Growth of head circumference of Malaysian infants and pre-school children

126 Malaysian children, 65 boys and 61 girls from higher income families were followed-up regularly from birth to six years of age in the University Hospital, Kuala Lumpur. The study confirms the observations of previous studies that growth velocity of head circumference is most rapid during the first few months of infancy and then decreases so that by the fifth year of life the increment is minimal. It also confirms the fact that boys have bigger head circumferences than girls. The paper also presents the head circumference distance and velocity percentile charts which can be used to monitor the head circumference of Malaysian children.     

The upper arm muscle and fat area of Santal children: an evaluation of nutritional status

Aims: The purpose of this study is to determine the growth pattern of upper arm muscle area (UAMA), upper arm fat area (UAFA) and upper arm muscle area by height (UAMAH) and assessment of magnitude of undernutrition on the basis of these parameters in Santal children.
Methods: UAMA and UAFA of 890 (473 boys and 417 girls) Santal children aged 5–12 years were calculated from mid-upper arm circumference and triceps skinfold.
Results: Growth curves of UAFA-for-age and UAMA by height in Santal boys and girls are placed at lower level of reference curve indicating severe undernutrition. The growth curves of UAMA-for-age in Santal children of both sexes do not indicate severe undermutrition. 17.13% Santal boys and 20.63% girls were truly undernourished on the basis of three Z-scores of height-for-age, weight-for-height and UAMAH of each subject. Santal children have more UAMA and less UAFA compared to similar undernourished children of Sugalis.
Conclusion: Growth curves of UAFA-for-age and UAMA by height are good indicators of nutritional status in Santal children. UAMA and UAFA may not be similarly affected in undernourished children of every community. A comprehensive approach to identify the truly undernourished child has been suggested from this study.     

Physical growth and nutritional status of garhwali girls

Objective: The present study was conducted to evaluate physical growth and nutritional status of 214 school-going girls ranging in age from 5 to 12 years of rural area in Pauri Garhwal district of Uttaranchal.Methods: Physical growth was evaluated using eleven standard anthropometric measurementsviz., height, body weight, sitting height, biepicondylar humerus, bicondylar femur, head circumference, chest circumference, upper arm circumference, biceps skinfold, triceps skinfold and subscapular skinfold. To assess the nutritional status, weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age have been calculated using NCHS standards.Results: It has been observed that the well nourished Indian girls and American girls show better performance in physical growth parameters as compared to the Garhwali girls at all ages. The Garhwali girls were found to be comparable with rural Indian girls in their growth status. Grade-I and Grade-II malnutrition was prevalent among the Garhwali girls, however, Grade-III malnutrition was found to be present in only a few girls.Conclusion: This average to poor nutritional status of the present Garhwali girls may be attributed to low dietary intake, low-middle socio-economic background, uneducated or partially educated parents, large family size, gender discrimination etc.     

Posthospitalization growth and bone mineral status of normal preterm infants. Feeding with mother's milk or standard formula

The growth and bone mineralization were studied in ten preterm infants fed human milk and 14 preterm infants fed cow's milk-based formula. After discharge from the hospital, at 42, 48, and 56 weeks' postmenstrual age, anthropometric measures of weight, length, occipital frontal circumference, mid-upper arm circumference, triceps, and subscapular skin folds were obtained. Blood was drawn for determinations of serum calcium, phosphorus, 25-hydroxyvitamin D, alkaline phosphatase, and albumin levels. Bone mineral analyses were performed by photon absorptiometry. Mean (+/- SD) gestational ages in nursing and formula-fed infants were similar (32.0 +/- 2.5 vs 31.5 +/- 1.5 weeks), as were their mean (+/- SD) birth weights (1.76 +/- 0.42 vs 1.52 +/- 0.30 kg). After hospitalization, both groups had similar rates of growth in weight, length, head circumference, mid-upper arm circumference, triceps, and subscapular skinfold thickness. The formula-fed group had higher serum phosphorus levels at 42 weeks, higher serum calcium levels at 48 weeks, and higher serum albumin concentrations at 56 weeks than the breast-fed group. By 56 weeks' postmenstrual age, the bone mineral content was higher in the formula-fed group. Our data suggest that after hospitalization, preterm infants fed their own mother's milk have similar growth patterns but a different bone mineralization rate compared with preterm infants fed a standard cow's milk-based formula.     

The relationship between sleep duration and obesity in Turkish children and adolescents

Aim: To determine the relationship between sleep duration and obesity in Turkish children and adolescents.
Methods: This study was conducted in Turkey with 5358 children aged 6 to 17 years. Height, weight, waist circumference (WC), mid-upper arm circumference (MUAC), triceps skinfold thickness were measured. Body mass index (BMI), arm fat area were calculated. Self-reported sleep duration by parents were obtained.
Results: As sleep duration increased, BMI, which was significantly higher in girls sleeping ≤8 h, decreased (p < 0.05). WC, MUAC, BMI were significantly higher in boys sleeping ≤8 h versus males sleeping ≥10 h. Boys sleeping ≤10 h in 6.0–17.0-years had significantly higher risk of overweight/obesity. In 6.0 to 17.0 years, the risk of overweight/obesity in boys sleeping 9–10 h, 8–9 h and ≤8 h were 1.86-, 1.74- and 2.06-times higher respectively, versus children sleeping ≥10 h (p < 0.05).
Conclusion: Sleep duration may be an important factor for obesity and providing ≥10 h of sleep is recommended as a prevention strategy for obesity.     

Association between serum leptin and anthropometric parameters at birth and at 15th day of life in infants born asymmetrically small for gestational age

The aim of this study was to investigate changes in skinfold measurements taken at three sites, mid-arm circumference and umbilical circumference during the first 15 days of life; and to evaluate relationships between anthropometric measurements and umbilical cord blood serum leptin levels in infants born small for gestational age (SGA) and appropriate for gestational age (AGA) infants. Of 50 newborn infants, 25 were SGA and 25 were AGA. Neonates' weight, mid-arm circumference (MAC), umbilical circumference (UC), and triceps, subscapular and periumbilical skinfold thicknesses were measured (Holtain callipers) immediately after delivery. Anthropometric parameters were measured again at 15th days of age. At birth, mean birth weight, mean skinfold thickness, MAC and UC measurements in the AGA group were significantly higher than those of the SGA group. These differences were also found on the 15th day. Birth weight correlated with all skinfold thicknesses, MAC and UC at birth. Weight at 15th day of life correlated with skinfold thicknesses, MAC and UC at 15th day of life. Cord blood leptin level was significantly lower in the SGA than in the AGA infants. This difference continued on the 15th day. When cord blood leptin level was compared with that of the 15th day, we found that leptin levels in the cord blood were significantly higher. There were significantly positive correlations between leptin levels and birth weight and skinfold thicknesses when the infants were all grouped together. When the newborns were grouped according to birth weight, there were positive correlations between cord blood serum leptin levels and these parameters in the AGA group, but no correlation in the SGA group. At the 15th day of life serum leptin levels correlated with weight, subscapular and triceps skinfold thickness in the AGA group, but only with triceps skinfold thickness in the SGA group.     

Vitamin A and neonatal anthropometry.

Low levels of vitamin A have a major impact on growth, development, and immunity. The aim of this study was to determine the relationship between cord concentrations of vitamin A and neonatal anthropometry in 711 babies born at term in Brazil. Gestational age of the babies was evaluated by the Capurro method. Vitamin A was measured by high performance liquid chromatography. Concentrations of vitamin A in cord blood correlated significantly (p < 0.001) with birthweight (r = 0.24), length (r = 0.20), chest circumference (r = 0.24), mid-upper arm circumference (r = 0.23), triceps skinfold thickness (r = 0.26), and head circumference (r = 0.12) of the babies. The anthropometric measurements of the babies were sorted by the vitamin A concentrations (means and standard deviations) and divided into quartiles. Differences between the quartiles were tested by analysis of variance. Babies in the bottom length, head circumference and triceps skinfold thickness quartiles had lower mean vitamin A concentrations than those of quartiles two, three and four. Babies in the bottom birthweight, chest and mid-upper arm circumferences quartiles had lower mean vitamin A concentrations than those of quartiles three and four (p < 0.003). These data shows that smaller/shorter babies had lower concentrations of vitamin A than heavier/longer babies, probably reflecting the important role of this micronutrient on growth.     

Revised standards for triceps and subscapular skinfolds in British children.

Revised centile standards are given for triceps and subscapular skinfold measurements in boys and girls aged from one month to 19 years. The school age data are based on London measurements made in 1966, and the infant data on Midland Infant Welfare Clinic figures in 1966-67. All centiles are above those given in the earlier standards published in 1962, and particularly so in infancy. It is emphasized that the standards represent what is, not what ought to be.     

Changes in skinfolds and mid-upper arm circumference during pregnancy in Argentine women

This investigation describes the pattern of changes in mid-upper arm circumference (MUAC), triceps, biceps and subscapular skinfold thicknesses during the course of pregnancy, and its relationship with maternal and newborn outcomes. A prospective cohort of 1066 pregnant women were selected in seven different urban regions in Argentina. Measurements of MUAC were carried out at 16, 28 and 36 gestational weeks. In a subsample of 488 women, triceps, biceps and subscapular skinfold thicknesses were measured. Mean total increase in subscapular, tricipital and bicipital skinfolds from 16 to 36 weeks of gestation were 4.5, 3.6 and 2.6 mm, respectively. MUAC showed a mean increase of 1.7 cm in the same period. Overweight or obese women at the start of pregnancy had lower increases in all measurements compared with women with normal or low body mass index. Maternal anthropometry was related to birthweight; women who gave birth to infants of less than 3000 g had lower average values in all measurements than those who had normal birthweight infants. LMS curves for MUAC and skinfolds by gestational age are presented, which can be used as a reference to assess maternal nutrition status during pregnancy. MUAC, tricipital and subscapular skinfold for gestational age curves are proposed for monitoring maternal nutritional status during pregnancy. MUAC cut-off points of 24.5, 25.5 and 26.5 cm for 16, 28 and 36 weeks of gestation, respectively, are also proposed as a proxy to detect low birthweight.     

Value of the measurement of arm circumference/head circumference in the evaluation of the nutritional status of infants and young children

In 1970, Kanawati and McLaren proposed a nutritional criterion based on the arm circumference/head circumference (AC/HC) ratio, valid from 3 months to 4 years of age. For these authors, there were 4 situations: normal nutrition (ratio greater than 0.31), slight undernutrition: (0.31 greater than ratio greater than 0.28), medium undernutrition: (0.28 greater than ratio greater than 0.25) and severe undernutrition (ratio less than 0.25). A longitudinal study was undertaken on 45 children admitted in our unit for nutritional assistance (total parenteral nutrition and enteral nutrition). Weight, arm circumference and triceps skinfold were measured at regular intervals during their stay in hospital (total: 141 measurements). There was a strong correlation (p less than 0.001) between the values of AC/HC and weight for age, weight for height, triceps skinfold and arm circumference. There was no correlation between AC/HC, height for age and head circumference for age. Furthermore, this criterion seemed to be independent from the degree of hydratation in cases with dehydratation or oedemas (Kwashiorkor). AC/HC ratio is a simple and reliable criterion for nutritional follow-up. It is easily reproduced and independent from sex and age between ages 3 months and 4 years.     

German head circumference references for infants, children and adolescents in comparison with currently used national and international references

Aim: To present valid head circumference (HC) percentiles from early infancy to 18 years and to compare them with percentiles currently used in Germany by Prader, as well as to international WHO and CDC references. Methods: Nationally representative sample of 17,158 children and adolescents aged 0.25–17.98 years (KiGGS study 2003–2006) with standardized HC measurement. HC references were created using Cole’s LMS method. Results: The median growth of HC is largest in the first year of life. Adult HC is reached at age 16 years in girls, while in boys, HC growth continues through age 17 years and adult HC have to be derived from future KiGGS follow‐up examinations. KiGGS percentiles are quite similar from early infancy to early school age compared to older Prader references, but higher thereafter (maximum difference of median HC: girls 1.4 cm, boys 0.9 cm). KiGGS percentiles are also higher than WHO and CDC percentiles over most of the compared age range, but differences are less pronounced compared to Prader. Conclusion: The KiGGS HC references presented here for boys and girls aged 4 months through 17 years are more valid than currently used German references. Because of the similarity of KiGGS and the currently used reference by Prader in early infancy, the currently used Prader reference for 0–4 months could complement KiGGS to cover the entire age range from birth to the end of adolescence.     

Nutritional anthropometry in children from 0 to 6 years of age in different geographical areas

Anthropometric data of 12,769 clinically normal children 0-6 years of age from 12 different geographical areas in Africa and Asia are presented. Height, weight, arm circumference and triceps skinfold thickness were measured and presented for age. Derived variables, as muscle circumference, muscle area and muscle proportion-for-age were computed. Weight, arm circumference and muscle area-for-height were calculated. Comparison of these 12 cross-sectional growth patterns shows important differences between groups. The observed differences show that height-for-age, weight-for-age, arm circumference-for-age and weight-for-height are not sufficient to describe adequately and to interpret the variations in nutritional status.     

Lack of improved growth outcome related to nonnutritive sucking in very low birth weight premature infants fed a controlled nutrient intake: a randomized prospective study

The effect of nonnutritive sucking during gavage feeding on nutritional outcome and gastrointestinal transit time was evaluated in 18 premature appropriate for gestational age infants whose birth weights were less than or equal to 1,400 g and gestational ages were less than or equal to 30 weeks. Infants were randomized to a treatment (nonnutritive sucking infants received a pacifier for 30 minutes with each feeding, 12 times per day until they reached a weight of 1,500 g, eight times per day thereafter) or control (no pacifier) group. The nine nonnutritive sucking (five girls, four boys) and nine control (five girls, four boys) infants were treated for 14 days. Infants were without medical complications and were fed a single premature formula by intermittent gastric gavage at exactly 120 kcal/kg/d throughout the study period. Weight gain, linear growth, subscapular and triceps skinfold, and arm circumference accretions were assessed weekly. Serum proteins (albumin, prealbumin, retinol-binding protein, and transferrin) were measured weekly. Gastrointestinal transit times were measured weekly using carmine red markers. In contrast to previous studies, these data indicate no apparent effect of nonnutritive sucking on growth outcome, serum proteins, or gastrointestinal transit time in growing, very low birth weight infants when nutrient intake was controlled. In a subgroup of eight boys (four nonnutritive sucking, four control), energy and fat excretions were determined from 72-hour fecal collections and energy expenditure was estimated from six-hour cumulative heart rate measurements. Neither excretion of fat and calories nor estimated energy expenditure was affected significantly by nonnutritive sucking in this subgroup of baby boys. Fat excretion correlated well (r = .987) with energy excretion.     

Spinal bone mineral density in children aged 5.00 through 11.99 years

Lumbar spine (L-2, L-3, L-4) bone mineral density was measured in 184 healthy boys and girls aged 5.00 through 11.99 years by dual photon absorptiometry. Weight, height, age, triceps skinfold thickness, and midarm circumference were also measured. Weight, height, and age were highly correlated with bone mineral density. In the population studied, a quadratic regression equation using body weight as the independent variable best described bone mineral density: bone mineral density = 0.3209 + [0.0168 (weight)] - [0.0001 (weight2)].     

Serum leptin levels during childhood and adolescence: relationship with age, sex, adiposity and puberty

We studied serum leptin levels in 189 healthy children to evaluate related factors during childhood and adolescence. Leptin correlated with body mass index (BMI), triceps skinfold thickness (p<0.001) and body weight (p<0.01). Obese children and girls had higher leptin levels than non-obese children and boys, respectively (p<0.001). In girls, leptin correlated positively with age, skinfold thickness and BMI (p<0.001). In boys, leptin correlated negatively with age (p<0.001) and positively with skinfold thickness (p<0.05). Prepubertal boys had higher leptin levels than prepubertal girls and pubertal boys (p<0.05). Pubertal girls had higher leptin levels than prepubertal girls and pubertal boys (p<0.001). Leptin levels in girls were higher at Tanner stages 4 and 5 than at stage 1 (p<0.001). In conclusion, serum leptin levels are related with adiposity, have obviously age-related gender differences during childhood and adolescence, and may be involved in the maturation of reproductive capacity.     

Gender-specific prevalence and associated risk factors of prehypertension among rural children and adolescents in Northeast China: a cross-sectional study

Little is known about the prevalence and risk profile of prehypertension among Chinese children and adolescents. The aim of the present study was to investigate the prehypertensive status and its associated risk factors among rural Chinese children and adolescents. We conducted a cross-sectional study including 5,245 children and adolescents (2,732 boys and 2,513 girls) aged 5–18 years in Northeast China. Main anthropometric data and related information were collected. The overall prevalence of prehypertension and hypertension was 15 % and 20.2 %, respectively. The prevalence of prehypertension among boys was 15.7 %, compared to that of 14.2 % among girls (P?=?0.256). After adjusting for age, race, weight status, waist circumference, triceps skinfold, family income, smoking and drinking status, boys aged 12–14 and 15–18 years had a 2.86- and 5.97-fold risk of prehypertension, respectively, compared to those aged 5–8 years. Overweight and obese boys had an increased risk of prehypertension in comparison to those with normal weight (overweight: odds ratio [OR]?=?1.837, 95 % confidence interval [CI] 1.321–2.556; obese: OR?=?2.941, 95 % CI 1.783–4.851). A larger triceps skinfold (≥90th percentile) was significantly related to increased odds of prehypertension (OR?=?2.32; 95 % CI, 1.516–3.55) among boys. For girls, only older age was found to be a risk factor for prehypertension. Conclusion: Pediatric prehypertension is highly prevalent in rural Northeast China. The risk factors for prehypertension differed among boys and girls. A more comprehensive risk profile of prehypertension among children and adolescents needs to be established for early prevention.     

Growth and skeletal maturation in children with phenylketonuria

Schaefer F, Burgard P, Batzler U, Rupp A, Schmidt H, Gilli G, Bickel H, Bremer HJ. Growth and skeletal maturation in phenylketonuria. Acta Paediatr 1994;83:534–41. Stockholm. ISSN 0803–5253 Growth and skeletal maturation was evaluated in 82 children participating in the German Colkdborative Study of Children Treated for Phenylketonuria (PKU). Height, weight, head circumference and bone age were recorded at regular intervals for the first 6 years of life. The mean SD score (SDS) for height was not significantly different from zero at study entry, but decreased mainly during the second year of life to a nadir of -0.78 in boys and -0.54 in girls at 2.5 years. During the subsequent years, a significant trend towards a regain of height SDS was noted in both sexes. Weight-for-height SDS was close to zero in both sexes, with a significant continuous increasing trend throughout the observation period. Head circumference SDS decreased in boys during the first year of life from -0.28 to -0.68, whereas girls showed only a minor change. During the further follow-up period, head circumference SDS remained at approximately -0.3 in boys and 0.0 in girls. While the mean verbal and performance IQ of the total study population at 5 and 6 years of age did not differ from a group of 212 healthy non-PKU children, patients with a head circumference SDS less than the population median at 2 years of age exhibited poorer cognitative abilities at school age than those patients with a relative head size greater than the population median. The children with a head circumference less than the median at 2 years had smaller head sizes already at birth; in addition, the change in relative head size during the first 2 years was correlated significantly with cognitive abilities at school age in boys. Mean bone age was identical to chronological age at each time point of observation. The rate of maturation was one year of bone age per year of chronological age. No correlation between phenylalanine intake or phenylalanine concentrations and the rates of body or head growth or skeletal maturation could be established. We conclude that despite adequate weight gain, moderate growth retardation occurred during the first 2 years of life in this group of children treated for PKU. Growth was more compromised in boys than in girls and tended to be compensated during later follow-up. Early infantile head circumference and growth appear to be predictors of cognitive development.     

Trends in growth in England and Scotland, 1972 to 1994

AIM: To monitor the growth of 5 to 11 year old English and Scottish children from 1972 to 1994. No similar data are available from any other study. DESIGN: Mixed longitudinal. SUBJECTS: In England 7000 children were sampled in the first year, falling to 5000. In Scotland the original sample was 2000 but this was enlarged later to 3500. MAIN OUTCOME MEASUREMENTS: Height, weight, weight for height index, and triceps skinfold thickness. RESULTS: Height of English children in most age groups increased by more than 1 cm and by more than 2 cm in Scotland during the period 1972 to 1994. Triceps skinfold measurement increased by almost 8% in 7 year old English boys and by 7% in 7 year old girls. In Scotland triceps skinfold measurement increased by nearly 10% in 7 year old boys and by 11% in 7 year old girls. Weight for height index followed a similar pattern. CONCLUSION: Children in England and Scotland are becoming taller for a given age. The increases in fatness indicate an urgent need for realistic interventions for reductions in obesity in the whole population. As weight for height index is less sensitive than skinfold thickness we recommend triceps and subscapular skinfold thickness measurements for monitoring obesity in children.     

Secular trend of growth in Malaysian children

Over the past hundred years in industrialised countries and recently in some developing countries, children have been getting larger and growing to maturity more rapidly. This paper compares the growth of Malaysian children with similar socioeconomic backgrounds but born about twelve years apart. Data were obtained from records of 227 children born between 1968 and 1973 and 238 children born between 1980 and 1985. The children were followed-up regularly at the University Hospital Child Health Clinic in Kuala Lumpur for a variable period from birth to five years of age. Measurements for their weight, length and head circumference were taken at each visit. There is a directional indication that boys and girls of the 1980-1985 cohort are taller, heavier and have bigger head circumferences from birth to five years of age and the difference widens as the child grows older. This study clearly shows that a positive secular trend has taken place in the last decade, reflecting an improvement of living conditions with time. The factors involved in the positive secular trend are manifold and the most important is probably nutrition.     

Mid-upper ARM circumference in infants

Summary A longitudinal study of mid-upper arm circumference of infants at monthly intervals indicated statistically insignificant male and female differences, greater increase in the first six months of infancy than the second six-month-period and significant positive correlation coefficients between weight and arm girth for all age periods and in both sexes. From the Department of Preventive and Social Medicine, Institute of Medical Sciences, Varanasi, 5. An erratum to this article is available at .