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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 32  |  Issue : 1  |  Page : 12-17

Applicability of various body weight status classifications for the caries-free 3–6-year-old school going children of Mathura city


1 Department of Paediatric and Preventive Dentistry, Dental College, RIMS, Lamphelpat, Imphal, Manipur, India
2 Department of Paediatric and Preventive Dentistry, Teerthankar Mahavir Dental College and Research Centre, Moradabad, Uttar Pradesh, India
3 Department of Oral Pathology, Dental College, RIMS, Lamphelpat, Imphal, Manipur, India
4 Public Health Dentist, MHS grade IV, Dental Surgeon, PHC Heingang, Govt of Manipur, Manipur, India

Date of Web Publication18-Jun-2018

Correspondence Address:
Dr. Bhoomika Devi Wairokpam
Department of Pediatric and Preventive Dentistry, Dental College, RIMS, Lamphelpat, Imphal - 795 004, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_14_17

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  Abstract 

Background: In a global perspective, there is a requirement of a universal classification system to monitor the worldwide childhood obesity. Confusion concerning which classification system to use on national levels complicates monitoring of the development of the obesity and comparisons between various studies.
Objectives: This study highlights the specific problems associated with body mass index (BMI) classifications, compares the body weight status according to Indian, Centers for Disease Control and Prevention (CDC), and international classifications, and determines their applicability for the caries free 3-6 years old children of Mathura city.
Materials and Methods: A total of 150 children aged caries free 3–6 years without contributing medical history from Mathura city were selected for this study. Weight (kg) and height (m) measurements were done; BMI (kg/m2) and the body weight statuses were evaluated using Indian-, CDC-, and international-based classifications. Chi-square test was used to compare the body weight status derived from these classification systems.
Results: The majority of the caries free children (96%) were classified as underweight according to BMI-based Indian and international classifications. About 59.3% and 36% of children were classified as underweight and normal body weight status according to CDC classification. There was significant difference observed in the body weight status derived from the BMI-based Indian with the CDC classification.
Conclusions: Majority of the disease-free (systemic and dental caries free) 3–6-year-old children were observed to be underweight. The BMI-based Indian and international classifications are applicable for the evaluation of body weight statuses for these children of Mathura city.

Keywords: Body mass index, body weight, overweight, underweight


How to cite this article:
Wairokpam BD, Yeluri R, Ngairangbam S, Khundrakpam E. Applicability of various body weight status classifications for the caries-free 3–6-year-old school going children of Mathura city. J Med Soc 2018;32:12-7

How to cite this URL:
Wairokpam BD, Yeluri R, Ngairangbam S, Khundrakpam E. Applicability of various body weight status classifications for the caries-free 3–6-year-old school going children of Mathura city. J Med Soc [serial online] 2018 [cited 2018 Sep 21];32:12-7. Available from: http://www.jmedsoc.org/text.asp?2018/32/1/12/213949


  Introduction Top


Body weight of a population can be viewed as a continuum from underweight to obesity. Both underweight/malnutrition and overweight/obesity have significant adverse implications on health,[1] and in children, weight varies not only with sex and age but also with height.[2] The growing concern about childhood weight-related problems demands researches to utilize the body weight classification system. However, there emerges an urgent need to develop a universally accepted one. The absence of a universal classification system leads to inability and difficulty in monitoring the worldwide development of childhood obesity.[3] Confusion concerning which classification system to use on national levels complicates monitoring of the development of the obesity epidemic, stratification for selective interventions in public health, screening in clinical practice, and comparisons between various studies. Without appropriate classification systems, inefficiencies and discrepancies will result.

This study was designed to evaluate and compare the body weight status of the caries free 3–6-year-old children of Mathura population according to the Centers for Disease Control and Prevention (CDC) (USA), body mass index (BMI)-based international, and Indian classifications, respectively. The study also highlights the specific problems associated with internationally accepted BMI and body weight classifications system when applied to various ethnic groups and also to determine their applicability for the caries free 3–6-year-old children of Mathura city.


  Materials and Methods Top


The study was carried out in tertiary care teaching hospital, Mathura, Uttar Pradesh, India, as well in various schools in the Mathura city for duration of 6 months from August 2010 to January 2011. The Institutional Ethical Committee Clearance was obtained before the beginning of this study. An informed written consent was also obtained from the parents of the children who participated in the study and also the higher authorities of the respective school. The study was conducted by the trained students and faculties of the tertiary care teaching hospital. However, the study population was selected through the screening camps in various schools as well as the children attending dental outpatient department (OPD). The children attending dental OPD who are caries free, for example, patients reported with gingivitis, oral ulcers, malocclusion, etc., without dental caries also participated in the study. Patients who had dental caries, any other dental problems, and contributing medical history were referred to the concerned departments for their needful treatment. Convenience sampling was done to select seven schools, and all the students ranging in age between 3 and 6 years were included in this study. A total 2018 children were examined, and out of this, only 150 caries-free children were found out and included in the study. Sample size calculation based on scientific method was not used. As dental caries and diet are correlated, high sugar and refined carbohydrates can be a contributing factor for dental caries as well as for obesity. Some evidence exists that an impaired dentition can affect the individuals by causing dietary restrictions by means of difficulty in chewing, possibly compromising their nutritional status, and well-being.[4] To rule out caries-related contributing factors for weight status, only caries-free children are selected. Since dental caries is one of the most common infectious diseases which affect 98% of the population, therefore, 150 children who are caries free in this age group are selected for the study. To rule out the geographical variations, children who were the residents of Mathura city only were included in this study. The economic statuses of only those children who are above the poverty line (India) according to the eleventh 5-year plan (2007–2012)[5] were included in this study, and children with any contributing medical history were excluded from this study. The selection of the children above the poverty line and from the same socioeconomic status in the study helped in eliminating the bias and the cause of nutritional deficiency due to poverty. Thus, the inclusion and exclusion criteria for participant selection derived were:

Inclusion criteria:

  • Children who gave consent
  • Children having the age group of 3–6 years
  • Dental caries-free children
  • Residents of Mathura city
  • Children above the poverty line.


Exclusion criteria:

  • Children with any contributing medical history
  • Children having one or more carious teeth.


A single trained and calibrated examiner who is a pediatric dentist and standardized with the procedure of dental hard tissue examination performed a comprehensive clinical examination with the assistance of one recorder. The intraoral hard tissue examination included the recording of the decayed, missing, or filled surfaces so that one hundred and fifty dental caries-free children with decayed, extracted, and filled tooth surfaces (defs) = 0 were chosen in this study. This score of defs = 0 indicates that the particular child is caries free. Measurements of the weight (kg) and height (m) were done making the children stand straight on a standard balanced beam scale (SAMSO, New Delhi, India) and stadiometer (SAMSO, New Delhi, India), respectively. The height was measured to the nearest 0.1 cm and the weight was measured in kilograms to the nearest 100 g. The children were measured wearing light clothing and without shoes. The BMI (kg/m 2) was calculated according to the formula given by the CDC (USA),[7] weight in kilograms (kg) divided by height in meter square (m 2).



The BMI percentile for age and sex was determined and the body weight statuses were evaluated using CDC-,[8] Indian-,[9] and international [9]-based classifications. The Indian classification uses BMI scores, where (1) underweight (<18.5 BMI scores), (2) normal (18.5–23.0 BMI scores), (3) overweight (23.1–25.0 BMI scores), and (4) obese (>25.0 BMI scores). The CDC uses BMI percentiles to classify 2–20-year-old children into four weight groups. Age- and gender-specific BMI percentile are categorized as: (1) underweight (<5th percentile), (2) normal weight (5th–84th percentile), (3) at risk for overweight (>85th–95th percentile), and (4) overweight (>95th percentile). The international classification determines weight status using BMI scores, where (1) underweight (<18.5 BMI scores), (2) normal (18.5–24.9 BMI scores), (3) overweight (25.0–29.9 BMI scores), and (4) obese (>30.0 BMI scores). The comparison of the body weight status obtained from CDC and international classifications with those derived from the Indian classification was carried out by Chi-square test using Statistical Package for Social Science Software Version 11.5 for Windows developed by SPSS. Inc., IBM. Significance for all the statistical tests was predetermined at P < 0.05.


  Results Top


BMI calculated as weight in kilograms divided by height in meter square can be used to express weight adjusted for height. [Table 1] shows weight-wise distribution of the children based on the BMI-based Indian, international, and CDC classification. Majority of the children are underweight with 96.00% in the BMI-based Indian and international classification. However, in CDC classification, majority of the children are underweight and normal with 59.3% and 36%, respectively. [Table 2] shows weight-wise comparison of the children between the BMI-based Indian and CDC-based classifications. Significant differences in the weight status were found between the two classifications. [Table 3] shows weight-wise comparison of the children between the BMI-based Indian and international classifications. There was no significant difference observed in the weight status among these classifications. [Table 4] shows weight-wise comparison of the children between the BMI-based international and CDC-based classifications. Significant differences in the weight status were found between the two classifications. [Table 5] shows the age- and gender-specific mean (standard deviation [SD]) BMI of each age group. The female children have mean (SD) BMI of 16.88 ± 3.21, 15.89 ± 4.21, 13.96 ± 1.59, and 14.30 ± 1.24 for 3, 4, 5, and 6 years old, respectively, whereas male children have mean (SD) BMI of 15.81 ± 2.75, 17.56 ± 4.87, 14.81 ± 2.90, and 13.71 ± 1.37 for 3, 4, 5, and 6 years old, respectively.
Table 1: Weight-wise distribution of the children based on the body mass index-based Indian classification

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Table 2: Weight-wise comparison of the children between body mass index-based Indian and Centers for Disease Control and Prevention-based classifications

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Table 3: Weight-wise comparison of the children between body mass index-based Indian and international classifications

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Table 4: Weight-wise comparison of the children between body mass index-based international and Centers for Disease Control and Prevention-based classifications

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Table 5: Age- and gender-specific mean (standard deviation) body mass index of each age group

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  Discussion Top


An accepted method to evaluate an individual's body weight relative to the population norms is through calculation of the BMI using formula:[10]



The risk of overweight is increased among persons with high birth weight (4000 g or more) and parental obesity.[11] Race and ethnicity seem to influence children's health both directly and indirectly;[12] mixed results on the impact of race/ethnicity appear to stem from socioeconomic and demographic confounding. Racial background is also a highly relevant factor, with Negroid and Hispanic children being approximately twice as likely to be obese as those of Caucasian non-Hispanic children.[13] The income of an individual also works both at the family and community levels in influencing the health. A higher income promotes improved living conditions, for example, safe housing and facility to buy sufficient, healthy food. There is evidence of powerful biochemical and physiologic links between the individual socioeconomic experience for the economically disadvantaged children and adverse health measures.[14] Various countries have different racial, socioeconomic, demographic, and other factors which likely to give bias result when the same body status classification is used in different countries. Currently, there is no universally accepted system for classification of children based on body weight status although several BMI-based approaches have been proposed.[15]

The study is one of the first of its kind. There is not much literature available which compares the various body weight status classifications and their applicability among different races. Only the result of the study is discussed and compared. This study was planned to evaluate whether the established body weight status classifications of CDC (USA)[8] and BMI-based international [9] go well with that of Indian [9] classifications based on the Mathura population. An expert group of the World Health Organization survey concluded in 1997 stated that there was an urgent need to develop such a system,[16] but till now, no consensus has been reached. In addition to these, national variants also exist in many countries.[17] For national use, national systems are likely to be more appropriate. This study was designed to evaluate and compare the body weight status of the 3–6-year-old children of Mathura population according to CDC (USA), BMI-based international, and Indian classifications, respectively. The study also highlights the specific problems associated with internationally accepted BMI and body weight classifications system when applied to various racial classes and also to determine their applicability for the 3–6-year-old children of Mathura city.

In a global perspective, the absence of a universal classification system leads to inability to monitor the worldwide development of childhood obesity.[3] Without appropriate classification systems, inefficiencies will result. Even though BMI is widely used for classification of adult obesity, its use in children and adolescents is controversial because of a number of problems associated with BMI as a measure of adiposity in childhood. During childhood, BMI varies with age and sex,[18] and maturation patterns differ between the countries influencing the time course of these variations.[19] Creating a universal classification system for an ethnically diverse world population is problematic for children and adults alike. The ethnic differences are apparent both in terms of body fat distribution and in terms of percentage body fat (%BF) correlation to disease risk: in the South Pacific and Asia, higher %BF values are associated with any given BMI in adults, and BMI-related risk seems to occur at lower BMI values compared with white persons.[20] In children, similar ethnic variations seem to exist.[21] In addition, maturation patterns vary between countries, a fact that heavily influences the body composition in adolescence.[22]

Hence, in this study, the body weight status of healthy children of Mathura city was determined using BMI-based Indian [9] classification and compared with those obtained from CDC [8] and international [9] classification. The results from our study in [Table 1] show that the majority of the children were underweight with 96.00% in both the BMI-based Indian [9] and international [9] classification. Whereas in CDC [8] classification, the underweight and normal body weight status children are 59.3% and 36%, respectively. Diet has a major role to play with the body status of an individual. Diet and dental caries are also strongly correlated. One possible factor of these children being underweight can be related to diet. The association of children having dental caries free may be due to their intake of less starchy or limited carbohydrate diet, which also contributes to their underweight body status. Further studies are needed to rule out the association between diet, dental caries, and body weight status. [Table 3] shows that there was no significant difference in the body weight status among the BMI-based Indian [9] and international [9] classifications, although in [Table 2] and [Table 4], significant differences were found between CDC [8] and Indian [9] as well as with the international [9] classification. Comparing the other two classifications with the BMI-based Indian [9] classification, it can be stated that the Indian as well as the international [9] classification can be applicable for the evaluation of various body weight status classifications for the 3–6-year-old school going children of Mathura city. [Table 5] shows the age- and gender-specific mean (SD) BMI of each age group. The female children have mean (SD) BMI of 16.88 ± 3.21, 15.89 ± 4.21, 13.96 ± 1.59, and 14.30 ± 1.24 for 3, 4, 5, and 6 years old respectively, whereas male children have mean (SD) BMI of 15.81 ± 2.75, 17.56 ± 4.87, 14.81 ± 2.90, and 13.71 ± 1.37 for 3, 4, 5, and 6 years old, respectively. The mean BMI of 3-year-old female children are higher as compare to the elder age group. However, the 4-year-old male children have higher mean BMI as compare to the 3-, 5-, and 6-year-old boys in the study.

However, monitoring of the underweight body weight status, improve screening procedures, and extensive studies related to this underlying cause should be explored. Local participations and community-based involvements will help and strengthened the improvement of the underweight body status in these caries free and medically fit children.


  Conclusions Top


The following conclusions drawn from this study are:

  • Majority of the disease-free (systemic and dental caries) 3–6-year-old school going children in this study were found to be underweight
  • Diet can be a contributing factor for these dental caries-free children being underweight
  • BMI-based Indian and international classifications are applicable for the evaluation of body weight status of the 3–6-year-old school going children of Mathura city
  • Further studies are needed to find the major contributing factors of these children classified as underweight
  • The study findings cannot be generalized to certain population as the study sample is less. Further studies are required to be conducted in the various zone of the country with larger samples.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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