BMI-for-age Z-score Research Articles

Investigating the impact of the COVID-19 pandemic on the nutritional status of infants and toddlers: insights from China.

A comprehensive understanding of the impact of the COVID-19 pandemic on childhood nutrition is crucial for devising effective mitigation strategies. However, existing knowledge regarding the pandemic's effect on childhood nutritional status remains limited. Furthermore, research focusing on young children aged 0-3years is scarce. Leveraging the outbreak that originated in Wuhan in Dec 2019, the epicenter of China's first and largest outbreak, and national survey and statistical yearbook data, this study conducted a natural experimental analysis with the consideration of geographical exposure, temporal exposure and survey cohort effects to investigate the pandemic's impacts on varying nutritional indicators of infants and toddlers aged 0-36months. A comprehensive set of sensitivity analyses, robustness checks and falsification tests were conducted. The potential heterogeneities across socioeconomic and age groups were also examined. The pandemic was robustly predictive of a higher weight-for-age z-score (WAZ) and length/height-for-age z-score (HAZ), and a lower likelihood of underweight. The effects of the pandemic on increasing WAZ and reducing underweight were more pronounced among children from economically disadvantaged backgrounds or aged 0-12months. Additionally, the increasing HAZ was primarily among children from households with lower family income. Moreover, the pandemic was negatively linked to the body mass index (BMI)-for-age z-score (BAZ) of children residing in more developed cities, and positively linked to overweight/obesity among children aged 13-24months. This study adds to a more comprehensive understanding of the impact of the COVID-19 pandemic on childhood nutrition. Notably, the findings highlight that weight gain attributable to the pandemic was predominantly among vulnerable children from disadvantaged backgrounds and younger age groups, who were already at a higher risk of overweight/obesity before the pandemic. Consequently, our findings imply the necessity of greater caution to the widened gap in childhood malnutrition post-pandemic. Furthermore, the study emphasizes the importance of implementing adaptable strategies with the consideration of social justice to safeguard all children's right to optimal growth from exogenous shocks and to achieve the children-related SDGs by 2030.

Parental Feeding Practices, Weight Perception, and Children's Appetitive Traits Are Associated with Weight Trajectories in Preschoolers: A Longitudinal Study in China.

This study aimed to examine the trajectories of body mass index-for-age z-score (BAZ) in preschoolers and its association with parental feeding practices, weight perception, and children's appetitive traits. A total of 433 preschoolers and their parents from eight public kindergartens in Shanghai were assessed annually over two years. A group-based trajectory model was employed to identify distinct BAZ patterns. Logistic regression was utilized to investigate the baseline factors associated with the BAZ trajectories. Three distinct BAZ trajectories were identified among the preschoolers: "low-stable group" (n = 154, 37.3%), "moderate-stable group" (n = 214, 47.3%), and "progressive overweight and obesity group" (n = 65, 15.4%). The children perceived as overweight and obese by parents (OR = 10.57, 95% CI: 4.89-22.86), and those with lower satiety responsiveness at baseline (OR = 0.86, 95%CI: 0.76-0.97) were more likely to fall into the progressive overweight and obesity group as opposed to the moderate-stable group. Conversely, the children perceived as underweight by parents (OR = 457, 95%CI: 2.71-7.70) had a higher likelihood of being in the low-stable group rather than the moderate-stable group. This study unveiled three unique body weight trajectories among preschool children. Parental perception of children's weight and lower satiety responsiveness were associated with preschoolers' subsequent weight change, while parental feeding practices were not associated.

Nutritional status of tribal and non-tribal school-going children in rural Bangladesh: A comparative study

BackgroundInadequate nutrition of school-going children is a major concern in Bangladesh, and it can negatively affect their productivity. It is important to consider the food pattern, socio-cultural, and economic differences between tribal (T) and non-tribal (NT) communities in Bangladesh when evaluating their nutritional status. This study aimed to investigate the nutritional status of school-going children in the rural area of Rajshahi district’s High Barind Tract (HBT) region of Bangladesh. Additionally, we compared the nutritional status between T and NT school-going children in the same area.MethodsThis was a cross sectional household study. Data were collected from T and NT households in the HBT region in the Rajshahi district of Bangladesh, from January to June of 2019. A total of 500 (T 81, NT 419) school-going children aged 6–13 years were selected as samples using mixed sampling, including convenience sampling (non-probability) and simple random sampling (probability) methods. Nutritional status was assessed using body mass index-for-age z-score (BAZ) and height-for-age z-score (HAZ) according to WHO guidelines. Thinness was defined as BAZ < -2SD and stunting as HAZ < -2SD. Descriptive statistics, Z-proportional test, and logistic regression model were used to analyze the effect of selected independent variables on nutritional status of T and NT children.ResultsAmong school-going children, 15.20% were suffering from thinness (T 12.30% and NT 15.80%) and 17.80% stunting (T 13.60% and NT 18.60%), respectively. The difference in thinness (p > 0.05) and stunting (p > 0.05) were not significant between T and NT. The distribution of BAZ and HAZ of T and NT children were normally distributed, and were positioned negatively compared to the WHO standards. The logistic model identified the following factors for thinness: (i) mother with non-or-primary education (aOR = 1.89, 95% CI: 1.05–3.43, p < 0.05), (ii) underweight mother (aOR = 3.86, 95% CI: 1.48–10.06, p < 0.01), and (iii) underweight father (aOR = 4.12, 95% CI: 1.50-11.29, p < 0.01). For stunting, the factors were: (i) mother as a housewife (aOR = 2.79, 95% CI: 1.16–6.71, p < 0.05), (ii) father working as labour (aOR = 1.77, 95% CI: 1.01–3.278, p < 0.05), (iii) severe food insecurity in the household (aOR = 2.37, 95% CI: 1.23–4.54, p < 0.05), and (iv) children playing outside regularly more than 2 h (aOR = 2.19, 95% CI: 1.31–3.67, p < 0.01).ConclusionIn rural Bangladesh, the nutritional status of T and NT school-going children did not show significant defferences. However, the mean z-score values for both groups of children were lower than the WHO standard, indicating that both communities have poor nutritional status.

Protein and fat intake impact on growth of primary school girls in Kerman, Iran

The school age period is characterized by significant physical and intellectual growth, necessitating the monitoring of macronutrient intake and its impact on weight and height. The objective of this study is to investigate the association between the quality and quantity of protein and fat consumption with anthropometric indices in primary school girls in Kerman. This cross-sectional analysis was conducted on primary school girls aged 6–12 (n 330) from ten schools in Kerman, Iran. A validated and reliable dish-based 185-item food frequency questionnaire was used. We calculated the amount of proteins and fats as the percentage of daily calories and grams per day. Plant-based and animal-based proteins were used to assess the protein quality. To assess the fat quality, we considered trans fatty acids (TFA), cholesterol, vegetable oils, solid vegetable oils, animal oils, omega-6 Polyunsaturated fatty acids (PUFAs), omega-3 PUFA, and (PUFAs + Monounsaturated fatty acids (MUFAs))/Saturated fatty acids (SFAs), PUFAs/SFA, and (MUFA + PUFA)/(SFA + TFA). There was a significant positive association between height-for-age z-score (HAZ) and plant protein (p < 0.001) and vegetable oils (p = 0.038) after adjustment. In higher tertiles of animal protein, weight-for-age z-score (WAZ) (p = 0.024) were significantly higher. A significant positive association was observed between omega-3 PUFA and mid-upper arm circumference (MUAC) (p = 0.039) and BMI-for-age z-score (BAZ) (p = 0.016). Our study emphasizes the importance of monitoring protein and fat intake in primary school girls for optimal growth. Positive associations were found between plant-based protein, vegetable oils and HAZ, as well as animal protein and WAZ, highlighting the impact of protein quality on growth indicators.

Prevalence and associations between micronutrient deficiencies and growth indicators of 10-18-year-old female adolescents living in Vietnam

Although in recent decades progress has been made in reducing the global burden of micronutrient deficiencies (MNDs), nonetheless MNDs prevalence remains high in some populations(1). Among the micronutrients, deficiencies in iron, zinc and vitamin A are particularly prevalent, and causally associated with adverse health outcomes for children and adolescents. The aim of this study was to examine the prevalence and associations between MNDs and components of the double burden of malnutrition in female adolescents utilizing the nationally representative Vietnam General Nutrition Survey 2020.1,471 female adolescents were included and categorised into: pre-adolescent (10-12-year-old), middle-adolescent (13-15-year-old), and late-adolescent (16-18-year-old) groups. Biomarkers of micronutrients, anthropometry, and sociodemographic data were selected for analyses. WHO growth reference values were applied to define stunting (height-for-age z-score (HAZ) &lt; −2 SD), thinness (BMI-for-age z-score (BAZ) &lt; −2 SD) and overweight (BAZ &gt; 1). Iron deficiency was defined as serum ferritin&lt;15μg/L (&lt;70 μg/L for individuals with inflammation), vitamin A insufficiency (VAI) as serum retinol&lt;1.05 μmol/L, zinc deficiency was based on Zinc International Consultative Group Recommendation, and inflammation as C-reactive protein &gt;5 mg/L or α1-acid glycoprotein &gt;1 g/L. One or multiple MNDs were defined as individuals with ≥ 1 MNDs.Data were analysed by STATA 17 (STATA Corporation, US). Descriptive and logistic regression analyses were performed based on the sampling weight adjustments for the estimation at population level. Multivariate logistic regressions between MNDs and growth indicators were presented as crude (COR) and 95% confidence intervals or adjusted odds ratio (AOR), after adjusting for sociodemographic variables (age, ecological area, demographic, ethnicity, and wealth index) and inflammation.Compared to the pre-adolescent group, prevalence of stunting doubled in late adolescence (12.4% to 26.8%). Meanwhile, the prevalence of overweight and thinness decreased with age (29.7% to 22.0% and 9.4% to 2.7%, respectively). Overall, the prevalence of MNDs increased with age. Zinc deficiency occurred most often in the entire cohort (39.8% in 10-18) and contributed the most to multi-MNDs. Prevalence of one or multiple MNDs increased with age, from 58.1% in pre-adolescence to 80% in late adolescence. In logistic regression analyses adjusting for inflammation and sociodemographic factors, stunting increased the risk of having ≥1 MNDs (AOR: 1.94 (1.3, 2.88), p=0.002), but not individual MND alone. Thinness increased the risk of VAI (AOR: 2.38 (1.34, 4.22), p=0.005). No association was found between any MND and overweight, although overweight was protective against zinc deficiency (COR: 0.76 (0.59, 0.99), p=0.04) in the unadjusted model.Female late adolescents in Vietnam had a higher prevalence of stunting and MNDs, but lower prevalence of thinness and overweight in comparison to pre-adolescents. Stunting was a risk factor associated with having one or multiple MNDs. Thinness was associated with higher risk of VAI. No association was found between overweight and MNDs in this cohort.

Current status of pubertal sexual characteristics development of 2 704 girls aged 6-18 years in Tongzhou District of Beijing

Objective: To understand the current status of pubertal sexual characteristics development of girls aged 6-18 years in Tongzhou District of Beijing and to compare the differences in sexual characteristics development among girls characterized as thin, normal, overweight, and obese. Methods: A cross-sectional survey was conducted among 2 844 girls aged 6-18 years in Tongzhou District of Beijing from September 2022 to July 2023. The developmental stages of breast and pubic hair were assessed on site, and menarche status was inquired. Weight and height were measured. The girls were subsequently characterized into thin, normal, overweight and obese groups. Basic information (including family and personal history) was obtained through questionnaires. Probit probability unit regression was applied to calculate the age of each Tanner stage of sexual characteristics development and the age of menarche. The χ2 test was applied to compare the counting data between two or multiple groups. Results: A total of 2 844 girls were surveyed and 2 704 girls met the inclusion criteria, resulting in a valid response rate of 95.1%. Among these girls, 1 105 (40.9%) were aged 6-9 years, 1 053 (38.9%) were aged 10-13 years, and 546 (20.2%) were aged 14-18 years. The of height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and body mass index-for-age Z-score (BAZ) were 0.46(-0.23,1.16), 0.69(-0.16,1.67), and 0.67(-0.27,1.73) respectively. The prevalences of thin, overweight, and obesity were respectively 1.7% (45/2 704), 17.3% (467/2 704), and 19.9% (538/2 704), respectively. There were 45 girls in the thin group, 1 654 girls in the normal weight group, 1 005 girls in the overweight and obesity group. The age of Tanner stage breast 2 (B2), Tanner stage pubic hair 2 (P2), and menarche was 9.0 (95%CI 8.9-9.1), 10.5 (95%CI 10.4-10.6), and 11.4 (95%CI 11.3-1.5) years, respectively. The current status of breast and pubic hair maturity in girls with pubertal development shows that 64.6% (1 211/1 874) of these girls had breast development preceding pubic hair development, 32.4% (607/1 874) had concurrent breast and pubic hair development, and 3.0% (56/1 874) had pubic hairs development preceding breast development. The interval age between B2 and B5 was 4.7 (95%CI 4.6-4.8) years, between P2 and P5 was 4.5 (95%CI 4.4-4.6) years, and between B2 and menarche was 2.4 (95%CI 2.3-2.5) years. The ages of sexual characteristics development in overweight and obese groups were earlier than that in normal and thin groups. The ages of B2 in thin, normal, overweight, and obese groups were 10.0 (95%CI 9.5-10.6), 9.3 (95%CI 9.2-9.4), and 8.6 (95%CI 8.4-8.7) years, respectively. The age of menarche in thin, normal, overweight, and obese groups were 13.1 (95%CI 12.4-13.7), 11.6 (95%CI 11.4-11.7), and 11.1 (95%CI 11.0-11.2) years, respectively. The interval ages between B2 and B5 and between P2 and P5 was 4.5 and 4.1 years, respectively in the overweight and obese groups, and those in normal group and thin group was 4.7 and 4.5 years, 4.6 and 4.7 years, respectively. Conclusions: The ages of sexual characteristics development and menarche tend in Tongzhou District of Beijing to be earlier than that being reported of Beijing's survey 20 years ago. Girls characterized as overweight and obese not only start puberty at an earlier age than girls of normal weight, but also have a shorter developmental process.

Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis

The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies. Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated. The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD-0.028, 95% CI-0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD-0.045, 95% CI-0.079 to-0.011) but not in highly educated populations (MD 0.003, 95% CI-0.093 to 0.098). Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better. This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS).

The effectiveness of albendazole against hookworm infections and the impact of bi-annual treatment on anaemia and body mass index of school children in the Kpandai district of northern Ghana.

The impact of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) (initiated in 2000 in Ghana and ran for 12 years) in mitigating soil-transmitted helminth (STH) infections in LF-endemic areas is unknown. During a 1-year hiatus which ensued between 2011 and 2012, a longitudinal study was conducted to determine GPELF effect on hookworm infections in selected communities involved in the programme since its inception, while measuring the effectiveness of biannual ALB treatments on schoolchildren living in such communities. A total of 399 school children aged 3 to 18 years were randomly selected from four communities in the Kpandai district of northern Ghana. Each presented a single stool sample at baseline, 21 days post-treatment, at the 3rd and 6th months, 21 days post-second intervention (i.e. following sample collection and treatment with ALB in the 6th month), and in the ninth month of the study period. Haemoglobin (hb) levels were also measured at all time points using finger prick blood samples and a URIT digital test kit. Each participant submitting a sample, was treated with a single-dose ALB (400mg) at baseline and in the sixth month. Stool samples were processed by preparing duplicate Kato-Katz slides per sample, and examined by microscopy. The Body Mass Index-for-age z-scores (BAZ) of participants were assessed following the determination of BMIs at each time point by measuring their height and weight with a stadiometer and weighing scale. Overall hookworm prevalences were 25.68% (95% CI = 20.51-31.75) at baseline, 11.18% (95% CI = 7.87-15.41) 21 days post-treatment, 11.78% (95% CI = 8.38-16.11) and 6.95% (95% CI = 4.41-10.43) in the 3rd and 6th months, 0.91% (95% CI = 0.19-2.65) 21 days post-second intervention, and 8.46% (95% CI = 5.62-12.23) in the ninth month. Observed overall faecal egg count reduction rates (ERRs) were 94.21% (95% CI = 81.50%- 100.00%) 21 days after baseline treatment, 97.70% (95% CI = 85.08-100.00) and 96.95% (95% CI = 84.18%- 100.00%) in the 3rd and 6th months, 99.98% (95% CI = 86.42%- 100.00%) 21 days post-second intervention, and 17.18% (95% CI = 14.07%- 20.67%) in the 9th month. Respective cure rates (CRs) were 62.35% (95% CI = 46.71-81.56%), 85.88% (95% CI = 67.32-100.00%), 87.06% (95% CI = 68.36%- 100.00%), 98.82% (95% CI = 78.83%- 100.00%), and 36.36% (95% CI = 9.91%- 93.11%). Additionally, increases in the percent frequency of 'normal hb' (p < 0.01) were observed across the study time points, whilst 'normal BAZ' cases remained high (from 94.87% to 98.87%) throughout the study period. These findings primarily indicate satisfactory effectiveness of ALB which may be maintainable in mass drug administration programmes by the modification of treatment strategies from annual to bi-annual regimes. This could minimize the likelihood of emerging poorly-responding hookworm phenotypes in Ghana. Additionally, a positive impact of bi-annual treatment on participant anaemia status is herein indicated with particular regard to the school children in our cohort.

Childhood physical activity and pubertal timing: findings from the LEGACY girls study.

There is limited research on whether physical activity (PA) in early childhood is associated with the timing of pubertal events in girls. We used data collected over 2011-16 from the LEGACY Girls Study (n = 984; primarily aged 6-13 years at study enrolment), a multicentre North American cohort enriched for girls with a breast cancer family history (BCFH), to evaluate if PA is associated with age at thelarche, pubarche and menarche. Maternal-reported questionnaire data measured puberty outcomes, PA in early childhood (ages 3-5 years) and total metabolic equivalents of organized PA in middle childhood (ages 7-9 years). We used interval-censored Weibull parametric survival regression models with age as the time scale and adjusted for sociodemographic factors, and we tested for effect modification by BCFH. We used inverse odds weighting to test for mediation by body mass index-for-age z-score (BMIZ) measured at study enrolment. Being highly active vs inactive in early childhood was associated with later thelarche in girls with a BCFH [adjusted hazard ratio (aHR) = 0.39, 95% CI = 0.26-0.59), but not in girls without a BCFH. In all girls, irrespective of BCFH, being in the highest vs lowest quartile of organized PA in middle childhood was associated with later menarche (aHR = 0.70, 95% CI = 0.50-0.97). These associations remained after accounting for potential mediation by BMIZ. This study provides new data that PA in early childhood may be associated with later thelarche in girls with a BCFH, also further supporting an overall association between PA in middle childhood and later menarche.

Cord blood vitamin A and vitamin D levels in relation to physical growth in exclusively breastfed infants aged 0-6 months.

Vitamins A and D are essential for the health of pregnant women and infants. Nevertheless, the relationship between umbilical cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants remains uncertain. This cohort study aims to examine the relationship between cord blood vitamins A and D levels and the physical growth of exclusively breastfed infants aged 0-6 months. 140 singleton mother-infant pairs were recruited in total. Questionnaires were used to collect maternal and infant information, and liquid chromatography was utilized to quantify the levels of vitamins A and D in the umbilical cord blood. Anthropometric measurements were conducted at birth, at 3 and 6 months of age, and the weight-for-age z-score (WAZ), length-for-age z-score (LAZ), head circumference-for-age z-score (HAZ), and BMI-for-age z-score (BMIZ) were calculated. Univariate and multivariate linear regression models were used for the analysis. The average concentration of vitamins A and D in cord blood was 0.58 ± 0.20 μmol/L and 34.07 ± 13.35 nmol/L, both below the normal range for children. After adjusting for confounding factors, vitamin A levels in cord blood positively correlated with HAZ growth in infants aged 3-6 months (β= 0.75, P < 0.01) while vitamin D levels negatively correlated with LAZ growth (β= -0.01, P = 0.01) and positively correlated with BMIZ growth (β= 0.02, P < 0.01). Higher Vitamin A levels at birth promote HAZ growth in infants aged 3-6 months while higher vitamin D levels at birth promote BMIZ growth in infants aged 3-6 months. https://register.clinicaltrials.gov, identifier NCT04017286.

Effects of Primary Caregivers’ Feeding Habits on the Nutrition Status of Pre-schoolers in Rupandehi District of Nepal

Healthy food habits of primary caregivers may contribute to the overall growth, development, and optimal health of the ppreschoolers. This quantitative research aimed to examine the impact of the feeding practices of caregivers on nutritional status of 384 preschoolers (aged 36-71 months) in Rupandehi District of Nepal. The effects of feeding habit were compared with the nutritional status and thus the impact was examined. Information regarding socio-economic standing, demographics, feeding habits, and children’s nutrition statuses were collected through direct interviews and anthropometric measurement. The nutritional status of the children, including height-for-age (HAZ), weight-for-height (WAZ), and BMI-for-age z-scores (BAZ), was assessed using WHO Anthro, WHO Anthro Plus, and SPSS version 26 software. Statistical analysis involved Chi-square tests and logistic regression with a significance threshold established at p&lt;0.05. The finding indicates that 44.5% of preschoolers had normal nutrition status, whereas 38.8% received sufficient feeding practices from their caregivers. Feeding habits, economic status, fathers' occupation, and family structure appeared as significant predictors of preschoolers’ nutrition status. Preschoolers from economically marginalized backgrounds, with fathers in business occupations, and living in joint families were found to be at higher risk of poor nutrition. The findings imply that implementing feeding habit interventions to the children of lower economic backgrounds is desirable to bring the changes in their nutritional status. So, some nutritional strategies should be taken into consideration to take care of the children who are in joint families and whose parents could not give more time due to their occupation.

Dietary Diversity Score and Nutritional Status of Adolescent Girls with Anemia in Bandung Region

This study aimed to determine the association between Dietary Diversity Scores (DDS) and nutritional status among adolescent girls with anemia. Seventy-one adolescent girls aged 15−17 years from high schools in Bandung were selected using Probability Proportional to Size (PPS). The data on the sociodemographic characteristics, health and nutritional status, and DDS of the subjects were collected. Results showed that the mean DDS was classified as high. There was no significant association between DDS and BMI-for-age Z-score (BAZ) and Waist-Hip Ratio (WHR) in adolescent girls with anemia (p&gt;0.05). Therefore, DDS was not associated with nutritional status in adolescent girls with anemia.

Factors influencing the prevalence of anaemia in female adolescents: A population-based study of rural setting in Karanganyar, Indonesia

BackgroundAnaemia among women of reproductive age (15–49 years) poses substantial public health concerns, particularly in LMICs, due to its adverse effects during pregnancy and childbirth. Understanding its determinants is pivotal for devising strategies to combat this condition. This study investigates the prevalence of anaemia and its associations with anthropometric indices, dietary habits, and menstruation status among female adolescents in Karanganyar, a rural subdistrict in Indonesia. MethodsIn this population-based cross-sectional study, a multi-stage sampling method was employed to represent all female high-school students in Karanganyar. Participants underwent capillary haemoglobin testing, anthropometric measurements, and completed dietary intake and menstruation status assessments. Anaemia was defined as Hb < 12.0 g/dL. Logistic regressions were performed to assess the associations between anthropometric indices, dietary intake, menstruation status, and the prevalence of anaemia. ResultsApproximately 49 % of female adolescents in Karanganyar had anemia. Both BMI and Mid-Upper-Arm-Circumference exhibited inverse associations with anaemia [AOR(95%CI): 0.87(0.79–0.95) and 0.89(0.81–0.99)]. Compared to individuals with BMI-for-age-Z-Score (BAZ) > -2 SD, those with BAZ < −2 SD had more than double the odds of anaemia [2.43 (0.94–6.29)]. Consumption of fruits [0.32(0.10–0.98)] and vegetables [0.30(0.11–0.78)] were negatively associated with anaemia. No association was observed between menstruation status (length, duration, pads/day) and anaemia. DiscussionHigh prevalence of anaemia among female adolescents in Karanganyar, and potentially other rural areas in Indonesia, underscores the need for targeted interventions. Being underweight rapidly increases the risk of anaemia, emphasizing the importance of nutritional improvements. Consuming iron-rich fruits and vegetables may prevent anaemia. Menstruation status did not appear to be a determinant of anaemia.

The association between different types of amino acid intake and physical growth among children

Background & aimsRestricted linear growth and abnormal weight status are commonly observed among children in low-income countries, possibly due to inadequate protein intake. Considering the role of protein intake and amino acid (AA) synthesis in growth and development, it has been suggested that there may be an association between AA intake and physical growth. We aimed to investigate the association between different types of AA intake and physical growth among children. MethodsA cross-sectional study including 780 six-year-old children referred to 10 health care centers for vaccination between October 2017 and March 2018 was conducted. Anthropometric data was collected using standard methods, and dietary intake was assessed using a validated food-frequency questionnaire (FFQ)‏ in an interview by a trained technician. ResultsChildren in the highest tertile (3rd) of branched-chain amino acids (BCAA) intake had a higher weight-for-age z-score (WAZ) (P = 0.02) and body mass index-for-age z-score (BAZ) (P = 0.001) compared to those in the lowest tertile (1rd). Interestingly, BAZ was significantly associated with the highest tertile of acidic AA intake (P = 0.04), while an inverse association was observed between the highest tertile of aromatic AA (phenylalanine and tyrosine) intake and BAZ (P = 0.01) . No significant associations were observed between the highest tertile of sulfuric, aliphatic, or neutral AA and BAZ, height-for-age z-score (HAZ) or WAZ. Further, underweight was associated with the 3rd tertile of aromatic, alcoholic, aliphatic or neutral AA and BCAA intake. Aliphatic and neutral AA intake was also increased the risk of overweight. Finally, stunted growth patterns were associated with the highest tertile of acidic, alcoholic. ConclusionFindings presented in this study showed that higher BAZ and WAZ are associated with 3rd tertiles of BCAA intake, but lower BAZ were associated with 3rd tertiles of aromatic AA (phenylalanine and tyrosine) intake.Future research in other populations are needed to confirm these findings.

Maternal Pre-Pregnancy BMI, Breastfeeding, and Child BMI.

Breastfeeding practices may protect against offspring obesity, but this relationship is understudied among women with obesity. We describe the associations between breastfeeding practices and child BMI for age z-score (BMIz), stratified by maternal BMI. We analyzed 8134 dyads from 21 cohorts in the Environmental Influences on Child Health Outcomes Program. Dyads with data for maternal pre-pregnancy BMI, infant feeding practices, and ≥1 child BMI assessment between the ages of 2 and 6 years were included. The associations between breastfeeding practices and continuous child BMIz were assessed by using multivariable linear mixed models. Maternal pre-pregnancy BMI category prevalence was underweight: 2.5%, healthy weight: 45.8%, overweight: 26.0%, and obese: 25.6%. Median child ages at the cessation of any breastfeeding and exclusive breastfeeding across the 4 BMI categories were 19, 26, 24, and 17 weeks and 12, 20, 17, and 12 weeks, respectively. Results were in the hypothesized directions for BMI categories. Three months of any breastfeeding was associated with a lower BMIz among children whose mothers were a healthy weight (-0.02 [-0.04 to 0.001], P = .06), overweight (-0.04 [-0.07 to -0.004], P = .03), or obese (-0.04 [-0.07 to -0.006], P = .02). Three months of exclusive breastfeeding was associated with a lower BMIz among children whose mothers were a healthy weight (-0.06 [-0.10 to -0.02], P = .002), overweight (-0.05 [-0.10 to 0.005], P = .07), or obese (-0.08 [-0.12 to -0.03], P = .001). Human milk exposure, regardless of maternal BMI category, was associated with a lower child BMIz in the Environmental Influences on Child Health Outcomes cohorts, supporting breastfeeding recommendations as a potential strategy for decreasing the risk of offspring obesity.

Determinants of Anishinabeck infant and early childhood growth trajectories in Northwestern Ontario, Canada: a cohort study

BackgroundThe Developmental Origins of Health and Disease (DOHaD) paradigm emphasizes the significance of early life factors for the prevention of chronic health conditions, like type 2 diabetes (T2DM) and obesity, which disproportionately affect First Nations communities in Canada. Despite increasing DOHaD research related to maternal health during pregnancy, early childhood growth patterns, and infant feeding practices with many populations, data from First Nations communities in Canada are limited. In partnership with Sandy Lake First Nation, the aims of this project were to characterize birthweights and growth patterns of First Nations infants/children over the first 6 years of life and to study the impact of maternal and infant social and behavioral factors on birthweight and growth trajectories.MethodsWe recruited 194 families through community announcements and clinic visits. Infant/child length/height and weight were measured at 1 and 2 weeks; 1, 2, 6, 12, and 18 months; and 2, 3, 4, 5 and 6 years. Maternal and infant/child questionnaires captured data about health, nutrition, and social support. Weight-for-Age z-score (WAZ), Height-for-Age z-score (HAZ), and BMI-for-Age z-score (BAZ) were calculated using WHO reference standards and trajectories were analyzed using generalized additive models. Generalized estimating equations and logistic regression were used to determine associations between exposures and outcomes.ResultsWAZ and BAZ were above the WHO mean and increased with age until age 6 years. Generalized estimating equations indicated that WAZ was positively associated with age (0.152; 95% CI 0.014, 0.29), HAZ was positively associated with birthweight (0.155; 95% CI 0.035, 0.275), and BAZ was positively associated with caregiver’s BMI (0.049; 95% CI 0.004, 0.090). There was an increased odds of rapid weight gain (RWG) with exposure to gestational diabetes (OR: 7.47, 95% CI 1.68, 46.22). Almost 70% of parents initiated breastfeeding, and breastfeeding initiation was modestly associated with lower WAZ (-0.18; 95% CI -0.64, 0.28) and BAZ (-0.23; 95% CI -0.79, 0.34).ConclusionsThis work highlights early life factors that may contribute to T2DM etiology and can be used to support community and Indigenous-led prevention strategies.

The Relationship Between Anthropometric Z-Score Measurements and Ocular Structures in Turkish Children.

Objective (Aim): This study explores the contact between anthropometric Z-score values and ocular parameters in children. Recent studies investigated the relationship, and contact between anthropometric measurements and ocular parameters in children, and height, weight, body mass index, and percentile curves are mostly used as anthropometric data. However, today, different scoring systems such as "Z-score" classify anthropometric values. Methods: Height and body mass index Z-scores were calculated for 725 children. Biometric and refractive measurements of all children were noted. For different reference values, those with a Z-score below the negative value of the reference were defined as a low Z-score, those between the negative and positive value of the reference were defined as a normal Z-score, those with a Z-score greater than the positive value of the reference were defined as a high Z-score. The mean ocular measurement results in the low, normal, and high Z-score groups were compared, and they were pointed to reach the reference value in both negative and positive sides which created the foremost critical contrast between the groups. Results: For a value of "-1" and "+1.5" in the height Z-score, from low to normal and from there to high Z-score group, axial length, and average corneal radius increased, and average corneal power decreased significantly. Anterior chamber depth increased from normal to high Z-score group, but no critical distinction was made between low and normal Z-score groups. Moreover, no critical distinction was observed in spherical equivalent refraction, central corneal thickness for height, and all values of body mass index. Conclusion: Considering a Z-score value of "-1" and "+1.5" as a reference value in children and anticipating the changes that may happen in the ocular structures of children at both ends of the Z-score, it may be useful to understand the effect of body development on ocular development more. Abbreviations: AL = Axial Length, ACD = Anterior Chamber Depth, BMI = Body Mass Index, NCHS = The United States National Center for Health Statistics, WHO = World Health Organization, NFHS 2 = National Family Health Survey 2, SER = Spherical Equivalent Refraction, CR = Average Corneal Radius, CP = Average Corneal Power, CCT = Central Corneal Thickness, HFAsZ = Height for Age Z-Score, BMIsZ = BMI for Age Z-Score, L = Low Z-score, N = Normal Z-score, H = High Z-score.

The Potential use of Anthropometric Parameters to Predict the Anemia Status of Adolescent Girls

The study assesses the potential use of anthropometric parameters and their optimal cut-off value for predicting the anemia status of adolescent girls. This cross-sectional study analyzed data from 2,184 adolescent girls aged 15‒19 years from West Bandung and Sumedang districts of Indonesia who participated in the Better Investment for Stunting Alleviation Program (BISA). Anemia is defined as a Haemoglobin (Hb) level &lt;12 g/dl and was analyzed by HemoCue® 201+. Anthropometric parameters studied were Body Weight (BW), BMI-for-Age z-Score (BAZ), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), and Waist-to-Height Ratio (WHtR) and all were measured according to WHO procedure. Receiver Operating Characteristics (ROC) was used to analyze the potential of anthropometric parameter to predict anemia status. Based on multivariate analysis, a significant correlation was found between age (OR=0.88; 95% CI:0.79‒0.97) and WHtR (OR=0.12; 95% CI:0.02‒0.63) with anemia status. The ROC analysis revealed that the WHtR parameter had the highest Area Under the Curve (AUC) for predicting anemia, although with a very low accuracy (AUC=0.529). The optimal cut-off with value of WHtR for adolescent girls was ≤0.44. This study suggests that WHtR is a potential parameter for early detection of anemia status among adolescent girls and needs to be confirmed with further studies.

Effectiveness of a school-based intervention to manage overweight and obesity among adolescents in Seremban, Malaysia: A cluster randomized controlled trial

The aim of the study was to evaluate the effectiveness of a school-based intervention programme among overweight and obese adolescents in Seremban, Negeri Sembilan, Malaysia. A cluster randomised controlled trial was conducted to evaluate the effect of the intervention (n = 200) and compared with control group (n = 200). The intervention was developed based on social cognitive theory, conducted in a group based, five-session of face-to-face, bi-weekly for 10 weeks. The primary outcomes were body mass index (BMI) and BMI-for-age z-scores (BAZ), whereas the secondary outcomes were breakfast consumption, physical activity level, self-efficacy, and body satisfaction. T-tests and generalized linear mixed model analysis were used to examine the effectiveness of the intervention at baseline, immediate post-intervention, and 3-month post-intervention, while controlling for covariates. A significant intervention effect was found in reducing BMI and BAZ. BMI of the participants in the intervention group was reduced from 28.10 kg/m2 to 27.93 kg/m2, and further decreased to 27.80 kg/m2, while BAZ was reduced from 2.19 to 2.12, and further decreased to 2.07, from baseline to immediate post-intervention, and 3-month follow-up, respectively. Furthermore, there was significant improvement in breakfast consumption frequency, physical activity scores, healthy eating and weight self-efficacy scores, perceived physical activity self-efficacy scores, and body discrepancy scores as compared with the control group. The integrated school-based intervention programme was effective in reducing BMI and BAZ among overweight and obese participants. The results suggested that this programme could be integrated as one of the regular school co-curricular programmes.

The Efficacy of Egg White Powder on Anthropometric Indices in Malnourished Children

Background: White egg powder provides essential amino acids compounds. This study aims to investigate the theory that a regular consumption of white egg powder would improve weight gain and appetite in children with malnutrition. Methods: The present experimental study was conducted among children aged 3-6 years with mild to severe malnutrition referred to Ghadir Mother and Child Hospital affiliated with Shiraz University of Medical Sciences from April to October 2017. The malnourished children received egg white protein (1 g/kg of their current body weight) for 3 weeks. Weight loss as a primary outcome and weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and BMI-for-age Z-score (BAZ) were measured as secondary outcomes, assessed at baseline and after six weeks of study. Results: Of the 23 children included, 20 finished the study. Weight increased in all children although it was not significant (P = 0.101). A lower appetite was seen at the end of the intervention, but it was not significant (P = 0.575). Malnutrition based on WHZ and BAZ decreased compared to the baseline measurement, while the changes were not significant. Regarding other markers, no statistically significant changes were found compared to the baseline measurement. Conclusion: The addition of white egg powder to complementary nutrition could not improve weight gain and appetite in malnourished children. Further research with a larger study population and longer intervention time is needed to demonstrate the clear effect of egg white on improving malnutrition in children.