文献综述

儿童生长曲线的发展历程、构建方法与应用

  • 高雨霏 ,
  • 钱耐思 ,
  • 杨之雨 ,
  • 晋珊 ,
  • 陆慧萍 ,
  • 吴骋 ,
  • 宋花玲 ,
  • 虞慧婷
展开
  • 1.上海中医药大学公共健康学院(上海 201203)
    2.上海市疾病预防控制中心疾病预防控制信息所(上海 201107)
    3.上海市松江区疾病预防控制中心(上海 201620)
    4.海军军医大学卫生勤务系(上海 200433)
*具有同等贡献
宋花玲 电子信箱:99SHL@163.com
虞慧婷 电子信箱:yuhuiting@scdc.sh.cn

收稿日期: 2025-06-16

  录用日期: 2026-02-12

  网络出版日期: 2026-03-31

基金资助

国家自然科学基金项目(82003486);上海市“科技创新行动计划”技术标准项目(22DZ2206000);上海市加强公共卫生体系建设三年行动计划(2023—2025年)重点学科建设项目(GWVI-11.1-31);松江区科技攻关项目(2023SJKJGG022)

Child growth curves: historical development, construction methodologies, and applications

  • GAO Yufei ,
  • QIAN Naisi ,
  • YANG Zhiyu ,
  • JIN Shan ,
  • LU Huiping ,
  • WU Cheng ,
  • SONG Hualing ,
  • YU Huiting
Expand
  • 1. School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    2. Institute of Disease Control and Prevention Information, Shanghai Municipal Center For Disease Control & Prevention, Shanghai 201107, China
    3. Shanghai Songjiang District Center for Disease Control and Prevention, Shanghai 201620, China
    4. Department of Health Services, Naval Medical University, Shanghai 200433, China

Received date: 2025-06-16

  Accepted date: 2026-02-12

  Online published: 2026-03-31

摘要

生长曲线是儿童保健和儿科临床中用于动态监测儿童生长发育的重要工具。本文回顾了生长曲线200多年的发展历程,从18世纪的手绘记录到现代的精细化建模,生长曲线已成为评估儿童健康的关键技术。中国在生长曲线研究方面已取得一定进展,本土化生长曲线更符合国内儿童的生长特点,尤其在评估农村儿童生长迟缓方面具有显著优势。文章介绍了生长曲线的构建方法,包括非参数方法(如三次样条法、惩罚样条法、核估计法、局部加权散点回归平滑法)和参数方法(如LMS法和GAMLSS法),并比较了这些方法的优势、局限性和适用场景。未来研究将聚焦于个体化生长曲线的制定以及本土化标准的构建,提高评估的精准性,以更好地服务于儿童健康监测和疾病预防,促进儿童健康。

本文引用格式

高雨霏 , 钱耐思 , 杨之雨 , 晋珊 , 陆慧萍 , 吴骋 , 宋花玲 , 虞慧婷 . 儿童生长曲线的发展历程、构建方法与应用[J]. 临床儿科杂志, 2026 , 44(4) : 373 -380 . DOI: 10.12372/jcp.2026.25e0686

Abstract

Growth curves are indispensable for monitoring children's growth in child health care and pediatrics. In our article, we traces growth curves ranging over 200 years, from the hand-drawn charts in the early 18th century to algorithmic modeling in modern ages, highlighting their crucial role in assessing child health. China has made progress in growth curves research, with localized versions better reflecting domestic children's growth patterns, especially in detecting growth retardation in rural populations. In this article we also introduce growth curves construction methods, including non - parametric approaches (e.g., cubic spline, penalized splines, kernel estimation, LOWESS/LOESS) and parametric approaches (e.g., LMS, GAMLSS), comparing their merits, limitations, and applicability. Future research will focus on creating individualized growth curves and building localized standards to enhance assessment accuracy, thereby better supporting child health monitoring and disease prevention.

参考文献

[1] World Health Organization. WHO child growth standards: head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age: methods and development[M/OL]. Geneva: World Health Organization, 2007 [2025-02-18]. https://iris.who.int/handle/10665/43706.
[2] 王艺楠. 构建生长曲线的方法学比较及其医学应用研究[D]. 重庆: 重庆医科大学, 2018.
  Wang YN. Comparison of constructing growth curve methods and its medical application[D]. Chongqing: Chongqing Medical University, 2018.
[3] Cole TJ. The development of growth references and growth charts[J]. Ann Hum Biol, 2012, 39(5): 382-394.
[4] Tanner JM. A history of the study of human growth[M]. London: the Press Syndicate of the University of Cambridge, 1981.
[5] Freeman JV, Cole TJ, Chinn S, et al. Cross sectional stature and weight reference curves for the UK, 1990.[J]. Arch Dis Child, 1995, 73(1): 17-24..
[6] Hamill PV, Drizd TA, Johnson CL, et al. NCHS growth curves for children birth-18 years. United States[M]. United States:Vital Health Statistics - Series 11, 1977.
[7] Robert J Kuczmarski. 2000 CDC Growth Charts for the United States: methods and development[M]. Hyattsville, Md:Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, 2002.
[8] 宗心南. 中国7岁以下儿童生长标准的修订[J]. 中国儿童保健杂志, 2023, 61(12): 1123.
  Zong XN. Updated growth standards for Chinese children under 7 years of age[J]. Zhongguo Ertong Baojian Zazhi, 2023, 61(12): 1123.
[9] 张艺宏, 孙君志, 李宁. 我国1943—2014年儿童少年身高体重生长变化分析[J]. 中国学校卫生, 2016, 37(10): 1578-1581.
  Zhang YH, Sun JZ, Li N. Analysis of growth changes in height and weight of Chinese children and adolescents from 1943 to 2014[J]. Zhongguo Xuexiao Weisheng, 2016, 37(10): 1578-1581.
[10] 李辉. 中国儿童生长状况:营养和发育变化趋势[J]. 中国循证儿科杂志, 2009, 4(5): 405-410.
  Li H. Growth status of Chinese children: trends in nutrition and development[J]. Zhongguo Xunzheng Erke Zazhi, 2009, 4(5): 405-410.
[11] 全国学生体质健康调研组. 2005年全国学生体质与健康调研结果[J]. 中国学校体育, 2006(10): 6-8.
  National Student Physical Health Research Group. Results of the 2005 national student physical fitness and health survey[J]. Zhongguo Xuexiao Tiyu, 2006(10): 6-8.
[12] 宗心南, 李辉. 中国不同胎龄新生儿生长参照标准的建立:调查方案设计和标准研制方法[J]. 中国循证儿科杂志, 2020, 15(4): 251-260.
  Zong XN, Li H. Establishment of growth standards for Chinese newborns by gestational ages: Study design and statistical methods[J]. Zhongguo Xunzheng Erke Zazhi, 2020, 15(4): 251-260.
[13] 张亚钦, 李辉, 宗心南, 等. 中国0-18岁儿童青少年坐高下肢长比和坐高身高比的参照标准与生长曲线[J]. 中国循证儿科杂志, 2023, 18(4): 298-302.
  Zhang YQ, Li H, Zong XN, et al. Growth charts of sitting-height / leg length ratio and sitting-height / height ratio for Chinese children and adolescents aged 0-18 years [J]. Zhongguo Xunzheng Erke Zazhi, 2023, 18(4): 298-302.
[14] 李辉, 季成叶, 宗心南, 等. 中国0-18岁儿童、青少年身高、体重的标准化生长曲线[J]. 中华儿科杂志, 2009, 47(7): 487-492.
  Li H, Ji CY, Zong XN, et al. Height and weight standardized growth charts for Chinese children and adolescents aged 0 to 18 years[J]. Zhonghua Erke Zazhi, 2009, 47(7): 487-492.
[15] 潘其乐. 健康儿童青少年身高增长趋势的追踪研究[C/OL]. 中国体育科学学会, 2023: 313-314.
  Pan QL. A longitudinal study on the height growth trend of healthy children and adolescents[C/OL]. China Sport Science Society, 2023: 313-314.
[16] 宗心南, 李辉. 7岁以下儿童中国生长标准与世界卫生组织新标准比较[J]. 中国儿童保健杂志, 2010, 18(3): 195-198+201.
  Zong XN, Li H. Comparison of the China child growth standards and the WHO child growth standards from 0 to 7 years old[J]. Zhongguo Ertong Baojian Zazhi, 2010, 18(3): 195-198+201.
[17] 刘裕, 何健荣, 郭勇, 等. 生长曲线构建的不同方法比较[J]. 中国卫生统计, 2015, 32(4): 571-575.
  Liu Y, He JR, Guo Y, et al. Comparison of statistical methods for the construction of growth reference curves[J]. Zhongguo Weisheng Tongji, 2015, 32(4): 571-575.
[18] 陈长生. 非参数回归和生长曲线统计分析方法研究及其医学应用[D]. 第四军医大学, 1998.
  Chen CS. Research on nonparametric regression and statistical analysis methods for growth curves and their medical applications[D]. Fourth Military Medical University, 1998.
[19] 尚磊, 徐勇勇, 侯茹兰, 等. 采用三次样条函数拟合体重百分位数曲线[J]. 中国卫生统计, 2001(5): 11-13.
  Shang L, Xu YY, Hou RL, et al. Fitting weight percentile curves using cubic spline functions[J]. Zhongguo Weisheng Tongji, 2001(5): 11-13.
[20] 陈长生, 徐勇勇, 尚磊. 儿童生长曲线的光滑样条和核估计拟合[J]. 中国卫生统计, 1997(4): 3-5.
  Chen CS, Xu YY, Shang L. Fitting growth curves for children using smoothing splines and kernel estimation[J]. Zhongguo Weisheng Tongji, 1997(4): 3-5.
[21] 陈长生, 徐勇勇, 夏结来, 等. 中国香港地区0-7岁儿童生长曲线的非参数模型构建[J]. 中华预防医学杂志, 2000(1): 48-50.
  Chen CS, Xu YY, Xia JL, et al. Nonparametric model construction of growth curves for children aged 0-7 years in Hong Kong, China[J]. Zhonghua Yufang Yixue Zazhi, 2000(1): 48-50.
[22] 韩雨辰. 用LMS法建立南京市3-6岁儿童身高,体重,体质指数生长曲线及国际标准的比较[D]. 扬州大学, 2016.
  Han YC. Establishing growth curves for height, weight, and BMI of children aged 3-6 in nanjing using the LMS method and comparison with international standards[D]. Yangzhou University, 2016.
[23] Grajeda LM, Ivanescu A, Saito M, et al. Modelling subject-specific childhood growth using linear mixed-effect models with cubic regression splines[J]. Emerg Themes Epidemiol, 2016, 13(1): 1.
[24] Nadaraya EA. On estimating regression[J]. Theory Probab Appl, 1964, 9: 141-142.
[25] Watson GS. Smooth regression analysis[J]. Sankhya, 1964, 26: 359-372.
[26] Gasser T, Rosenblatt M. Smoothing techniques of curve estimation: proceedings of workshop held in Heidelberg[M]. Heidelberg: Springer Berlin, 1979.
[27] Cleveland WS. Robust locally weighted regression and smoothing scatterplots[J]. J Am Stat Assoc, 1979, 74(368): 829-836.
[28] Cole TJ, Green PJ. Smoothing reference centile curves: The lms method and penalized likelihood[J]. Stat Med, 1992, 11(10): 1305-1319.
[29] Villar J, Cheikh Ismail L, Victora CG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project[J]. Lancet, 2014, 384(9946): 857-868.
[30] 宗心南, 李辉. 生长曲线的拟合方法及营养评价界值点的选择[J]. 中国循证儿科杂志, 2011, 6(2): 153-156.
  Zong XN, Li H. Fitting methods for growth curves and selection of cut-off points for nutritional assessment[J]. Zhongguo Xunzheng Erke Zazhi, 2011, 6(2): 153-156.
[31] Rigby RA, Stasinopoulos DM. Generalized additive models for location, scale and shape[J]. J R Stat Soc C, 2005, 54(3): 507-554.
[32] Organization W H. Obesity: Preventing and managing the global epidemic: report on a who consultation[M]. Geneva: World Health Organization, 2000.
[33] Cole TJ, Statnikov Y, Santhakumaran S, et al. Birth weight and longitudinal growth in infants born below 32 weeks’ gestation: a UK population study[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(1): F34-F40.
[34] Neuhauser HK, Thamm M, Ellert U. Blood pressure percentiles by age and height from nonoverweight children and adolescents in Germany[J]. Pediatrics, 2011, 127(4): e978.
[35] Fredriks AM, Buuren SV, Burgmeijer RF. Continuing positive secular growth change in the Netherlands 1955-1997[J]. Pediatr Res, 2000, 47(3): 316-323.
[36] Ramos CF, Pérez SG, Jané CM, et al. Construction of the birth weight by gestational age population reference curves of Catalonia (Spain): Methods and development[J]. Gac Sanit, 2009, 23(1): 76-81.
[37] 陈茜. 基于GAMLSS构建父母身高修正的儿童身高生长曲线研究[D]. 重庆医科大学, 2020.
  Chen Q. Growth charts of children’s height based on allowing for parental height by GAMLSSS[D]. Chongqing Medical University, 2020.
[38] Zhang H, Li J, Su X, et al. Growth charts of brain morphometry for preschool children[J]. NeuroImage, 2022, 255: 119178.
[39] 冯围围, 黄小娜, 王惠珊. 8个城市1-4岁母乳喂养儿童体格生长百分位曲线研究[J]. 中华流行病学杂志, 2017, 38(4): 503-507.
  Feng WW, Huang XN, Wang HS. Percentile curves on growth among breastfed 1-4 year olds in 8 urban areas[J]. Zhonghua Liuxingbingxue Zazhi, 2017, 38(4): 503-507.
[40] 姚菲, 缪华章, 祝新红, 等. 广东省单胎新生儿胎龄别出生体质量百分位数曲线研究[J]. 中国妇幼保健, 2018, 33(7): 1448-1452.
  Yao F, Miao HZ, Zhu XH, et al. Study on singleton birth weight percentiles curve for gestational age in Guangdong[J]. Zhongguo Fuyou Baojian, 2018, 33(7): 1448-1452.
[41] 姚菲, 缪华章, 祝新红, 等. 广东省双胎新生儿胎龄别出生体重百分位数曲线研究[J]. 中国生育健康杂志, 2018, 29(2): 126-133.
  Yao F, Miao HZ, Zhu XH, et al. Birth weight percentiles curve by gestational age for twins born in Guangdong Province[J]. Zhongguo Shengyu Jiankang Zazhi, 2018, 29(2): 126-133.
[42] Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants[J]. BMC Pediatr, 2013, 13(1): 59.
[43] 李静, 肖喜荣, 潘怀燕. 智能胎儿生长监测预警系统架构研究及实现[J]. 中国数字医学, 2020, 15(3): 57-59.
  Li J, Xiao XR, Pan HY. Research and implementation of the intelligent fetal growth monitoring and early warning system[J]. Zhongguo Shuzi Yixue, 2020, 15(3): 57-59.
文章导航

/