中国儿童营养状况15年变化分析——应用2006世界卫生组织儿童生长标准评价中国儿童营养状况

目的探讨2006年WHO新标准与NCHS参考标准评价中国儿童营养状况的差别。方法利用2005年中国儿童营养监测调查资料,比较不同生长标准的儿童Z评分和营养不良率的差别。结果2种标准评价农村儿童的Z评分有显著差别,不同月龄儿童表现不一致。农村儿童WHO标准计算的低体重率是6.1%,低于NCHS参考标准得到的8.6%(P<0.0001),除了<6月龄的婴儿,其余年龄组WHO标准儿童低体重率都要低于NCHS参考标准。农村儿童WHO标准生长迟缓率是16.3%,高于NCHS参考标准的13.0%(P<0.0001),<6月龄以下儿童WHO标准生长迟缓率是NCHS参考标准的2.1倍;儿童消瘦率没有显著性差别(P>0.05),但是<6月龄儿童WHO标准消瘦率是NCHS参考标准的1.9倍。利用WHO标准计算的城市儿童超重率是6.7%,要高于NCHS参考标准得到的5.4%(P<0.0001)。结论与NCHS参考标准相比,WHO标准评价儿童的营养情况随月龄、评价指标的不同而改变,WHO标准可以更好地监测婴儿早期的生长变化,有必要应用该标准进一步分析现有数据。     

Parental tobacco use is associated with increased risk of child malnutrition in Bangladesh

OBJECTIVES: We investigated the relation between parental tobacco use and malnutrition in children <5 y of age and compared expenditures on foods in households with and without tobacco use. METHODS: Tobacco use, child anthropometry, and other factors were examined in a stratified, multistage cluster sample of 77 678 households from the Bangladesh Nutrition Surveillance Project (2005-2006). Main outcome measurements were stunting, underweight, and wasting, and severe stunting, severe underweight, and severe wasting. Secondary outcomes included the proportion of household expenditures spent on food. RESULTS: The prevalence of parental tobacco use was 69.9%. Using the new World Health Organization child growth standards, prevalences of stunting, underweight, and wasting were 46.0%, 37.6%, and 12.3%, respectively. After adjusting for potential confounders, parental tobacco use was associated with an increased risk of stunting (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.12-1.21, P < 0.0001), underweight (OR 1.17, 95% CI 1.12-1.22, P < 0.0001), and wasting (OR 1.10, 95% CI 1.03-1.17, P = 0.004), and severe stunting (OR 1.16, 95% CI 1.10-1.23, P < 0.0001), severe underweight (OR 1.21, 95% CI 1.13-1.30, P < 0.0001), and severe wasting (OR 1.14, 95% CI 0.98-1.32, P = 0.09). Households with tobacco use spent proportionately less per capita on food items and other necessities. CONCLUSIONS: In Bangladesh parental tobacco use may exacerbate child malnutrition and divert household funds away from food and other necessities. Further studies with a stronger analytic approach are needed. These results suggest that tobacco control should be part of public health strategies aimed at decreasing child malnutrition in developing countries.     

Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality

Objective

To compare the estimated prevalence of malnutrition using the World Health Organization’s (WHO) child growth standards versus the National Center for Health Statistics’ (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy.

Methods

A secondary analysis of data on 9424 mother–infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants’ weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards.

Findings

The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6–12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6–12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%).

Conclusion

Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.     

Parasite and maternal risk factors for malnutrition in preschool-age children in Belen, Peru using the new WHO Child Growth Standards

Child malnutrition, including wasting, underweight and stunting, is associated with infections, poor nutrient intake, and environmental and socio-demographic factors. Preschool-age children are especially vulnerable due to their high growth requirements. To target interventions for preschool-age children in a community of extreme poverty in Peru, we conducted a household survey between October 2005 and January 2006 to determine the prevalence of malnutrition and its risk factors. Of 252 children < 5 years old, the prevalence of wasting, underweight and stunting was 26.6, 28.6 and 32.1 %, respectively, based on the new WHO Child Growth Standards. Risk factors for wasting were: (1) moderate-high intensity Trichuris infection (OR 2.50; 95 % CI 1.06, 5.93); (2) hookworm infection (OR 6.67; 95 % CI 1.08, 41.05); (3) age (OR6-month 1.27; 95 % CI 1.11, 1.46); (4) maternal education (secondary incomplete) (OR 5.77; 95 % CI 2.38, 13.99); and (5) decreasing maternal BMI (OR1 kg/m2 1.12; 95 % CI 1.02, 1.23). Risk factors for underweight were: (1) moderate-high intensity Trichuris infection (OR 4.74; 95 % CI 1.99, 11.32); (2) age (OR6-month 1.22; 95 % CI 1.07, 1.38); (3) maternal education (secondary incomplete) (OR 2.92; 95 % CI 1.40, 6.12); and (4) decreasing maternal BMI (OR1 kg/m2 1.11; 95 % CI 1.02, 1.21). Risk factors for stunting were: (1) age (OR6-month 1.14; 95 % CI 1.02, 1.27) and (2) decreasing maternal height (OR1 cm 1.12; 95 % CI 1.06, 1.20). Overall, risk factors for malnutrition included both child and maternal determinants. Based on these data, locally appropriate and cost-effective dietary, de-worming and educational programmes should be targeted to mothers and preschool-age children.     

中国部分农村地区3岁以下儿童营养状况及相关因素研究

目的 了解中国中西部10省农村地区3岁以下儿童的营养状况及其相关影响因素.方法 在10省46个项目县地区采用人口比例(PPS)抽样方法,对230个乡920个村的13 532名3岁以下儿童的营养状况进行了问卷调查和体格发育检测.以年龄别身高(HA)、年龄别体重(wA)和身高别体重(WH)作为衡量儿童营养状况的指标.采用Epi Data 3.02软件建立数据库,采用SPSS 11.5软件进行统计分析.结果 项目地区3岁以下儿童生长迟缓(HAZ＜-2)、低体重(WAZ＜-2)和消瘦(WHZ＜-2)的患病率分别为12.4%、11.8%和5.7%,其中男童高于女童,少数民族高于汉族,西部地区高于东部和北部地区.汉族儿童低体重和生长迟缓的患病率分别为9.5%和9.8%,而少数民族儿童低体重和生长迟缓的患病率分别为15.6%和16.5%,明显高于汉族儿童,差异有统计学意义(P＜0.01).营养不良患病率有随年龄上升趋势,生长迟缓、低体重和消瘦的患病率分别在24月龄、15～30月龄和15月龄达到峰值.HA、WA和WH的Z值分布较NCHS/WHO标准分别向左偏移了0.59、0.60和0.26个单位(P＜0.01),提示儿童整体营养状况均受到不同程度的影响.低体重儿童2周腹泻和感冒的患病率为15.9%和13.5%,分别高于正常体重儿童,差异有统计学意义(P＜0.01).多因素非条件logisitic回归分析显示,6月龄以下儿童生长迟缓主要与母亲是否在家照顾有关;6月龄以上儿童生长迟缓与年龄、性别、民族、排行、母亲文化程度、单独做饭和地区等因素有关;6月龄以上儿童低体重受年龄、民族、母亲文化程度、6～8月龄是否添加鸡蛋和地区等因素的影响.结论 中国中西部农村地区3岁以下儿童的营养不良患病率有随年龄上升的趋势;地区间营养不良患病率差异明显.     

Prevalence of malnutrition in human immunodeficiency virus/acquired immunodeficiency syndrome orphans in the Nyanza province of Kenya: a comparison of conventional indexes with a composite index of anthropometric failure

The prevalence of undernutrition in children is commonly reported using a conventional index, which identifies three conventional categories: stunting, underweight, and wasting. Recently, a composite index of anthropometric failure was developed to categorize undernutrition into seven mutually exclusive categories, including single failures (stunting, underweight, or wasting) and multiple failures (stunting and underweight, stunting and wasting, underweight and wasting, and stunting and underweight and wasting). This cross-sectional study used baseline data gathered during a feeding program targeting orphans and vulnerable children impacted by human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS) in Kenya to compare the conventional index with the composite index of anthropometric failure. Children younger than 5 years of age who participated in the feeding trial were included in the analysis (n=170). The conventional index found that the prevalence of undernutrition included 31.2% stunted, 14.1% underweight, and 5.9% wasted children, whereas the composite index of anthropometric failure estimated a more severe overall prevalence rate (38.2%); thus, the conventional index did not uncover the complexity of malnutrition experienced. Of the 53 children classified as stunted by the conventional index, the composite index of anthropometric failure identified 36 (67.9%) as stunted and 17 (32.1%) as stunted and underweight. Thus, the composite index of anthropometric failure was able to distinguish children with multiple anthropometric failures. In total, multiple anthropometric failures were found in 22 of the 65 children with anthropometric failure. These data suggest that the complexity and prevalence of undernutrition may be underestimated using the conventional index because it does not identify children experiencing multiple anthropometric failures. The ability of the composite index of anthropometric failure to identify children with multiple anthropometric failures may have profound implications for prioritizing, designing, and targeting nutritional interventions.     

应用人体测量法评估湖南省宜章县0～7岁农村儿童的营养状况

目的应用人体测量法评估宜章县0～7岁农村儿童营养状况。方法采用横断调查设计，随机抽样，获得2969名0～7岁儿童，以身长和体重作为衡量儿童营养状况的指标，采用Z值法以WHO参考人群为标准评估该儿童群体的营养状况。结果年龄别身高（HA）Z值的标准差波动在1．13～1．33，年龄别体重（WA）Z值的标准差波动范围较大在1．02～1．43，特别是1岁以内的儿童。与WHO参考分布相比，该儿童群体的HAZ值和WAZ值显著左移约1个单位，身高别体重（WH）Z值左移0．4个单位，生长迟缓、低体重和消瘦的患病率分别为20．1％、21．6％和6．8％。营养不良患病情况在出生后3个月龄内较低，6月龄后患病率迅速上升，在15月龄左右达到20％～30％，此后有所下降但维持在较高水平上。低体重与生长迟缓和消瘦问有显著的相关关系，Pearson相关系数分别为0．815和0．636（P〈0．01），发育迟缓与消瘦间没有发现显著的相关关系。结论该县农村儿童的整体营养状况受到不良影响，相对于WHO参考人群营养不良患病率较高，低的HA和WA可能是该地区农村儿童的主要问题。     

Nutritional status of under-five children living in an informal urban settlement in Nairobi, Kenya

Malnutrition in sub-Saharan Africa contributes to high rates of childhood morbidity and mortality. However, little information on the nutritional status of children is available from informal settlements. During the period of post-election violence in Kenya during December 2007-March 2008, food shortages were widespread within informal settlements in Nairobi. To investigate whether food insecurity due to post-election violence resulted in high prevalence of acute and chronic malnutrition in children, a nutritional survey was undertaken among children aged 6-59 months within two villages in Kibera, where the Kenya Medical Research Institute/Centers for Disease Control and Prevention conducts population-based surveillance for infectious disease syndromes. During 25 March-4 April 2008, a structured questionnaire was administered to caregivers of 1,310 children identified through surveillance system databases to obtain information on household demographics, food availability, and child-feeding practices. Anthropometric measurements were recorded on all participating children. Indices were reported in z-scores and compared with the World Health Organization (WHO) 2005 reference population to determine the nutritional status of children. Data were analyzed using the Anthro software of WHO and the SAS. Stunting was found in 47.0% of the children; 11.8% were underweight, and 2.6% were wasted. Severe stunting was found in 23.4% of the children; severe underweight in 3.1%, and severe wasting in 0.6%. Children aged 36-47 months had the highest prevalence (58.0%) of stunting while the highest prevalence (4.1%) of wasting was in children aged 6-11 months. Boys were more stunted than girls (p < 0.01), and older children were significantly (p < 0.0001) stunted compared to younger children. In the third year of life, girls were more likely than boys to be wasted (p < 0.01). The high prevalence of chronic malnutrition suggests that stunting is a sustained problem within this urban informal settlement, not specifically resulting from the relatively brief political crisis. The predominance of stunting in older children indicates failure in growth and development during the first two years of life. Food programmes in Kenya have traditionally focused on rural areas and refugee camps. The findings of the study suggest that tackling childhood stunting is a high priority, and there should be fostered efforts to ensure that malnutrition-prevention strategies include the urban poor.     

Protein-energy malnutrition and soil-transmitted helminthiases among Orang Asli children in Selangor, Malaysia

This study aims to determine the prevalence of protein-energy malnutrition and its association with soil-transmitted helminthiases in Orang Asli (Aborigine) children in Selangor, Malaysia. The results obtained from 368 children aged 2-15 years showed that the overall prevalence of mild and significant underweight was 32.1% and 56.5% respectively. The prevalence of mild stunting was 25.6% while another 61.3% had significant stunting. The overall prevalence of mild and significant wasting was 39.0% and 19.5% respectively. The overall prevalence of ascariasis, trichuriasis and hookworm infection were 61.9%, 98.2% and 37.0% respectively and of these 18.9%, 23.5% and 2.5% of the children had severe infection of the respective helminthes. The overall prevalence of giardiasis was 24.9%. The present study vividly shows that stunting and underweight are highly prevalent among Orang Asli children and therefore of concern in this community. In this population intestinal parasitic infections, especially severe trichuriasis and giardiasis, were identified as the main predictors of stunting and wasting respectively, in addition to age between 2 to 6 years.     

新会区5岁以下儿童营养不良流行病学调查与分析

目的调查新会区5岁以下儿童营养不良患病率,分析其影响因素。方法采用分层整群抽样的方法,对6432名5岁以下儿童进行体格检查、家长问卷调查,对资料进行统计描述,进行儿童营养不良病因的Logistic多因素回归分析。结果新会区2008年5岁以下儿童低体重、发育迟缓和消瘦的患病率分别为3．90％、2．97％、3．08％,城区营养不良患病率低于农村,〈6个月年龄组的营养不良患病率最低,随着年龄组的增大,营养不良患病率逐渐上升,性别方面无差异。多因素Logistic回归分析显示影响患病率的相关因素主要有：农村居住、年龄、反复呼吸道感染、腹泻、母亲文化程度及不良饮食习惯等。结论新会区5岁以下儿童营养不良需引起重视,做好儿童常见病的防治,加强科学喂养知识宣传,改变不良饮食习惯,对降低新会区儿童营养不良患病率有着重要意义。     

An evaluation of the impact of a US$60 million nutrition programme in Bangladesh

OBJECTIVE: To compare levels of childhood malnutrition in areas where the Bangladesh Integrated Nutrition Project had been operational for over 5 years with matched non-project areas, with the purpose of evaluating whether the project had achieved its objective of reducing the prevalence of underweight among children <24 months. METHODS: The study involved an ex-post cross-sectional survey in six thanas (a locality with a population of approximately 200,000-450,000 people) in Bangladesh. Participants were 6,820 households (4,554 in the project areas and 2,266 in the non-project areas) including 7183 children aged 6-59 months selected using a two-stage stratified cluster sampling frame. Main outcome measures were moderate and severe underweight, wasting and stunting reported using z scores, and indicators of mothers' reported nutritional knowledge and practice. RESULTS: 2,388 children aged 6-23 months and 6815 children aged 6-59 months had clean anthropometric data. No significant difference was found between the socio-economic variables of households in the project and non-project areas. No significant difference was found in the prevalence of either severe or moderate underweight (weight-for-age) in children aged 6-23 months in the project and non-project areas: 183 (11.4%, 95% confidence interval 9.9-13.2%) children in project areas and 96 (12.2%, 95% confidence interval 9.9-14.8%) children in non-project areas. Mothers in project areas reported significantly better caring practices than in non-project areas. CONCLUSION: There is no evidence that the Bangladesh Integrated Nutrition Project has achieved its objectives to reduce severe underweight by 40% if project areas are compared ex-post with non-project areas. There is urgent need to review the evidence behind investments based on growth monitoring and promotion.     

广州市社区足月小样儿 0~2岁体格发育的纵向研究

目的 了解足月小样儿生后2年内的体格发育和营养状况,为制定足月小样儿生长发育干预策略提供科学依据。方法 采用前瞻性的研究方法,选取2016年1月—2018年4月广州出生的足月小样儿为小于胎龄儿(SGA)组,选取同种族、同社区、同年龄的足月正常体重儿为适于胎龄儿(AGA)组,定期对生长参数进行了纵向评估,比较两组儿童体格发育特点。结果 1) SGA组生后各年龄组体重和身长Z评分均小于AGA组,但生后第一年Z评分呈上升趋势,体重增长(△Z评分为1.17±1.10)、身长增长(△Z评分为0.65±1.23)均大于AGA组。2) 67.65%和50.98% 的SGA在婴儿期出现体重和身长追赶生长;婴儿期生长速率与2岁时营养状况相关(P<0.01)。3) SGA组在各年龄的低体重、生长迟缓、消瘦率均高于AGA组,2岁时发生率在8%~15%。超重和肥胖率低于AGA组,2岁时超重率为2.94%。两组间低体重、生长迟缓和超重率比较,差异有统计学意义(χ²=4.40、4.18、5.38,P<0.05); SGA组6月龄贫血患病率高达43.63%。结论 足月小样儿生后一年内体重和身长均有追赶生长。营养不良发生状况不容忽视,应注意预防足月小样儿营养不良和6月龄贫血。     

Prevalence of malnutrition in Indian preschool-age children: a survey of wasting and stunting in rural Tamil Nadu, 1983

A cross-sectional survey of the nutritional status of 1223 preschool-age children was carried out in a development area in the southern Indian state of Tamil Nadu. Altogether, 45% of the children were underweight (low weight-for-age), 51% were stunted (low height-for-age), and 21% were wasted (low weight-for-height). The rates of severe malnutrition using any of these criteria were low, and only 9.6% of the children were both wasted and stunted. The nature of the malnutrition strongly depended on age group. Rates of stunting increased with age, reaching 63% in the fifth year of life, whereas rates of wasting peaked at 36% in the second year of life and declined to 14% in the fifth year. Surveys that are designed to produce information on stunting and wasting are important in the planning and evaluation of nutrition intervention programmes.     

Childhood malnutrition within the indigenous Wayuú children of northern Colombia

ABSTRACT

Malnutrition contributes to nearly half of all preventable deaths in children under the age of five. While the burden of disease is heaviest in Sub-Saharan Africa, South, and Southeast Asia, malnutrition in Latin America remains high, especially within indigenous communities. This study evaluates the prevalence of malnutrition and its relationship with access to healthcare resources within 172 indigenous Wayuú communities in La Guajira, Colombia. Healthcare workers administered a health questionnaire and collected anthropometric measurements on all children 6 months to 5 years of age within the Wayuú households. These data were utilised to calculate the prevalence of acute malnutrition, stunting, and underweight. Of all surveyed Wayuú children, 22.9% and 18.3% met criteria for moderate and severe malnutrition, 33.4% and 28.1% met criteria for moderate and severe stunting, and 28.1% and 16.6% were moderately and severely underweight. Across all categories, malnourished children were older, less likely to have had a medical professional present at birth, less likely to have received medical care after birth, and more likely to have been born in a non-medical, community setting. The prevalence of malnutrition is much higher than national levels in Colombia. This population requires urgent assistance to address their disproportionately high rates of malnutrition.     

运用人体测量法评估中国西部40个县农村3岁以下儿童的营养状况

目的运用人体测量法评估中国西部40个县3岁以下儿童的营养状况。方法采用横断面调查设计和分层多阶段随机抽样法,获得7252名3岁以下儿童,以身长和体重作为衡量儿童营养状况的指标,采用Z值法以WHO/NCHS参考人群为标准评估该儿童群体的营养状况。结果年龄别身高(HA)Z值的标准差波动在1.10～1.30,年龄别体重(WA)Z值的标准差波动范围较大在1.06～1.40,特别是对1岁以内的儿童。与WHO/NCHS参考分布相比,该儿童群体的HAZ值和WAZ值显著左移约1个单位,身高别体重(WH)Z值左移约0.4个单位,生长迟缓、低体重和消瘦的总患病率分别为23.0%、22.6%和7.5%,各地区县儿童的营养不良患病情况差异较大。营养不良患病情况在出生后3月龄内较低,其生长迟缓的患病率为5.9%～9.0%,低体重患病率为1.1%～3.5%,6月龄后患病率迅速上升,在15月龄左右达到20%～30%,此后有所下降但维持在较高的水平上。低体重与生长迟缓和消瘦间有显著的正相关关系,Pearson相关系数分别为0.815和0.636(P＜0.01),发育迟缓与消瘦间没有发现显著的相关关系。结论40个县儿童的整体营养状况受到了不良影响,意味着该地区儿童的营养不良不仅仅是个别或部分儿童的健康问题,相对于WHO/NCHS参考人群营养不良患病率较高,低的HA可能是该地区儿童的主要问题。单独使用WA时解释要谨慎,因为它无法区分生长迟缓或低体重。准确收集年龄数据和准确测量身长体重是运用人体测量法评估儿童营养状况的关键。     

Estimating the effect of measles vaccination on child growth using 191 DHS from 65 low- and middle-income countries

BackgroundChildhood vaccinations reduce morbidity and mortality and are highly cost-effective. They may also protect children from malnutrition and lead to improved child growth. Stunting, wasting and underweight are targets used to monitor progress towards the achievement of the sustainable development goals (SDGs).MethodsWe use data from Demographic and Health Surveys (DHS) covering the period from 1990 to 2017 to estimate the effect of measles vaccination at 12 months of age on stunting, wasting, and underweight. For causal estimation, we use household- and mother-fixed effects, which allows us to compare outcomes across siblings while controlling for all observed and unobserved confounders that are shared by the siblings, such as household social characteristics and home location. In addition, we control for a wide range of sibling-varying confounders, including sex, age, birth order and mother’s age at birth, as well as vaccination with diphtheria-tetanus-polio (DPT), as a broad indicator of general likelihood to receive vaccinations.ResultsOur samples include 347,808 individuals in 132 surveys from 59 countries (for stunting), 430,963 individuals in 190 surveys from 65 countries (for wasting), and 353,520 individuals in 130 surveys from 59 countries (for underweight). Measles vaccination is associated with significantly reduced odds of stunting (odds ratio 0.90 [95% CI 0.86–0.94], p < 0.001) and underweight (odds ratio 0.90 [95% CI 0.86–0.95], p < 0.001). The association with wasting is weaker and not statistically significant (odds ratio 0.95 [95% CI 0.89–1.02], p = 0.143). Our results remain robust across several alternative specifications of our regression models.ConclusionsMeasles vaccination substantially reduces stunting and underweight among children in low- and middle-income countries. Increasing measles coverage from the current low to near-universal levels would provide a large boost to child growth and the attainment of the SDGs.     

Nutritional status of breastfed infants in rural Zambia: comparison of the National Center for Health Statistics growth reference versus the WHO 12-month breastfed pooled data set

Cross-sectional data for breastfed infants in rural Zambia were used to evaluate the effect of applying two different data sets as a reference, i.e. the WHO 12-month breastfed pooled data set and the National Center for Health Statistics (NCHS) growth reference in terms of prevalence of malnutrition (stunting, underweight, and wasting). A total of 518 infants who were attending mother-and-child health clinics were included. Age, weight and length were recorded. Anthropometric Z-scores were calculated in two ways: by applying the NCHS growth reference and by using the WHO breastfed data set. Anthropometric Z-scores calculated using the breastfed data set were lower during the first 6-7 months of life compared with those calculated by applying the NCHS growth reference. This resulted in a higher proportion of children aged 0-6 months being classified as stunted and underweight using the breastfed data set versus the NCHS growth reference. After the age of 7 months, similar prevalences of stunting or underweight were observed. Relatively few infants were classified as wasted. In order to adequately assess the prevalence of stunting and underweight in breastfed infants, it is recommended that a new growth reference be developed, as has been initiated by WHO.     

云南省贫困地区6~23月龄婴幼儿营养生长状况调查

目的 了解及分析云南省贫困地区兰坪县和鹤庆县6~23月龄婴幼儿的营养与生长发育状况,为营养包的进一步发放提供理论依据。方法 采取分层整群抽样的方法,以兰坪县和鹤庆县共10个乡24个村642名婴幼儿作为研究对象,进行问卷调查、体格指标测定和指血血红蛋白检测。采用WHO 2006的身高标准体重参考值作为评价标准计算Z评分,应用SPSS 17.0软件进行统计分析。结果 云南省贫困地区兰坪县和鹤庆县仅有不到6%的乳母在1 h内开奶,且婴幼儿出生4个月内母乳喂养率为72.1%;同时,该地区6~23月龄婴幼儿生长迟缓率为14.2%,低体重率为7.9%,消瘦率为5.1%,均低于2002年贫困农村的总体水平,且生长迟缓率在三个年龄段之间差异有统计学意义。在各不同年龄段仍然存在重度消瘦和低体重的婴幼儿比例,这可能与看护人的文化程度有一定的影响;贫血率为35.2%,低于2009年调查的中西部地区46县6~35月龄的婴幼儿贫血患病率(45.9%),6~11月龄婴幼儿贫血发病率相对较高,并且随着年龄的增大贫血率呈现逐渐降低的趋势。结论 云南省兰坪县和鹤庆县6~23月龄婴幼儿的营养不良率较高,需采取措施改善婴幼儿的营养健康状况。     

甘肃省贫困农村地区5岁以下儿童营养不良和贫血状况调查

目的分析甘肃省贫困农村地区5岁以下儿童营养不良和贫血状况及其影响因素,为制定儿童营养相关的策略和政策提供科学依据。方法采用多阶段随机抽样方法,对1398名调查对象的营养状况进行分析,用Z评分法和血红蛋白值评价儿童营养和贫血状况,用Logistic回归分析可能的影响因素,应用SPSS 13.0软件进行统计分析。结果调查儿童中低出生体重儿占5.4%;近2周有腹泻和上呼吸道疾病的儿童分别占15.1%和31.1%;6个月内婴幼儿的母乳喂养率、混合喂养率和人工喂养率分别为45.3%、43.2%和11.4%。儿童的生长迟缓率为11.7%、低体重率为7.8%、消瘦率为6.6%、贫血率为11.7%,儿童生长迟缓率、低体重率、消瘦率和贫血率在各月龄组间差异均有统计学意义(P<0.01),其中24～36月龄组生长迟缓率最高,低体重率、消瘦率和贫血率的患病高峰在6～12月龄,各月龄组性别间差异均无统计学意义(P>0.05)。多因素分析结果表明,儿童生长迟缓的影响因素是出生体重(OR=1.001),低体重的影响因素有月龄(OR=1.019)、出生体重(OR=1.001),消瘦的影响因素有月龄(OR=1.054)和出生体重(OR=1.001),贫血的影响因素为月龄(OR=1.029)。结论甘肃省贫困农村地区5岁以下儿童营养不良和贫血状况仍然较为严重,应针对各年龄段儿童营养不良状况特点制定相应干预措施,从而改善甘肃省贫困地区儿童营养健康状况。