Cuban Experience Using Growth and Development as a Positive Indicator of Child Health.

Mercedes Rubén-Quesada,Vilma Tamayo-Pérez,María Del Carmen Machado-Lubián,Mercedes Esquivel-Lauzurique,Ciro González-Fernández

doi:10.37757/mr2019.v21.n4.12

Abstract

Growth and development is considered the best positive indicator of children's quality of life and well-being. Studies have been carried out in Cuba since the early 20th century and large scale, periodic an-thropometric surveys have been regularly conducted by its National Health System to chart modifications in growth patterns of children and adolescents. These surveys have produced national references for the anthropometric indicators most commonly applied in individual assessment of the health and nutritional status of children and ado-lescents in health care settings. These have also provided data for estimating the magnitude and characteristics of secular growth trends, and for comparing growth of Cuban children with that of children in other countries and with WHO's proposed growth standards. The data have also served as evidence of persisting social gradients. The most important results include, as positive data, the positive secular trend in school-aged children's growth of 9.7 cm between 1919 and 2005, with an average increase of 1.1 cm per decade, and, in preschool children, 1.9 and 1.8 cm in boys and girls, respectively, between 1972 and 2015. More recent studies have detected unfavorable changes associated with a marked increase in adiposity and, therefore, in the prevalence of excess weight and obesity. Another interesting result is the gradual movement toward WHO height-for-age standards in preschool children in Havana, verified in surveys conducted in 2005 and 2015. KEYWORDS Growth and development, growth, child development, children, adolescents, nutrition, obesity, pediatrics, Cuba.

Highlights

Increasing interest in anthropometric surveys in the coming decades will alert us to problems such as obesity and its unfavorable consequences for health
It has long been known that a child may stop growing during situations of extreme deprivation followed by varying degrees of compensatory growth once deprivation is reversed.[3]
IMPORTANCE This paper presents convincing evidence that child growth and development surveys provide important, direct positive indicators contributing to health and well-being assessments of children in Cuba and can be important tools for other low- and middle-income countries

Summary

INTRODUCTION

Increasing interest in anthropometric surveys in the coming decades will alert us to problems such as obesity and its unfavorable consequences for health. Population differences Variations in growth are expressed as a result of the interaction—mediated by epigenetic factors—between genetic factors and the environment in which children develop One example of these differences is seen in Cuban height and weight references, whose values are lower than WHO’s proposed standards in the lowest weight percentiles and in the height-forage indicator, which leads to differences in results of nutritional assessment in children.[21,22] The 2005 and 2015 surveys carried out in Havana offer an interesting result associated with those standards: initially negative height-for-age z-scores gradually approach positive values as age increases.[14,22] This differs from results reported in more than 50 low- and middle-income countries in which z-scores in this dimension moved quickly and progressively down from WHO standards up to age 2 years, and rose, but always maintaining z-scores under í0.25.[23] Median z-scores for children aged 0–5 years, (with their respective SD) were í0.07 (1.08) in the 2005 survey and 0.02 (1.17) in the 2015 survey.[14]

CONCLUSIONS

Findings

THE AUTHORS