The World Health Organization child growth standards: expected implications for clinical and epidemiological research

In 2006 and 2007, the World Health Organization (WHO) released two sets of child growth standards (World Health Organization, WHO Child Growth Standards. Methods and development. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. WHO, Geneva, 2006; World Health Organization, WHO Child Growth Standards: Methods and Development. Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age. WHO, Geneva, 2007) to replace the National Center for Health Statistics references (Hamill et al., National Center for Health Statistics, Vital and Health Statistics Series 11, No 165, 1977) as an international tool for growth and nutritional assessment. This paper explores the scope of implications for future anthropometric research, highlighting foreseeable effects on the choice of research questions, choice of nutritional indices, training of measurers, and issues of internal and external validity of research results. The conclusion drawn is that the introduction of the WHO child growth standards is expected to have wide implications for growth and nutrition research. The full scope of this effect will gradually become clear while researchers, similar to health care workers, make the transition to using the new standards, re-evaluate results of past approaches, and explore the uses and functional validity of the standards, including those for indices that were not previously available.     

中国九市七岁以下儿童生长迟缓状况调查研究

目的调查分析中国9个城市(简称九市)7岁以下儿童生长迟缓的发生情况。方法采用分层整群抽样方法,于2016年6—11月在北京、哈尔滨、西安(北片),上海、南京、武汉(中片),广州、福州、昆明(南片)九市对7岁以下的110499名儿童体格生长情况进行横断面调查。以2009年中国儿童生长标准为参照,身高低于同性别同年龄身高标准第3百分位判定为生长迟缓,位于第3~10百分位判定为身高偏矮。检出率按性别、地区、年龄等分组,组间生长迟缓检出率比较采用χ2检验。结果九市7岁以下儿童应调查113084名,实际调查110499名,调查率97.7%。生长迟缓总检出率为1.9%(2141/110499);城区低于郊区[1.6%(904/55524)比2.3%(1237/54975),χ2=56.246,P<0.01];男、女差异无统计学意义[1.9%(1121/57921)比1.9%(1020/52578),χ2=0.003,P=0.965];生长迟缓检出率在0~<3岁随年龄略下降[从0~<1岁组1.8%(312/17080)至2~<3岁组1.2%(168/13740)],之后略提高,6~<7岁为2.2%(240/11073)。不同地区比较,南片高于北、中片[城区3.3%(557/16664)比0.9%(193/20374)、0.8%(154/18486),郊区4.7%(769/16276)比1.1%(241/21924)、1.4%(227/16775),χ2=437.736、646.533,P均<0.01];而城区北、中片差异无统计学意义(χ2=1.429,P=0.232),郊区中片略高于北片(χ2=5.130,P=0.024)。九市中广州市生长迟缓率最高(6.1%,613/10019),各城市比较差异有统计学意义(χ2=1559.64,P<0.01)。生长迟缓程度构成显示以临界和轻度为主(78.4%,1679/2141),重度较少(7.2%,154/2141)。身高偏矮儿童检出率为5.2%(5721/110499)。结论九市7岁以下儿童生长迟缓处于较低流行状态,且检出生长迟缓儿童多为轻度。生长迟缓检出率郊区高于城区,男女差别不明显,南片地区高于北、中片地区。     

Health implications of chronic hepatosplenomegaly in Kenyan school-aged children chronically exposed to malarial infections and Schistosoma mansoni

Hepatosplenomegaly among school-aged children in sub-Saharan Africa is highly prevalent. Two of the more common aetiological agents of hepatosplenomegaly, namely chronic exposure to malaria and Schistosoma mansoni infection, can result in similar clinical presentation, with the liver and spleen being chronically enlarged and of a firm consistency. Where co-endemic, the two parasites are thought to synergistically exacerbate hepatosplenomegaly. Here, two potential health consequences, i.e. dilation of the portal vein (indicative of increased portal pressure) and stunting of growth, were investigated in a study area where children were chronically exposed to malaria throughout while S. mansoni transmission was geographically restricted. Hepatosplenomegaly was associated with increased portal vein diameters, with enlargement of the spleen rather than the liver being more closely associated with dilation. Dilation of the portal vein was exacerbated by S. mansoni infection in an intensity-dependent manner. The prevalence of growth stunting was not associated with either relative exposure rates to malarial infection or with S. mansoni infection status but was significantly associated with hepatosplenomegaly. Children who presented with hepatosplenomegaly had the lowest height-for-age Z-scores. This study shows that hepatosplenomegaly associated with chronic exposure to malaria and schistosomiasis is not a benign symptom amongst school-aged children but has potential long-term health consequences.     

Effect of wealth,social inequality,Mother's BMI,and education level on child malnutrition in India

Background and aimsThe differences in prevalence of malnutrition are mostly on account of social factors. However, we did not find any published study that provided an estimate of proportion of stunting and underweight among under-5 children due to household economic conditions, social inequalities, mother's BMI and education level. Hence, study has taken to study the effect of household economic status, social inequality, mother's BMI and education on stunting and underweight among children under-5 years and its determinants.MethodsThe study used Kids file of NFHS-4 (2015–16), which comprised 259,627 children aged less than five years. This data was analysed by bivariate and Forward Logistic Regression techniques using M.S. Excel and IBM SPSS-22 version.ResultsThe prevalence of stunting and underweight children was significantly higher among those born to underweight mothers, poor households, working women, and women had a home delivery. It was also high among children of 4th or higher birth order, those from scheduled castes and tribes, born to illiterate women and those residing in rural. The odds of stunting (OR = 2.67, 95% CI: 2.54–2.81) and underweight (OR = 2.74, 95% CI: 2.60–2.88) were more than two times higher among children living in poor households than among those from rich households. Poor households account for about 40% of stunted and underweight children. Fifteen percent of stunted children and 26.9% of underweight were born to underweight mothers. Overall, 60% of stunted and 56.6% of underweight children had illiterate mothers.Conclusionschildren of illiterate and underweight mothers, socially deprived and economically poor groups are at a higher risk of being stunted and underweight. Hence, necessary health programmes are needed for improving nutritional status by giving special attention to illiterate, underweight mothers, socially deprived and economically poor groups.     

Nutritional status of school-age children - A scenario of urban slums in India

Objectives

This article aims at describing, in a Belgian town, the frequency of the fear of falling and of subsequent activity restriction among non-institutionalised people aged 65 years and over, and at identifying persons affected by these two issues.

Methods

Cross-sectional survey conducted in Fontaine l'Evêque (Belgium) in 2006, using a self-administered questionnaire.

Results

The participants could fill in the questionnaire on their own or with the help of a third party if needed. The latter were not taken into account in this article. Analyses covered 419 questionnaires. Fear of falling and activity restriction were reported by, respectively, 59.1% and 33.2% of participants. They were more frequent among fallers but also affected non-fallers. In logistic regression analyses: gender, the fact of living alone and the number of falls were significantly associated with fear of falling; gender, age and the number of falls were significantly associated with activity restriction.

Conclusions

Our study, despite various limitations, shows the importance of fear of falling and of subsequent activity restriction among older people, among fallers as well as among non-fallers. It also provides information, though limited, concerning persons affected by these two issues in Belgium, and in other contexts as well. Given the ageing of our populations, it is important to take these problems into account when caring for older people.     

Evolution of the biochemical profile of children treated or undergoing treatment for moderate or severe stunting: consequences of metabolic programming?

Objectiveto evaluate changes in the biochemical profile of children treated or being treated for moderate or severe stunting in a nutrition recovery and education center.Methodsthis was a retrospective longitudinal study of 263 children treated at this center between August of 2008 to August of 2011, aged 1 to 6 years, diagnosed with moderate (z‐score of height‐for‐age [HAZ] < ‐2) or severe stunting (HAZ < ‐3). Data were collected on socioeconomic conditions, dietary habits, and biochemical changes, as well as height according to age.Resultsthe nutritional intervention showed an increase in HAZ of children with moderate (0.51 ± 0.4, p = 0.001) and severe (0.91 ± 0.7, p = 0.001) stunting during the monitoring. Increased levels of insulin‐like growth factor 1 (IGF‐1) (initial: 71.7 ng/dL; final: 90.4 ng/dL; p = 0.01) were also observed, as well as a reduction in triglycerides (TG) in both severely (initial: 91.8 mg/dL; final: 79.1 mg/dL; p = 0.01) and in moderately malnourished children (initial: 109.2 mg/dL; final 88.7 mg/dL; p = 0.01), and a significant increase in high‐density lipoprotein cholesterol HDL‐C only in the third year of intervention (initial: 31.4 mg/dL; final: 42.2 mg/dL). The values of total cholesterol (TC) and low‐density lipoprotein cholesterol (LDL‐C) levels remained high throughout the treatment (initial: 165.1 mg/dL; final: 163.5 mg/dL and initial: 109.0 mg/dL; final: 107.3 mg/dL, respectively).Conclusionthe nutritional treatment for children with short stature was effective in reducing stunting and improving TG and HDL‐C after three years of intervention. However, the levels of LDL‐C and TC remained high even in treated children. It is therefore speculated that these changes may result from metabolic programming due to malnutrition.     

Malnutrition Prevalence in Lasa Xizang Children and Adolescents

Objective To assess the prevalence of malnutrition among children and adolescents in Xizang （Tibet）. Methods We analyzed data from the Chinese National Survey on Students＇ Constitution and Health for the years 1995, 2000, 2005, and 2010 pertaining to Tibetan children and adolescents in Lase （Lhasa）, aged 7-18 years old. Numbers of survey subjects for these years were：2 393, 2 754, 2 397, and 2 643, respectively. Results Our results indicated that the rate of occurrence of stunting in Tibet has evidenced a gradual decline：for boys, from 26.8%in 2000 to 9.3%in 2010;and for girls, from 25.8%in 2000 to 10.8%in 2010. In general, the wasting rate for both boys and girls in Tibet has gradually decreased over time：for boys, from 17.7%in 1995 to 4.6%in 2005;and for girls from 12.5%in 1995 to 2.3%in 2005. The stunting rates of boys aged 7-13 years old and of girls aged 7-11 years old were 67.5%and 53.1%, respectively, while these rates for boys aged 14-18 years old and girls aged 12-18 years old were 32.5%and 46.9%, respectively. Conclusion Stunting and wasting rates of Tibetan children and adolescents indicate a gradual declining trend over time. The stunting rates of both boys and girls during early puberty were significantly higher than those during late puberty.     

南山区5岁以下儿童营养状况调查

本文通过对南山区２６０７名０～５岁儿童进行了生长发育状况调查，采用了年龄别体重、年龄别身高作为评价指标，用标准差记分评价法与１９８５年我国九市男女身高、体重测量值为参照人群进行比较，以分析南山区儿童的生长发育状况。结果显示肥胖、中、重度低体重、发育迟缓３种表现生长偏离类型的检出率分别为１．３８％、２．８４％、３．４９％。０～１岁组的营养不良发生率高于其它年龄组；常住儿童肥胖发生率明显高于暂住儿童，达３．０３％，提示肥胖已日益成为儿童生长发育偏离的突出问题     

中国和国际标准用于评价中国3～6岁儿童营养状况的比较研究

目的 采用中国2005年标准、中国疾病预防控制中心(CDC)2000生长发育标准和世界卫生组织(WHO) 2006-07标准评价中国部分地区3～6岁儿童营养状况,比较中国和国际标准评估结果之异同. 方法 依据3个标准,描述河北、江苏、浙江21县(市)210 308名3～6岁儿童消瘦、生长迟缓、低体重和超重/肥胖的发生率.采用配对卡方检验,比较中国标准与WHO和CDC标准评价结果之差异;采用Kappa统计量,评价国内与国际标准评价结果的一致性. 结果 依据中国、CDC和WHO标准计算的消瘦率依次为2.1％、4.1％和1.5％,生长迟缓率为28.3％、11.5％和15.4％,低体重率为9.3％、6.9％和4.2％,超重/肥胖率为18.9％、14.3％和15.3％.依据中国标准计算的营养不良指标以及超重/肥胖的发生率均高于WHO标准;依据中国标准计算的低体重、生长迟缓以及超重/肥胖的发生率均高于CDC标准,但消瘦率低于CDC标准.中国标准与国际标准对各指标评价结果的Kappa值范围是0.5 ～0.9. 结论 中国标准计算的4项指标的发生率均高于WHO新标准;除消瘦外,其他3项指标的发生率均高于CDC标准.中国与国际标准对4项儿童营养指标评价结果的一致性强度属中等偏高.     

中国中西部农村3岁以下儿童营养状况及影响因素分析

为了解中西部农村地区儿童的营养状况,于2010年10-11月对新疆、山西、甘肃和青海4省(自治区)项目地区1241名3岁以下儿童的营养状况进行调查. 1.对象与方法:资料来源于卫生部-嘉道理慈善基金会"农村社区健康促进"项目(Ⅱ)2010年终线调查数据.采用多阶段分层随机抽样的方法,在4省(自治区)的16个项目县随机抽取42个项目乡镇,再采用单纯随机抽样方法从42个项目乡镇各抽取2个村,共调查84个村(新疆42个,山西18个,甘肃和青海各12个).检查各村3岁以下儿童的身高、体重、血红蛋白(Hb),不得少于15人;共调查有效样本儿童1241人.