Computer-Guided, Population-Based Screening System for Growth Disorders (CrescNet®) and On-Line Generation of Normative Data for Growth and Development

Abstract

The mean age at which the diagnosis of growth disorders such as Turner’s syndrome, growth hormone (GH) deficiency or true GH-dependent gigantism is established is still rather late in many countries around the world. In addition, the question of secular trends in a given population and the rate at which childhood obesity is increasing in industrialized countries make it mandatory to establish a time-adapted system to develop percentiles for body height, weight and body mass index (BMI) and also to develop a screening system for growth disorders. In 1998 we established a network, now involving more than 160 paediatric practices in Germany and seven paediatric endocrinology departments. Paediatricians record heights, weights and growth velocities of all children in their care and systematically feed the data into the database at our centre usually by mailing formatted, structured data tickets. Data are then continuously analysed at the centre and the paediatricians in the network are informed immediately about their individual patients’ growth situations via phone or E-mail (feedback system). Regular annual conferences including structured reports, scientific presentations and discussion groups are organized for all participants at our centre. By May 2001, the data of 83,721 children and adolescents had been analysed. The mean values for height were 1–1.5 cm higher than the mean values in the German Synthetic Growth Curve, which serves as an internal standard. However, and most importantly, in comparison with the internal standard and historical normative data from Germany and Switzerland, there is a continuous increase in the 97th percentile for weight and BMI, while the third percentile remains unchanged. In addition, many children with short stature and tall stature due to a variety of endocrine disorders and genetic diseases which had not been diagnosed previously are now being identified. In conclusion, the databank allows for a continuous adaptation of normative curves based on a large number of children in a given population, i.e. eastern Germany. Secondly, the system allows for detection of pathological growth curves and is already serving to diagnose growth disorders in a defined population in a systematic way.

Secular trends in body mass index in German children and adolescents: a cross-sectional data analysis via CrescNet between 1999 and 2006

“…Body weight was measured using medically calibrated scales, with subjects wearing only light underwear. The standardized methods used to measure body length (infants up to 2 years of age), height (children older than 2 years and adolescents), and weight have been described elsewhere in detail [9,18,19]. All 294 participating pediatricians were supplied with, and used, the same type of stadiometer [21][22][23].…”

“…The extent to which obesity is affecting children in Germany and the rate at which the prevalence of obesity increases have been investigated in several studies [5][6][7]. In view of the enormous potential health-economic impact of pediatric obesity, its comorbidities and consequential diseases in childhood and adulthood at present and in the future [8][9][10][11][12][13]18], programs for the prevention and treatment of overweight and obesity are of paramount importance. However, such programs need to be based on reliable, representative, and recent data [14][15][16][17] that are collected in an ongoing process, and their success or failure needs to be assessed in a timely manner and reassessed at regular intervals.…”

“…Established at the Leipzig University Hospital for Children and Adolescents (Leipzig, Germany) in 1998, CrescNet (www.crescnet.org) is a computer-based, auxologic collaborative network connecting pediatricians in practice with endocrine specialists. Originally a regional project, CrescNet is in the process of expanding geographically to become a national database, one of its main objectives being to collect, in a standardized manner, large volumes of body length/height and weight data for timely analysis [9,18,19]. A special feature of CrescNet is that it longitudinally records data for children and adolescents who present for routine medical checkups.…”

New Predictors of the Metabolic Syndrome in Children—Role of Adipocytokines

“…1). This indicates not only that more children become obese, but, in addition, that the degree of obesity increases (8,9). The 97th centile crosses the adult cut-off of 25 kg/m 2 at an age range of about 10 y, and by 14 y 97th centile exceeds 30 kg/m 2 .…”

Clinical Examples of Disturbed IGF Signaling: Intrauterine and Postnatal Growth Retardation due to Mutations of the Insulin-Like Growth Factor I Receptor (IGF-IR) Gene

“…The mother's height was 148 cm (−2.6 SDS) and the father's height 178 cm (+0.1 SDS), resulting in a calculated target height for boys of 169.5 cm (−1.1 SDS). Postnatally, the infant failed to catch up growth and remained below the 3rd percentile for normal boys [27]. The boy was referred to our unit at the age of 14 months with extreme short stature (−3.8 SDS).…”