Evaluation of the Global Lung Initiative 2012 Reference Values for Spirometry in African Children
Michele Arigliani, Mario C. Canciani, Giovanni Mottini , Michele Altomare , Andrea Magnolato , Sofia Vanda Loa Clemente, Leon Tshilolo, Paola Cogo , and Philip H Quanjer + <>Author Information. Corresponding Author: Michele Arigliani, Email: firstname.lastname@example.org
Rationale: Despite the high burden of respiratory disease no spirometry reference values for African children are available. Objectives: 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. Methods: Anthropometry and spirometry were obtained in children aged 6-12 years from urban and semi-urban 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 to those of African-American children from the third National Health and Nutrition Survey (NHANES III). Measurements and Main Results: Spirometry data were analyzed from 1082 schoolchildren (51% boys) aged 6.0-12.8 years in Angola (N=306), D.R. 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, -0.07 (0.83) for FEV1/FVC. Due to 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 FEV1 and FVC compared to African-American peers from NHANES III. Children in Angola had the lowest, in Madagascar the highest zFEV1 and zFVC. Conclusions: 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 FEV1 and FVC without respiratory impairment, as shown by the normal FEV1/FVC ratio.
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