Ethnic group differences in nutritional status of young children from low-income areas of an urban county

A nutrition assessment survey was undertaken among 566 preschool children from randomly selected low income households located within an urban county. The purpose of the survey was to determine the prevalence of selected nutrition problems and to identify relationships among ethnic and economic variables and nutritional status. Underweight was identified in 1.8%, overweight in 15.4%, and short stature in 13.1% of children. Southeast Asian children had a higher prevalence of short stature than the other ethnic groups. Low hemoglobin values were identified in 4.3%, low hematocrit in 6.9%, and elevated erythrocyte protoporphyrin in 6.0% of children. The prevalence of elevated EP was significantly higher among Southeast Asian children than non-Southeast Asians and likely was due to iron deficiency. Results of the survey suggest that Southeast Asian children constitute the group at highest nutritional risk in the low income areas surveyed.     

Nutritional status of primary school children from low income households in kuala lumpur

Growth status was examined in relation to gender and age factors in urban primary school children (6-10 years old) from low income households in Kuala Lumpur, Wilayah Persekutuan. The sample consisted of 4212 boys (53%) and 3793 girls (47%). Data on weight and height data were obtained from two sources - investigator's and teachers' measurements of the school children. This study defined mildly and significantly underweight, stunted or wasted as z-score below minus one and below minus two of the NCHS/CDC reference median, respectively. Approximately 52% (n = 4149), 50% (n = 3893) and 30% (n = 2568) of the school children were underweight, stunted and wasted, respectively. However, the majority of these undernourished children were in the mild category. Prevalence of overweight (> 2 SD of NCHS/WHO reference median) was found in 5.8% of the sample. For both, prevalence of undernutrition and overnutrition, more boys than girls were found to be underweight stunted wasted and overweight. Compared to girls, boys had lower mean z-scores for the variables height-for-age (p<0.05) and weight-for-height (p<0.01). Older children had significantly lower mean z-scores for height-for-age (p<0.001) but higher mean z-scores for weight-for-height (P<0.001) than younger children. This finding indicates that with increasing age, stunting is associated with improved weight-for-height or that the children's weights have been adapted to their short statures. In conclusion, results demonstrate a high prevalence of underweight, stunting and wasting and an increasing prevalence of overweight among these low-income school children. Efforts recommended to address health and nutrition problems among school children should include health and nutrition monitoring (e.g. growth monitoring using the existing growth data collected by schools) and interventions.     

Anthropometric assessment of Kamayurá adolescents in the Upper Xingu, Central Brazil (2000-2001)

Despite the proximity between indigenous groups in the Upper Xingu Region and Brazilian national society, studies have shown adequate weight-for-height and low height-for-age in indigenous children. Little is known about the nutritional status of indigenous adolescents. The present study aimed to evaluate the nutritional status of Kamayurá adolescents. Anthropometric variables were collected from a sample of 65 adolescents (31 males and 34 females). Mean height was lower than both that of the Brazilian National Survey on Health and Nutrition and the reference population of the U.S. National Center for Health Statistics. There was a high rate of overweight in both males (38.7%) and females (23.5%), and one female adolescent was obese (2.9%). No overweight adolescent presented both the triceps and subscapular skinfolds above the 90th percentile. There were no cases of nutritional deficit among either male or female adolescents. Despite the high prevalence of overweight, the nutritional status of these adolescents is adequate, since the group presents low adiposity.     

Nutritional status and body composition of poor children in the outlying neighborhoods of La Plata, Argentina]

OBJECTIVES: To evaluate nutritional status and body composition as indicators of quality of life among poor children served by neighborhood soup kitchens in La Plata, Argentina. METHODS: From April to November 2004, we conducted a cross-sectional study of 608 healthy children from 1-11 years of age who were being served by two neighborhood soup kitchens in the outlying areas of the city of La Plata. The sample was stratified by age and sex. Height-for-age, weight-for age, and weight-for-height, were measured, as well as BMI, muscle mass and adipose tissue. Z-scores were computed for the data. Odds ratios and the respective 95% confidence intervals were calculated. RESULTS: Prevalence of low weight-for-age was 9%; low weight-for-height, 3%; and low height-for-age, 15%. The prevalence of overweight and obesity were 12.5% and 7.1%, respectively. Among the study sample, 47.2% had low muscle mass and 20.4% had low adipose tissue. Among overweight and obese children, adipose tissue was 34.3% higher than that of the reference population, while muscle mass was 12.5% lower. CONCLUSIONS: Undernutrition and obesity are both found among the community of children studied. The high prevalence of delayed growth (i.e., low height-for-age), undernutrition (i.e., low weight-for-age), and the acute lack of muscle mass even among overweight and obese children, seem to be part of the consequences of an inevitable process that unfolds in the face of adverse living conditions.     

Nutritional status of indigenous children from the Alto Xingu in 1980 and 1992 and follow-up of weight and height from the first through the fourth years of life

This study focused on the under-five population of the Alto Xingu region in Brazil, with the following objectives: (1) to evaluate height and weight increment from the first through the fourth years of life and (2) to compare nutritional status in 1980 and 1992. Height and weight increases were evaluated in 81 children. Weight and height were measured in 264 children evaluated in 1980 and in 172 in 1992 (< 10 years of age). Median Z-scores in the first and fourth years of life, respectively, showed: (1) a decrease in weight-for-age, (-0.12 in the first year and -0.51 in the fourth year of life; p = 0.002); (2) a decrease in weight-for-height (+1.31 and +0.08; p < 0.001); (3) an increase in height-for-age (-1.50 and -0.94; p < 0.001). Median Z-scores in 1980 and 1992 showed: (1) no change in weight-for-age (-0.61 in 1980 and -0.62 in 1992; p = 0.90); (2) no change in weight-for-height (+0.27 and +0.34; p = 0.10); and (3) a decrease in height-for-age (-1.04 and -1.22; p = 0.02). Height-for-age increased and weight-for-height decreased between the first and fourth years of life. A decrease in height-for-age was observed from 1980 to 1992, demonstrating the importance of nutritional surveillance among the population of the Alto Xingu.     

Overweight in Southeastern Pennsylvania children: 2002 household health survey data

OBJECTIVE: The authors sought to estimate the prevalence of overweight and risk for overweight and to examine relationships between body mass index (BMI) and socioeconomic and demographic characteristics among children in Philadelphia and four neighboring counties. METHODS: Data from the 2002 Philadelphia Health Management Corporation Household Health Survey was examined. RESULTS: Of 2,621 children aged 2 to 17 years, 36% were overweight or at risk for overweight and 23% were overweight. Prevalences of overweight and at risk for overweight were higher among younger children than among older children and adolescents. African American, Hispanic, and Asian children had higher prevalences than non-Hispanic white children. Childhood overweight was positively associated with household poverty, lower educational status, and higher BMI in the adult survey respondents. CONCLUSIONS: The observed inverse relationship between age and the prevalence of overweight among Southeastern Pennsylvania children and adolescents differs from previous reports of the prevalence of overweight in samples of U.S. children and adolescents. The high prevalence of overweight among children aged 2 to 9 years should focus attention on improving nutrition and increasing opportunities for physical activity and exercise among preschool and early school-age children.     

Differences in the prevalence of malnutrition resulting from using a national growth reference or an international growth reference]

OBJECTIVE: To evaluate if using an international growth reference versus a national growth reference leads to differences in the prevalences of low weight-for-height (wasting) and low height-for-age (stunting) in a sample of children 8 to 14 years old. METHODS: A cross-sectional study was carried out with a sample of 1,470 school-children (both boys and girls) in the city of La Plata, in the province of Buenos Aires, Argentina. Based on the data on weight and height, Z-scores were calculated with regard to the reference values from the United States of America's first and second National Health and Nutrition Examination Survey (NHANES I and NHANES II), and the reference values for Argentina from the Argentine Pediatric Society. The prevalences of wasting and stunting were calculated, using as the cutoff point two standard deviations below the median of the reference. The prevalences were compared using the chi-squared test with Yates' correction, and odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: The international reference was positively associated with a higher prevalence of stunting in the entire sample (OR = 5.12; 95% CI: 3.27 to 8.05), in the boys (OR = 4.36; 95% CI: 2.43 to 7.93), and in the girls (OR = 6.32; 95% CI: 3.10 to 13.27). The prevalence of wasting was similar with both references. The distribution of height-for-age was skewed to the left with respect to the international reference and to the right with respect to the Argentine reference, while the distribution of weight-for-height overlapped both references. CONCLUSIONS: The differences in the prevalences of stunting calculated according to the two references that were used indicate a different nutritional status for the population studied. The increase in the height of the children with respect to the Argentine reference points to the presence of a positive secular trend, and the increase can explain part of the differences in the prevalence of stunting.     

Determinants of child nutrition and mortality in north-west Uganda.

An anthropometric survey of children aged 0-59 months in north-west Uganda in February-March 1987 indicated a high prevalence of stunting but little wasting. Use of unprotected water supplies in the dry season, prolonged breast-feeding, and age negatively affected nutrition; in contrast, parental education level improved nutrition. Mortality during the 12 months following the survey was higher among those who had low weight-for-age and weight-for-height, but children who had low height-for-age did not have higher mortality. Weight-for-age was the most sensitive predictor of mortality at specificities > 88%, while at lower specificity levels weight-for-height was the most sensitive. Children whose fathers' work was associated with the distillation of alcohol had a higher risk of mortality than other children. The lowest mortality was among children whose fathers were businessmen or who grew tobacco.     

Pregnancy nutrition surveillance system--United States, 1979-1990.

Since 1979, the CDC Pregnancy Nutrition Surveillance System (PNSS) has monitored behavior and nutritional risk factors among low-income pregnant women participating in public health programs. Although the states contributing to the system have varied over the period, the PNSS is able to characterize the behavior and health outcomes of pregnant women from diverse low-income populations. In 1990, 66.2% of the women in the system initiated prenatal care during the first trimester of pregnancy; 26.4% smoked during pregnancy. Since 1979, the prevalence of smoking remained relatively stable for white women, but declined for blacks and Hispanics. Prepregnancy body mass index (BMI, defined as kg/m2) showed marked changes from 1979 through 1990; the prevalence of underweight (BMI < 19.8) declined steadily and the prevalence of overweight (BMI > 26) increased steadily. In 1990, 39.3% of the women had gestational weight gains below levels recommended by the National Academy of Sciences. Both prepregnancy underweight and inadequate gestational weight gain were associated with greater risk for low birth weight in the PNSS. The prevalence of anemia at each trimester has remained stable since 1979. In 1990, 9.8%, 13.8%, and 33% of the women reported by the PNSS were anemic in the first, second, and third trimesters, respectively. Anemia in the first trimester appeared to be strongly associated with a high risk of low birth weight; this association was attenuated in later trimesters. These findings indicate the need to improve iron nutrition among low-income women.     

Nutritional status of 0-to-59-month-old children in urban and rural areas of Cameroon]

The nutritional status of preschool-age children (0-59 months) in the Littoral Province of Cameroon was studied in a representative sample of the population of this age group in rural and urban areas, with a total of 2011 children. The nutritional indicators weight-for-height, weight-for-age, and height-for-age were compared with reference data from the United States National Center for Health Statistics. A high prevalence of stunting (15.2% in urban and 21.8% in rural areas, P < 0.0008) was found among the children. The prevalence of wasting was 4.0% in urban and 6.5% in rural areas (P < 0.03). In all age groups, rural children were shorter than urban children with no significant difference between the sexes. The increase in the prevalence of acute malnutrition (8.4%) since the last nutritional survey in 1978 (0.7%), which is probably due to a deterioration in the economic situation in recent years, indicates that urgent measures should be taken to improve the nutritional situation of these children, especially in the villages. The findings of the study could serve as baseline data for the evaluation of the effectiveness of future nutrition programmes.     

Growth Status and Related Medical Conditions Among Refugee Children in Massachusetts, 1995–1998

OBJECTIVES: This study analyzed growth and identified related medical conditions among refugee children in Massachusetts. METHODS: Between July 1995 and June 1998, 1825 refugee children were screened. Variables included positive tuberculin (purified protein derivative; PPD) test; dental abnormalities; pathogenic parasites; weight-for-age, height-for-age, and weight-for-height z scores; and body mass index greater than the 84th percentile. RESULTS: Of all the children, 21% had parasites, 62% had caries, and 25% had a positive PPD reaction. Twelve percent overall and 28% younger than 2 years had anemia. Eight percent had height-for-age z scores less than -2, and 6% had weight-for-age z scores greater than +2. Of those aged 1 to 9 years, 7% had weight-for-height z scores greater than +2. Weight-for-height z scores less than -2 were concentrated among Africans and East Asians (both 8%). Height-for-age z scores less than -2 were seen among African (13%), Near Eastern (19%), and East Asian (30%) children. Weight-for-height z scores greater than +2 and body mass index greater than the 84th percentile were concentrated among children from the former Yugoslavia (8% and 15%) and the former Soviet Union (8% and 14%). CONCLUSIONS: Recently arrived refugee children have significant growth abnormalities. European refugees were overweight; those from developing countries had growth retardation.     

Comparative analysis of growth, diet, and urinary N excretion in elementary school children from urban and rural areas of Korea.

Weight and height measurements, dietary intake records and overnight urine samples for two days were collected from 38 children in Seoul and 36 children in rural area of Korea. Median percentages of height-for-age, weight-for-age and weight-for-height of the children in Seoul were significantly higher than those of the rural children. A mild degree of stunting was prevalent in the rural area, while overweight was more dominant among the children in Seoul. Dietary intake of energy, protein and fat as well as urinary excretions of N and creatine were also higher in the Seoul children. Animal protein intake correlated most significantly with height-for-age. Fat intake was a more important factor for weight-for-age and weight-for-height. Urinary excretion of N or creatinine, together with dietary factors, was a significant independent variable in regression models for the growth indices of the children. The results show the heterogeneity of nutritional problems among different subgroups of the Korean population at the present time.     

Anthropometric indicators of nutritional status: implications for fitness,activity, and health in school-age children and adolescents from Maputo,Mozambique

BACKGROUND: Studies are needed to test the relevance of the anthropometric criteria for health and well-being, particularly in developing countries. OBJECTIVE: The objective of the study was to identify the relevance of anthropometric indexes as indicators of nutritional status. DESIGN: The sample consisted of 2316 subjects (n = 1094 males, 1222 females) aged 6-18 y from Mozambique. Anthropometric variables, maturity stage, physical fitness, physical activity, and metabolic fitness were measured. Samples of blood, urine, and feces were obtained. Subjects were classified in 5 nutritional groups labeled normal, low height-for-age (stunted), low weight-for-height (wasted), low height-for-age and low weight-for-height (stunted and wasted), and overweight, according to cutoffs set by a World Health Organization expert committee. Socioeconomic status was classified according to region of residence. RESULTS: Prevalence rates for males and females, respectively, in the nutritional groups were 3.0% and 2.3% (stunted group), 21.9% and 10.0% (wasted group), 3.0% and 0.8% (stunted and wasted group), and 4.8% and 7.7% (overweight group). With control for age, socioeconomic status, and maturity stage, the overweight group performed significantly worse than did the other groups on most of the fitness tests. Compared with the normal group, the 3 undernourished groups performed significantly worse in absolute strength tasks, better in endurance tasks, and equally in flexibility and agility. Very few differences were found in physical activity scores. The 3 undernourished groups had scores for the biochemical indicators that were similar to those of the normal group and had more favorable profiles for blood pressure and cholesterol. CONCLUSIONS: In this population, the cutoffs used to classify overweight status appear to appropriately identify potential health problems. No relevance to health was found for the lower cutoffs identifying undernourished children.     

Malnutrition in children with malignant solid tumours

Forty-eight children with newly diagnosed malignant solid tumours underwent prospective longitudinal anthropometric assessment. At diagnosis there was a marked discrepancy between the results of conventional assessment, which relies on height-for-age and weight-for-height and the results of arm anthropometry: the study group did not differ from controls or from reference standards in height-for-age or weight-for-height, but had significantly lower mid-upper-arm circumference and triceps skinfold thickness. Only 7% of patients were identified as malnourished by conventional assessment, compared with 26% by arm anthropometry. Conversely, during therapy, change in weight-for-height appeared to over-estimate deterioration in nutritional status.
We suggest that these observations are largely accounted for by the effects of tumour mass, which by adding to body weight at diagnosis, inevitably elevates weight-for-height and by decreasing during therapy exaggerates any loss of true body weight.
At diagnosis the prevalence of malnutrition identified by arm anthropometry was 27%. During therapy this increased to 46% ( P = 0.04), despite supplementary enteral or parenteral feeding in one third of patients.
Patients with abdominal primary disease were the most likely to be malnourished, both at diagnosis and during therapy. Patients with Wilm's tumour were particularly poorly nourished.
These results suggest that there is a greater need than previously realized for nutritional support in children with malignancy. There are also implications for the assessment and monitoring of nutritional status, not only in children with cancer but also in children with malnutrition secondary to other causes.     

Quantile regression approach to estimating prevalence and determinants of child malnutrition

Aim

Child malnutrition is also associated with higher incidence of morbidity and mortality. Therefore, it is imperative to have knowledge of its correlates and determinants. The objective of this paper is to examine the association between demographic and socioeconomic factors and child nutritional status in Bangladesh.

Subject and methods

A secondary data analysis was conducted using the 2014 Bangladesh Demographic and Health Survey data. The surveys used a stratified two-stage cluster sampling. In the first stage, 600 enumeration areas (EAs) were selected with probability proportional to the EA size. In the second stage of selection, a fixed number of 30 households per cluster will be selected with an equal probability systematic selection from the household listing. The sample constitutes 17,886 ever-married women age 15–49, with 34.38% and 65.62% from urban and rural areas respectively. The anthropometric indicators height-for-age, weight-for-age and weight-for-height z-scores were used as the primary and secondary outcome measures.

Results

Results show that age and birth order of child is negatively associated with height-for-age, weight-for-age, and weight-for-height z-scores. However, the size of the child at birth is positively allied with the three anthropometric indicators. Mothers’ BMI and educational level are positively connected with the nutrition z-scores, but these factors have differential effects at different points of the conditional distribution of the anthropometric z-scores. Moreover, the economic status of a family is an essential factor in determining the z-score of height-for-age, weight-for-age, and weight-for-height of a child.

Conclusion

The age, size of child at birth, mother’s BMI and educational status, and wealth index are very important determinants of the z-score of the anthropometric indicators of a child. In order to improve the nutritional status of children in Bangladesh, the authors suggest that a joint effort by the government, non-governmental organizations, and the community is absolutely essential.

     

Field-testing the WHO child growth standards in four countries

In April 2006 the WHO released a set of growth standards for children from birth to the age of 5 y. Prior to their release, the standards were field-tested in 4 countries. The main objective was to compare children's length/height-for-age and weight-for-length/height based on the new standards with clinician assessments of the same children. The study sampled children <5-y-old attending well-child clinics in 2 affluent populations (Argentina and Italy) and 2 less-affluent ones (Maldives and Pakistan). Length/height and weight were measured by doctors and epidemiologists who also recorded a clinical assessment of each child's length/height in relation to age and weight relative to length/height. Anthropometric indicators of nutritional status were generated based on the WHO standards. As expected, Pakistan and the Maldives had higher rates of stunting, wasting, and underweight than Italy and Argentina, and the reverse was true for overweight and obesity. Where stunting was prevalent, the children classified as short were a mean <-2 SD for height-for-age. In all sites, the children classified as thin were indeed wasted (<-2 SD for weight-for-height) and a positive association in trend was evident between weight-for-height and the line-up of groups from thin to obese. The overall concordance between clinical assessments and the WHO standards-based indicators attested to the clinical soundness of the standards.     

Overweight, stunting, and anemia are public health problems among low socioeconomic groups in school adolescents (12-15 years) in the North Gaza Strip

The objective of the study was to describe sociodemographic differences in nutritional status among school adolescents aged 12 to 15 years in north Gaza Strip. A cross-sectional survey was conducted in 2002 comprising 1022 students from 10 schools in Gaza city, Jabalia village, and Jabalia refugee camp. Height, weight, and hemoglobin levels were measured to assess nutritional status. Self-administered questionnaires were administered to students and parents to obtain data on sociodemographic characteristics. The prevalence of overweight/obesity, stunting, and anemia in the total sample was 17.9%, 9.7%, and 49.6%, respectively. More overweight/obese girls than boys were found (20.2% vs 15.4%). In girls, being from a low-income residential area, having employed fathers, and having reached puberty had highest risk of overweight/obesity, whereas in boys, those with medium socioeconomic status (SES) had the lowest risk of overweight. The mean height-for-age percentile was generally low for both sexes compared with the National Center for Health Statistics/World Health Organization reference, but stunting was more common in boys than girls (13.7% vs 6.2%). Age was positively associated with risk of stunting in boys, whereas in girls, SES and mother's education were negatively associated with stunting. Anemia prevalence was high in both girls and boys (51.3% vs 47.9%). Age and onset of puberty had an independent negative effect on anemia among boys. Girls from nuclear families and from Jabalia village had higher risk of being anemic. In conclusion, undernutrition and overnutrition coexisted in the study area. Anemia, stunting, and overweight among the adolescents are public health problems, especially among low SES groups that merit attention.     

甘肃省农村地区6~24月龄婴幼儿营养状况及其影响因素分析

目的 了解甘肃省农村地区不同民族婴幼儿的营养状况,分析影响因素。方法 采用多阶段分层随机整群抽样方法,在甘肃省抽取12个项目县,于2014年12月-2015年1月进行现场调查,收集样本量为3 663名。调查内容包括婴幼儿看护人问卷调查和婴幼儿的体格测量。结果 甘肃省6~24月龄婴幼儿营养不良发生率为21.3%,其中超重、消瘦、低体重和发育迟缓率分别为7.0%、4.0%、3.2%和7.1%。单因素分析结果显示,影响6~24月龄婴幼儿营养不良的因素有民族、性别、贫血状况、是否早产、出生身长和体重、看护人学历和职业、6个月内喂养方式、辅食添加时间、辅食添加种类以及营养素补充等。多因素Logistic回归分析显示性别、月龄、是否早产、看护人职业、科学喂养知识水平、辅食添加时间和种类的对营养水平的影响有统计学意义。结论 甘肃省6~24月龄婴幼儿营养状况总体有所改善,发育迟缓仍然是主要营养问题,超重率上升是需要特别关注的重要问题。建议采取综合措施改善儿童营养水平。     

Ethnic differences in the prevalence of overweight among young children in Hawaii

OBJECTIVES: To compare the prevalence of overweight among young children of different ethnic backgrounds and describe the age pattern of overweight in early childhood. METHODS: Cross-sectional study of 21,911 children, 12 to 59 months old, participating in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children in 1997-1998. They were grouped in eight ethnic categories. For 1-year-olds we defined overweight as weight-for-age at the 95th percentile or more and underweight as weight-for-age at less than the 10th percentile. For 2- to 4-year-olds overweight was defined as body mass index (BMI) at the 95th percentile or more, underweight as BMI less than 10th percentile, tall stature as height-for-age at the 95th percentile or more, and short stature as height-for-age at less than the 10th percentile. The National Center for Health Statistics 2000 growth charts were the reference values. The analysis included bivariate and multivariate methods. RESULTS: Large differences were found among ethnic groups. Among 1-year-olds, Samoans were the heaviest (17.5% overweight) and Filipinos the lightest (30.2% underweight). Among 2- to 4-year-olds, Samoans were the heaviest (27.0% overweight) and the tallest (16.9% tall), whereas Asians were the lightest (12.2% underweight), and Filipinos the shortest (19.0% short). Hawaiians and Asians also had a high percentage of short children (13.6% and 12.2%, respectively). Prevalence of overweight in all 2- to 4-year-olds was more than the expected 5%, especially for Samoans, Filipinos, Hawaiians, and Asians. At age 2 to 4 years, overweight was almost twice as prevalent as at age 1. Multivariate analysis showed that ethnicity (Samoan) had the strongest independent association with weight-for-age percentile, BMI, and overweight in the two age groups, followed by birth weight. CONCLUSIONS: This is the first study of overweight among children of Asian and Pacific Island backgrounds in Hawaii. It identified important characteristics of growth and will be helpful in the design of appropriate activities to prevent overweight.     

Interpretation of Z-score anthropometric indicators derived from the international growth reference

The WHO international growth reference was reviewed to identify characteristics that might affect the interpretation of anthropometric indicators derived from it. Discontinuities were found at the junction point of the two distinct data sets from which the reference curves are derived. Also, the Z-score derived percentile curves for weight-for-age and weight-for-height did not join due to differences in the variances of the two portions of the reference. Empirically an examination of data from international nutrition surveys revealed an artifactual drop in the prevalence of low height-for-age, low weight-for-height, and high weight-for-height at age 2 y, which is due substantially to these discontinuities rather than to intrinsic changes in nutritional status with age. Strategies are discussed for the interpretation of anthropometric indicators in light of these characteristics of the international reference.