranean anemia increased with age, approaching 50% at 12 years. Children practicing sport were over 80% …

6. at 9 years and 70% at 11 years. Football was the favorite discipline in male and dance in female. Obesity occurrence was minimal in association with football practice. This study stresses the potential value of the Noopolis “Healthy Growth Charter” and suggests that, after appropriate refining, it could become part of the educational career of young people.

7. Introduction Growth charters for children are derived from large, representative cross sectional surveys in US (Flegal et al., 2002), Canada (Anonymous, 2004), UK (Wright et al., 2002), Italy (Cacciari et al., 2006) and other areas (de Onis et al., 1996). These charters, however, are not currently used to monitor the growth of the whole population. Another information about anthropometric parameters and some other items of …

8. medical interest was collected in occasion of the obligatory enrollment army visit. This information, however, was limited to males and in Italy and some other countries the obligatory army service has been abolished. The present study was supported by CONI within a campaign against doping. It was aimed at assessing the Noopolis “Healthy Growth Charter” project, which to our knowledge is the first, consistent attempt to fill the above two gaps.

9. Subjects and methods The study involved 4000 primary schools in 18 out of 20 Italian regions, with an average of 70 students each. Hence the potential sample was of 279.580 subjects from 6 to 12 years . The Directors of the schools were contacted by mail with a personal letter. They were sent booklets with an illustrated story on doping; a questionnaire situated on the back cover …

10. of the booklet; 3 public notices; a DVD containing all the above material. They were asked to adhere to the campaign, distribute the booklets and return back the filled questionnaires. 2776 Directors out of 4000 expressed their interest, which corresponded to about 190.000 students out of 279.580. The questionnaire …

11. was administered only to students of 8-12 yrs, amounting roughly to 100.000 subjects. The filled questionnaires sent back were 1500, corresponding to about 1.5% of the involved sample. The agency entrusted with the campaign and related tests was Angelicum Film SrL, Milan.

12. Subjects and methods:the questionnaire • Gender, weight, height • Dental problems • Did you experience toothache? • Have you ever been visited by a dentist? • Do you use orthodontic devices? …

13. Subjects and methods:the questionnaire • Visual problems • Can you see a word on the blackboard from the back of the room? • Can you see it with a single eye? • Do you use glasses? …

14. Subjects and methods:the questionnaire • Mediterranean anemia • Are you aware of this condition? • Sport • Do you practice sports? • Which one?

15. Results • Self explanatory Figure 1 • Response rate by Regions • Self explanatory Figures 2 - 6 • Definition of obesity • Self explanatory Figures 7 - 28

16. 1. Geographic distribution

17. Response rate by Regions • Lombardia • Veneto • Campania • Emilia-Romagna • Piemonte • Toscana • Sicilia • Puglia • Others

18. 2. Age and sex Age years

19. 3. Weight (Kg) by age and gender Age years

20. 60 90 80 50 70 40 60 50 30 40 30 20 20 10 10 0 0 8 9 10 11 12 8 9 10 11 12 Mean 5th centile 95th centile Mean 5th centile 95th centile 4. Mean weight, 5th and 95th centiles. Boys and girls Age years

21. 5. Height (cm) by age and gender Age years

22. 170 180 160 170 150 160 140 150 140 130 130 120 120 110 110 100 100 8 9 10 11 12 8 9 10 11 12 Mean 5th centile 95th centile Mean 5th centile 95th centile 6. Mean height, 5th and 95th centiles.Boys and girls Age years

23. Obesity We defined obese the children with a body mass index (BMI) equal to or greater than the value of 95th centile of the corresponding age and sex according to WHO standards

24. 7. Obesity (%) by age and gender Age years

25. 8. Obesity (%) by gender and area of residence

26. 9. Dental problems (%) by sex

27. 10. Toothache by gender and age Age years

28. 11. Visited by a dentist by age and gender Age years

29. 12. Use of orthodontic devices by age and gender Age years

30. 13. Dental problems and obesity

31. 14. Visual problems by gender

32. 15. Visual problems (binocular) by age and gender Age years

33. 16. Possible amblyopia by age and gender Age years

34. 17. Use of lenses by age and gender Age years

35. 18. Knowledge of Mediterranean anemia by age and gender Age years

36. 19. Sport practice by age and gender Age years

37. 20. Mean weight and sport. Boys Age years

38. 21. Mean weight and sport. Girls Age years

39. 22. Mean height and sport. Boys Age years

40. 23. Mean height and sport. Girls Age years

41. 24. Obesity and sport

42. 25. Obesity and sport by age Age years

43. 26. Sport disciplines by gender

44. 27. Obesity and sport disciplines in boys

45. 28. Obesity and sport disciplines in girls

46. Discussion and Conclusions Height and weight: values in line, despite less accurate measures, with previously reported values (Cacciari et al., 2006). Obesity: also in line, deserving attention both by itself and in connection with the corresponding, related condition in the adult (Nader et al., 2006).

47. Discussion and Conclusions Dental problems: quite common, earlier in females, high frequency of medical control and orthodontic devices. Some inverse relation between the latter two and obesity, which might be indirect, due to cultural or psychological reasons.

48. Discussion and Conclusions Visual problems: quite common as well, use of lenses averaging 25 %. The consistent indication of possible undiagnosed amblyopic defects deserves careful attention. Mediterranean anemia: a surprisingly wide-spread knowledge in children, probably connected with current educational campaigns in schools.

49. Discussion and Conclusions Sports: widely practiced, probably mostly out of schools, football and dance being the preferred ones in males and females respectively. A clear-cut inverse relation was found between sport practice and obesity, football being the most effective one.

50. Noopolis “Healthy Growth Charter” Project This study confirms the potential value of an extended growth charter in the prevention and treatment of some common conditions. At the same time it points out some substantial adjustments: Other items should be considered, such as hearing, color-blindness, dyslexia and additional clues of learning and behavioral problems.