Elsevier

The Journal of Pediatrics

Volume 201, October 2018, Pages 93-99.e4
The Journal of Pediatrics

Original Articles
Effect of Adjusting for Tanner Stage Age on Prevalence of Short and Tall Stature of Youths in the United States

https://doi.org/10.1016/j.jpeds.2018.05.051Get rights and content

Objective

To evaluate the extent to which pubertal timing alters the classification of extremes of attained stature across race-ethnicity groups of youths in the US.

Study design

We performed analyses of height and Tanner staging data of 3206 cross-sectional national sample of youths ages 8-18 years (53% male, n = 1606), 72% of whom were non-Hispanic white, 9% Mexican American, and 19% non-Hispanic black . Specialized growth models were used to derive Tanner-stage-age-adjusted z scores (TSAHAZ). The prevalence of shortness (<−1SD) and tallness (≥+1SD) status was quantified using TSAHAZ.

Results

Highly variable patterns of prevalence of shortness and tallness via chronologic age height z score (CAHAZ) were observed in results stratified by race-ethnicity and sex. Tallness CAHAZ prevalence was high among non-Hispanic white and non-Hispanic black male youths relative to Mexican American (40.0%-43.3% vs 20.5%) with a similar pattern in female youths. In both sexes, this pattern was eliminated with TSAHAZ, with Mexican American youth becoming statistically not different from their non-Hispanic white and non-Hispanic black peers.

Conclusions

Differences in timing of puberty between race-ethnicity groups affects estimated prevalence of shortness and tallness of attained height that remains uncaptured with CAHAZ. Adjustment for pubertal development might help isolate crucial determinants of attained stature and other aspects of body composition that may be most responsive to intervention programs in populations. The curves developed by adjusting for pubertal status may help the clinician avoid misclassification of children with early and late pubertal development.

Section snippets

Methods

We performed secondary data analyses of anthropometric and Tanner staging data of US children ages 8-18 years from National Health and Nutrition Examinations Survey cycle 1988-1994 (NHANES III),11 which is a complex cross-sectional survey design (multistage sampling) of US noninstitutionalized civilians. The anthropometric variables used in this study (weight, height) were measured by trained technicians following standardized protocols.12 The key inclusion criterion was the availability of

Results

Mean age of the participants was 14.3 years for both sexes (Table I) with a range of 8-18 years. There were no pooled mean race-ethnicity differences for weight, height, and BMI. In terms of population maturation tempo, only 3%-8% of all participants were considered early “bloomers” based on their age being less than the US published national timing estimates by Sun et al, for their sex/race-ethnic population median age-at-entry into Tanner stage II. The cohort was generally in good health with

Discussion

Our study describes a model, which uses TSAHAZ to apply meaningful pubertal timing modifications to height data that critically assesses stature classification of tall or short. Through this model, specialized growth charts adjusted for pubertal status can be generated allowing the clinician to be guided by reference data rather than estimation.

Our study found in a cohort of US youths 8-18 years of age that TSAHAZ relative to CAHAZ impacted population prevalence of anthropometric indicators of

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    B.S.M. is a consultant for AbbVie, Ascendis, Ferring, Novo Nordisk, Pfizer, Sandoz, and Versartis and has received research support from Alexion, Armagen, Ascendis, Endo Pharmaceuticals, Genentech, Novo Nordisk, Sandoz, Sangamo, Sanofi Genzyme, Shire, Tolmar, Ultragenyx, and Versartis. The other authors declare no conflicts of interest.

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