title: Evaluation of the Global Lung Initiative 2012 Reference Values for Spirometry in African Children.
abstract: Despite the high burden of respiratory disease, no spirometry reference values for African children are available.
  
  
  
  Investigate whether the Global Lung Initiative (GLI-2012) reference values for spirometry are appropriate for children in sub-Saharan Africa and assess the impact of malnutrition on lung function.
  
  
  
  Anthropometry and spirometry were obtained in children aged 6 to 12 years from urban and semiurban schools in three African countries. Spirometry z-scores were derived using the GLI-2012 prediction equations for African Americans. Thinness (body mass index z-score < -2) was a surrogate for malnutrition. Spirometry outcomes were compared with those of African American children from the third National Health and Nutrition Survey.
  
  
  
  Spirometry data were analyzed from 1,082 schoolchildren (51% boys) aged 6.0 to 12.8 years in Angola (n = 306), Democratic Republic of the Congo (n = 377), and Madagascar (n = 399). GLI-2012 provided a good fit with mean (SD) z-scores of -0.11 (0.83) for FEV1, -0.08 (0.86) for FVC, and -0.07 (0.83) for FEV1/FVC. Because of low scatter, the fifth centile corresponded to -1.3 z-scores in boys and -1.5 z-scores in girls. Malnourished African children had a normal FEV1/FVC ratio but significant reductions of ∼0.5 z-scores (∼5%) in FEV1and FVC compared with African American peers from the third National Health and Nutrition Survey. Children in Angola had the lowest, and those in Madagascar had the highest, zFEV1and zFVC.
  
  
  
  The results of this study support the use of GLI-2012 reference values for schoolchildren in sub-Saharan Africa. Malnutrition affects body growth, leading to a proportionately smaller FEV1and FVC without respiratory impairment, as shown by the normal FEV1/FVC ratio.
authors: 1 Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Udine, Italy.
authors: Michele
authors: 0000-0002-5366-4594
authors: M
authors: Arigliani
authors: 1 Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Udine, Italy.
authors: Mario C
authors: MC
authors: Canciani
authors: 2 International Health Cooperation Project, University Campus Bio-Medico, Rome, Italy.
authors: Giovanni
authors: G
authors: Mottini
authors: 3 "Sapienza" University of Rome, Rome, Italy.
authors: Michele
authors: M
authors: Altomare
authors: 4 University of Trieste, Trieste, Italy.
authors: Andrea
authors: A
authors: Magnolato
authors: 5 Hospital Divina Providencia, Luanda, Angola.
authors: Sofia Vanda
authors: SV
authors: Loa Clemente
authors: 6 Service de Pédiatrie, Centre Hospitalier Monkole and Centre de Formation et d'Appui Sanitaire, Kinshasa, Democratic Republic of the Congo; and.
authors: Leon
authors: 0000-0002-6318-0227
authors: L
authors: Tshilolo
authors: 1 Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Udine, Italy.
authors: Paola
authors: 0000-0002-6235-140X
authors: P
authors: Cogo
authors: 7 Department of Pulmonary Diseases and.|8 Department of Paediatrics-Pulmonary Diseases, Erasmus Medical Centre, Erasmus University, Rotterdam, the Netherlands.
authors: Philip H
authors: PH
authors: Quanjer
mesh_terms: D000810:Angola / Q000453:epidemiology; D000886:Anthropometry; D002648:Child; D015362:Child Nutrition Disorders / Q000503:physiopathology; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D011446:Prospective Studies; D012016:Reference Values; D013147:Spirometry / Q000592:standards* / Q000706:statistics & numerical data
keywords: Africa; malnutrition; pediatrics; reference values; spirometry