BMI-for-age Z-score Research Articles

Adequate fruit and vegetable consumption and its association with overnutrition among primary school-aged children

Overnutrition among school-aged children increases substantially over the last decade. Among the direct causes of overweight/obesity is inadequate intake of fruit and vegetable. Prior studies have shown that fruit and vegetable (FV) is not merely the main source of vitamins andminerals, but also playing role on preventing weight gain through satiety regulation. This study aims to determine the association of FV consumption adequacy among 5-12 years schoolers and their overnutrition status. This cross-sectional study was conducted in Jakarta and Depok, carried out on 57 children who filled out an online questionnaire survey. Respondents’ characteristics were obtained through the self-administered online questionnaire. BMI for age z-score (BAZ) was calculated from the self-reported recall of body weight and height. The FV consumption was evaluated using the WHO STEP-wise questionnaire. Respondent’s characteristics were presented in frequency and percentage, while association test was done using Fisher Exact test (CI 95%). In this study, 40,4% of children were overweight and most children did not consume adequate portions of fruit and vegetable (73,7% and 57,9%, respectively). There are no significant association between FV consumption and children’s overnutrition (p= 0,171 and p= 0,788, respectively; CI 95%). Overall, a high proportion of children overnutrition was observed. However, there is no significant association was found between fruit and vegetable consumption and children’s overnutrition. There is a need for specific regulations and practices that may engage children in consuming fruit and vegetable on the daily basis.

The impact of a complex school nutrition intervention on double burden of malnutrition among Thai primary school children: a 2-year quasi-experiment

ObjectiveThis study assessed the impacts of the Dekthai Kamsai programme on overweight/obesity, underweight and stunting among male and female primary school students. Study designA quasi-experiment was conducted in 16 intervention and 19 control schools across Thailand in 2018 and 2019. In total, 896 treated and 1779 control students from grades 1 to 3 were recruited. In intervention schools, a set of multifaceted intervention components were added into school routine practices. Anthropometric outcomes were measured at baseline and at the beginning and end of every school term. MethodsPropensity score matching with linear and Poisson difference-in-difference analyses were used to adjust for the non-randomisation and to analyse the intervention's effects over time. ResultsCompared with controls, the increases in mean BMI-for-age Z-score (BAZ) and the incidence rate of overweight/obesity were lower in the intervention schools at the 3rd, 4th and 8th measurements and the 3rd measurement, respectively. The decrease in mean height-for-age Z-score (HAZ) was lower at the 4th measurement. The decrease in the incidence rate of wasting was lower at the 5th, 7th and 8th measurements. The favourable impacts on BAZ and HAZ were found in both sexes, while the favourable impact on overweight/obesity and unfavourable impact on wasting were found in girls. ConclusionsThis intervention might be effective in reducing BAZ, overweight/obesity, poor height gain, but not wasting. These findings highlight the benefits of a multifaceted school nutrition intervention and a need to incorporate tailor-made interventions for wasting to comprehensively address the double burden of malnutrition.

FACTORS ASSOCIATED WITH BODY WEIGHT STATUS AMONG CHILDREN WITH AUTISM SPECTRUM DISORDER AGED 2-11 IN KUCHING DIVISION, SARAWAK

The high prevalence of overweight and obese among children with autism spectrum disorder (ASD) gains attention due to its substantial adverse health impacts. This study aimed to determine the associations between sociodemographic characteristics, parental feeding practices, child eating behaviour, and dietary intake with the body weight status of ASD children in Kuching Division, Sarawak. A cross-sectional study was conducted among 124 ASD children (83.9% boys and 16.1% girls) aged 2-11 years, together with their caregivers. The weight and height of ASD children were taken, and body mass index-for-age z-score (BAZ) was computed using AnthroPlus software. Child feeding practices, eating behaviour, and dietary intake were assessed through interviews, with the aid of a questionnaire. Multiple binary logistic regression was used in data analysis. The prevalence of underweight, risk-of-overweight, overweight, and obese ASD children was 3.2% (3.8% boys; 0% girls), 4.8% (2.9% boys; 15.0% girls), 16.9% (17.3% boys; 15.0% girls), and 20.2% (23.1% boys; 5.0 % girls), respectively. The multiple binary logistic regression revealed that the caregivers with high perceived child weight (AOR 31.313, 95% CI=6.127-47.218), high concern towards child weight (AOR 1.774, 95% CI=1.112-2.829), and high sodium intakes (AOR 3.747, 95% CI= 1.515-9.269) were significantly associated with increased risk of overweight or obesity, explaining 37.2% of the variation in body weight status. It is important to prioritise the perspective of caregivers’ feeding practices especially the caregivers with high perceived child weight and concerned child’s weight as well as sodium level of the ASD children while planning for obesity intervention programmes.

Association of Breastfeeding Duration with Body Composition in Children Aged 3–5 Years

ObjectiveThis study aimed to assess the relationship between the body composition of children aged 3–5 years and breastfeeding status and duration. MethodsThe study was conducted using data from the National Nutrition and Health Systematic Survey for children 0–17 years of age in China (CNHSC), a nationwide cross-sectional study. Breastfeeding information and potential confounders were collected using standardized questionnaires administered through face-to-face interviews. The body composition of preschool children was measured using bioelectrical impedance analysis. A multivariate linear regression model was used to assess the relationship between breastfeeding duration and body composition after adjusting for potential confounders. ResultsIn total, 2,008 participants were included in the study. Of these, 89.2% were ever breastfed and the median duration of breastfeeding was 12 months (IQR 7–15 months). Among children aged 3 years, the height-for-age Z-score (HAZ) for the ever breastfed group was lower than that for never breastfed group (0.12 vs. 0.42, P = 0.043). In addition, the weight-for-age Z-score (WAZ) of the ever breastfed group was lower than that of the never breastfed group (0.31 vs. 0.65, P = 0.026), and the WAZ was lower in children aged 4 years who breastfed between 12 and 23 months than in those who never breastfed. Compared to the formula-fed children, the fat-free mass of breastfed infants was higher for children aged 3 years (12.84 kg vs. 12.52 kg, P = 0.015) and lower for those aged 4 years (14.31 kg vs. 14.64 kg, P = 0.048), but no difference was detected for children aged 5 years (16.40 kg vs. 16.42 kg, P = 0.910) after adjusting for potential confounders. No significant difference was detected in the weight-for-height Z-score (WHZ), body mass index (BMI)-for-age Z-score (BAZ), fat-free mass index, and body fat indicators in the ever breastfed and never breastfed groups and among various breastfeeding duration groups for children aged 3–5 years. ConclusionNo obvious associations were detected between breastfeeding duration, BMI, and fat mass indicators. Future prospective studies should explore the relationship between breastfeeding status and fat-free mass.

Nutritional Status of Female Children in Comparison to Their Male Siblings in India– A Secondary Analysis of National Family Health Survey (NFHS-5) Data

Introduction: As there was little literature available about gender disparities in undernutrition within household, this secondary analysis was performed on a large representative data with an objective to evaluate the Z-score differences, viz., Weight-for-age Z-score (WAZ), Height-for-age Z-score (HAZ), Weight-for-height Z-score (WHZ) and BMI-for-age Z-score (BAZ) of the Indian female under-5 children with their male siblings within same household. Methods: Individual data of 19083 pairs of siblings was analysed from the NFHS -5 data. Differences in the Z-scores of the siblings was calculated as male’s Z-score minus female’s Z-score and factors influencing them were studied. Results: The mean HAZ and WAZ scores were less than -1.4 Standard deviations (SD) for both genders – while the means of WHZ and BAZ scores were ranging between -0.67 to -0.83. The differences in Z scores were more or less distributed equally on both sides of zero, implying no disadvantage to any of the genders. The mean differences in the Z scores were minimal (-0.07 in HAZ, -0.04 in WAZ, -0.06 in WHZ and 0.01 in BAZ). Conclusion: There was little or no difference in the mean z scores of females and male siblings and did not indicate any gender advantage or disadvantage.

Undernutrition among rural school-age children: a major public health challenge for an aspirational district in Karnataka, India.

For school-age children, a healthy transition from childhood to adolescence and adulthood depends on proper nutrition. Globally, most nutritional surveys focus on preschool and adolescents, neglecting school-age children. Recent studies have shown the prevalence of thinness among adolescents to be 26.5% in Karnataka. Similarly, among children aged < 5 years in the Raichur district, the prevalence of stunting, wasting, and being underweight was 39.8, 23.2, and 40.7%, respectively. The present study aimed to bridge the data gap between < 5 years of children and adolescents through a nutritional survey of school-going children in Raichur, one of the aspirational districts of India. A cross-sectional survey was conducted from January to March 2020 among rural school-age children (n = 2700) in 30 villages of the Raichur district of Karnataka, India. The school children were selected through a multi-stage cluster sampling technique. The WHO Anthro-plus software was used for calculating the age and sex-specific Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and BMI-for-age (BAZ). Of the 2,700 school-age children surveyed, the mean weight and height were 22.2 kg (+5.8) and 124.9 cm (+11.6), respectively. The prevalence of children having weight-for-age Z-scores < -2 SD (Underweight) was 45.3% (95% CI: 42.7%-47.8%). The magnitude of stunting and severe stunting was 19.5% (95% CI: 18.0%-21.0%) and 7.6% (95% CI: 6.6%-8.6%), respectively. The proportion of children with BMI for age Z-scores < -2SD (thinness) was 43% (95% CI: 41.1%-44.9%), with sub-district Sindhanur having a dual burden of malnutrition. Despite many flagship programs, the prevalence of undernutrition in school-age children remains a considerable public health problem in the aspirational district of Raichur, India. Furthermore, exploratory studies are recommended to identify the factors associated with undernutrition among school-age children and strategize evidence-based intervention.

1385-P: Maternal Gestational Weight Gain and Children’s Genetic Susceptibility on Childhood Adiposity—A Longitudinal Cohort Study

Few studies have assessed the association of early-life environmental and genetic factors with the risk of childhood adiposity. The aim of the present study was to investigate the interaction between maternal gestational weight gain (GWG) and children’s genetic susceptibility on childhood adiposity. The present study included 1038 mother-child pairs. Body mass index (BMI) for age Z-score (BMI-Z) and childhood overweight were evaluated according to the World Health Organization (WHO) growth reference. Genetic risk score (GRS) was established by aggregating alleles of 10 BMI susceptibility single-nucleotide polymorphisms identified from a recent study. Children born to mothers with excessive GWG had higher BMI-Z (P&amp;lt;0.001), percentage of body fat (P&amp;lt;0.001), and prevalence of overweight (28.4% vs 15.9%, P&amp;lt;0.001) than those born to mothers with adequate GWG. Children’s BMI GRS was significantly and positively associated with BMI-Z, percentage of body fat and overweight risk (all P&amp;lt;0.05). Stratified analyses showed the positive association of children’s BMI GRS with adiposity risk was especially concentrated among mothers with pre-pregnancy normal weight but excessive GWG. The present study identified an interactive effect between maternal GWG and children’s genetic susceptibility on childhood adiposity risk. The findings provided new insight into the etiology of childhood obesity and highlighted the importance of GWG management. Disclosure H.Liu: None. W.Li: None. L.Wang: None. S.Zhang: None. W.Li: None. X.Yang: None. J.Leng: None. G.Hu: None. S.Wang: None. Funding European Foundation for the Study of Diabetes/Chinese Diabetes Society/Lilly Programme for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790, R01DK132011); National Institute of General Medical Sciences (U54GM104940)

Maternal pre-pregnancy body mass index, gestational weight gain and child weight during the first 2 years of life in an Amazonian birth cohort.

In socially vulnerable populations, evidence is needed regarding the role of maternal nutritional status on child weight during the first 2 years of life. We aimed to assess the association of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with offspring BMI-for-age z-scores (BAZs) during the first 2 years of life. A population-based birth cohort study was conducted with 900 mother-child pairs. Pre-pregnancy weight and weight at delivery were collected from medical records, and anthropometric data were measured at birth and at 6-month, 1-year and 2-year follow-up visits. Linear regression and linear mixed-effect models assessed associations with pre-pregnancy BMI, GWG and BAZ during the first 2 years of life. Pre-pregnancy overweight and obesity and excessive GWG were positively associated with BAZ at birth and at 1- and 2-year follow-up visits. There were no significant additional BAZ changes per year based on the exposures up to age 2 years. Elevated maternal pre-pregnancy BMI and GWG were associated with a child's higher BAZ at birth, and these differences remained constant throughout the first 2 years of life in Amazonian children. These findings highlight the importance of promoting adequate maternal weight before pregnancy and during prenatal care also in socially vulnerable populations.

Does Neighborhood Social Capital Longitudinally Affect the Nutritional Status of School-Aged Children? Evidence from China.

Previous research linking social capital to child nutritional status primarily constitutes cross-sectional studies. To investigate whether a longitudinal relationship exists, by conducting fixed-effects analyses with 16,977 repeatedly measured observations of 6193 children from the 2012, 2014, 2016, and 2018 China Family Panel Studies, this study explored the longitudinal effects of neighborhood participation, bonding trust, and bridging trust on the BMI-for-age z-score (BAZ) and BMI categories of school-aged children, differentiating between urban and rural residence. We found an increasing average BAZ, a decreasing prevalence of underweight, an increasing prevalence of overweight/obesity, and a reducing urban/rural gap in nutritional status. The levels of social capital components descended faster in the urban area. Bonding trust was predictive of a lower BAZ, a higher likelihood of being underweight, and a lower likelihood of being overweight/obese. Bridging trust was predictive of a higher BAZ. The longitudinal effects of bonding trust were significant among only the rural children. Our findings indicate that neighborhood social capital may impose causal impacts on the nutritional status of children. To effectively improve child nutritional status, a more empathetic governmental approach that promotes a more supportive distal social environment is needed.

The pattern of association between early childhood caries and body mass index in pre-school children within Aotearoa | New Zealand: a national cross-sectional study.

The relationship between childhood anthropometric measurements and dental caries has an inconsistent evidence-base. This study investigated dental caries experience and body mass index (BMI) measurements of children aged 4 years in a national cohort, after accounting for key confounding variables. A near whole-population cross-sectional study of children who had a health and developmental assessment, as part of the nationwide B4 School Check screening program, conducted in Aotearoa | New Zealand (ANZ) between 1 July 2010 and 30 June 2021 was studied. The extracted database included 582 820 children, of whom 572 523 (98.2%) had valid BMI and oral health records. Dental caries experience was derived from the 'lift the lip' oral health screening, and measured height and weight were used to calculate sex-specific BMI-for-age z-scores (BMIz). Analyses were adjusted for age, sex, ethnicity and area-level deprivation. Modified Poisson regression models using 2-degree fractional polynomial curves for BMIz were employed. In the extracted sample, the median age was 4.3 years (interquartile range: 4.1-4.5 years), 283 565 (48.7%) were female, 135 734 (23.4%) and 74 237 (12.8%) were identified as Māori and Pacific, respectively, and 140 931 (24.4%) lived in the most deprived areas of ANZ. Overall, 81 926 (14.2%) had dental caries identified. In unadjusted analyses, a significant J-shaped association was observed between dental caries experience and BMIz. However, in the adjusted analysis, a significant flattened S-shaped association was found; those with lower BMIz had lower predicted probabilities of dental caries experience. Large differences in predicted probabilities were observed between different sex, ethnicity and area-level deprivation groups. This study found significant non-linear associations between dental caries experience and BMI in 4-year-old children. However, the inclusion of confounders importantly changed the shape of this non-linear association. Sex, ethnicity and area-level deprivation inequalities had a greater impact on dental caries experience than BMI.

Effect of Sleeping Disorders on the Growth Parameters of Lebanese Children.

Sleep is a vital physiological function for the maintenance of health and quality of life by ensuring body rest and restoring its energy levels. Remarkably, some children have sleep disordered breathing (SDB) that can disturb their normal sleep and affect the quality of their lives. The aim of this study was to assess the correlation between SDB and growth impairments and wether the growth parameters vary among genders. This study was conducted in two steps: 1500 questionnaires were distributed to children aged 3 to 12 years. The questionnaire covered personal information, medical history, and the Pediatric Sleep Questionnaire. The latter was used to evaluate the incidence of sleep-disordered breathing and was completed by parents of the involved children. Growth assessment was then determined for the population to find the correlation between sleep disorders and growth impairments. A total of 931 completed questionnaires were returned (70.7% response rate). Among the respondents, 56.3% were females whereas 43.3% were males. The mean age was 8 years. The result showed that 16.11% of children were at high risk of sleep-disordered breathing. A significant effect of SDB syndrome on growth parameters (weight-for-age parameter z-score and BMI for age z-score) was observed among males. Concerning the weight for age z-score, a significant difference was found between the means of control and SDB individuals (P = 0.0302). In male groups, the difference was significant (P=0.043), while non-significant difference was found in female groups (P = 0.69). This study highlights a significant effect of SDB on growth parameters among males aged between 3 and 12 years.

Well-controlled gestational diabetes mellitus without pharmacologic therapy decelerates weight gain in infancy.

There are no prospective longitudinal studies on the association between well-controlled gestational diabetes mellitus (GDM) without pharmacologic therapy and the physical growth of offspring in infancy. We aimed to identify the trajectories in physical growth (from 0-12 months of age) in the offspring of mothers with well-controlled GDM without pharmacologic therapy in a prospective cohort in China. This study included 236 offspring of mothers with GDM and 369 offspring of mothers without GDM. Mothers with GDM were not on pharmacologic therapy. The length and weight of infants were measured at 0, 1, 3, 6, and 12 months. Linear mixed-effect models and linear mixed-effect models were applied. The fully adjusted model showed that the weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and BMI-for-age z-score (BMIZ) were similar at birth for the GDM and control groups. However, subsequent increases in WAZ and BMIZ for the GDM group lagged the increases for the control group at the subsequent periods of observation, 0-1, 0-6, and 0-12 months. Well-controlled GDM without pharmacologic therapy may normalize physical growth of offspring at birth and decelerate their weight gain in infancy. Whether glycemic control can mitigate the long-term effects of GDM on the growth trajectory in offspring remains unclear.

Incidence of malnutrition and changes in phosphocalcic metabolism in perioperative liver transplantation patients -a retrospective study in a tertiary children’s hospital in China

BackgroundThe primary aim of the study was to assess the nutritional status of pediatric liver transplant outpatients in nutrition clinic, particularly the nutritional status of their bones. MethodsOne hundred thirty-eight pediatric liver transplant outpatients, who had visited the nutrition clinic in Shanghai Children’s Medical Center between January 2017 and December 2019, were recruited. The bone mineral density (BMD) z-scores were determined by dual energy X-ray absorptiometry (DXA). Nutritional assessment was performed, and their corresponding height-for-age z-scores (HAZs)/weight-for-age z-scores (WAZs)/BMI-for-age z-scores (BMIZs) were obtained.ResultsA total of 138 patients came to our nutrition outpatient clinic, including 68 boys (49.3%) and 70 girls (50.7%). The median age was 0.87y (0.68y, 1.71y). Among these patients, 44 (31.9%) had acute malnutrition with WAZ/BMIZ value -1.14 (-2.38, -0.18), 55 (38.4%) had chronic malnutrition with HAZ value -1.51 (-2.39, -0.38), and 96 (69.6%) had a BMD lower than normal. The BMD z-score was significantly correlated with the WAZ/BMIZ value (Spearman’s correlation coefficient = 0.334, p < 0.001). A total of 37 infants re-visited the nutrition clinic for a follow-up after (147 ± 127) days. The WAZ/BMIZ value of the re-visiting patients and the BMD z-score of the re-visiting patients were significantly improved compared to those of the first-visit patients (p = 0.004 and p = 0.001 respectively).ConclusionsThere were different rates of malnutrition before and after liver transplantation. At the same time, BMD Z-score and serum vitamin D level of patients decreased. There was a significant correlation between BMD z-scores and WAZ/BMIZ values. Proper and professional nutrition guidance significantly improved the WAZ/BMIZ-values and BMD Z-score of liver transplantation patients.

PHYSICAL GROWTH AND NUTRITIONAL STATUS ASSESSMENT OF SCHOOL CHILDREN OF 6-12 YEARS IN SOCIOECONOMICALLY CHALLENGED AREAS OF RURAL BURHANPUR (MADHYA PRADESH)

Stronger immunity, fewer illnesses, improved health, and a productive society are all results of good nutrition. The majority of school-age children in India are undernourished or malnourished. Anthropometry is a quick and easy way to evaluate a child's dietary and socioeconomic status as they grow. Physical development, measured by weight and height, is seen as a crucial indicator of a community's growth and progress. So the aim of this study was to determine the prevalence of stunting and wasting. 150 children between the ages of 6 and 12 from socioeconomically deprived parts of rural Burhanpur were selected using the purposive sampling (volunteering) method and their heights and weights assessed using standardised techniques. Weight-for-age z-score (WAZ) BMI-for-age z-score (BAZ) and Height for age Z (HAZ) scores were calculated, and WHO growth references were used to categorise nutritional status. The prevalence of stunting, wasting and underweight children was found very high. . The overall prevalence of stunting was 72%, wasting was 77.94% and underweight students for their age were 66.73% as per WHO's international standards.School-aged children are frequently left out of surveys and surveillance programmes for nutrition and health. Therefore, there is a need for a nationwide health and nutritional survey that includes school-age children. The government of India needs to start a comprehensive nutrition education programme. Hence nutrition intervention programs should be launched among school children of rural Burhanpur district.

Effect of Moringa Oleifera fortified porridge consumption on protein and vitamin A status of children with cerebral palsy in Nairobi, Kenya: A randomized controlled trial.

Malnutrition due to inadequate dietary intake is commonly reported in children with Cerebral palsy (CP). Poor dietary intakes are majorly caused by feeding dysfunctions secondary to oro-motor impairment characteristic of the condition. Strategies that improve nutrient densities in foods can help enhance nutrient intakes by these children. This study investigated the effect of consumption of fermented finger millet porridge fortified with Moringa oleifera leaf powder (MoLP) on the protein and vitamin A status of children with CP. A randomized controlled trial was conducted among 113 children aged 5-11 years with CP. The study had two arms (intervention [N = 57] and control [N = 56]). The intervention group received a daily serving of fortified finger millet porridge for 3 months while the control group received non-fortified finger millet porridge servings. All children received the same amounts of porridge servings. The levels of serum albumin and retinol between the groups were compared at both baseline and end line. The BMI-for-age Z-scores (BMIAZ) and morbidity prevalence of the children were also assessed. At baseline, the two study groups were similar in all demographic and socio-economic characteristics, nutrient intakes, serum levels of albumin and retinol, weight status and morbidity. At end line, the children from the intervention group had significantly higher intakes of vitamin A at 717.12±432.7 μg/d (p = 0.038) and protein at 44.367±17.2 g/d (p = 0.031) respectively. The serum nutrients levels increased significantly from baseline by 0.456±0.12 g/dL (p<0.001) for albumin and by 0.243±0.10 μmol/L (p<0.001) for retinol among children in the intervention group. Among the children in the control group, the changes in the levels of both serum albumin 0.012±0.07 g/dL (p = 0.868) and serum retinol [0.0021±0.02 μmol/L (p = 0.890)] were not significant. At endline, the BMI-for-age Z-scores results showed that 10.52% and 34.0% of children from intervention and control group respectively were undernourished [χ2 = 30.985; p = 0.037]. Among the children in the intervention, group there was a significant change in the weight status between baseline and endline (p = 0.036). The weight status among children in the control group was not significantly different between baseline and endline (p = 0.109). Significant difference in morbidity prevalence between the two groups was also observed at endline (p = 0.003) with the prevalence being 24.6% and 51.8% among children in the intervention and control group respectively. Consumption of M. oleifera fortified porridge significantly improved the children's serum albumin and retinol levels, as well as BMIAZ. The trial is registered at Pan African Clinical Trials Registry, number PACTR202107669905145 URL link: https://pactr.samrc.ac.za/.

Assessment of Nutritional Status Among Children and Adolescents of Juang Tribe in Keonjhar District of Odisha, India

Assessment of the nutritional status is a major public health concern in India. Thinness (low BMI-for-age) is an important anthropometric measure of undernutrition. In the present scenario, tribal children were facing undernutrition due to lack of income, inadequate food intake, and suffering with various diseases. The objectives of the present study were to determine age groups and sex specific prevalence of thinness among children and adolescents of the Juang tribe of Keonjhar district in Odisha, India. The present cross-sectional study was carried out among 237 (106 male and 131 female) Juang children and adolescents aged 1–17 years. The prevalence of thinness was assessed by using proposed age-sex specific international reference. We used standard statistical technique for comparing the BMI-for-age z-score (BMIZ) means across the educational categories. The overall prevalence among the studied children was 15.61% and educational category wise prevalence of thinness among preschool, school going children, and adolescents were 11.94%, 19.05% and 15.12% respectively. Present scenarios of nutritional health status among Juang children and adolescents have secured a moderate position or have relatively improved. Continuity of the different intervention programs and government undertaking health policies may make a stable situation for good health among Juang children.

Lead Exposure in Infancy and Subsequent Growth in Beninese Children.

Studies suggest that elevated postnatal blood lead levels (BLLs) are negatively associated with child growth. This study aimed to investigate the associations of childhood BLLs at age one year and growth outcomes at age six years (n = 661) in a cohort of children in Allada, Benin. The growth outcomes studied are weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), BMI-for-age Z-score (BMIZ), weight-for-height Z-score (WHZ), head circumference (HC), growth velocities, underweight, stunting, and wasting. Multivariable regression models examined the associations between BLLs and growth outcomes, with adjustment for potential confounders. The geometric mean BLLs was 59.3 μg/L and 82% of children had BLLs >35 μg/L at the age of 12.8 months. After adjusting for confounding factors, no overall association was found between BLL quartiles and HAZ, WAZ, BMIZ, WHZ, growth velocities, wasting, and underweight. However, boys in the highest quartile had a 1.02 cm lower HC (95% CI: [−1.81, −0.24]) as compared to the lowest quartile. Furthermore, an increased odds of being stunted was observed in children in the highest quartile of exposure compared to the first (OR: 2.43; 95% CI: [1.11–5.33]) which remained statistically significant only among girls in sex-specific strata. Blood lead was found to be associated with an increased risk of childhood stunting and a lower head circumference in a resource-limited setting.

The Effects of Coconut Skim Milk and Coco-Dairy Milk Blend on the Nutritional Status of Schoolchildren.

Milk feeding can be an effective response to the high prevalence of child undernutrition as it provides significant amounts of nutrients. This study investigated and compared the effects of coconut skim milk (CocoM) and coco-dairy milk blend (CDMB) to cow's milk (CM) on improving the nutritional status of Filipino schoolchildren. The study followed a randomized, double-blind, controlled, parallel-group design. A total of 444 underweight/stunted schoolchildren aged 6.0–8.4 years old enrolled in Guadalupe Elementary School in Cebu City, Philippines, have participated. The participants were randomly allocated into three groups, that is, CocoM, CDMB, and CM, in which the milk products were packed in 200 ml color and number-coded bottles given for 95 days. The bottles were similar in form and shape, and the only differentiating factors were the code and color. Weight and height were measured using standard techniques. Nutritional indices such as weight-for-age z-score (WAZ), height-for-age z-score (HAZ), and BMI-for-age z-score (BAZ) were measured using the WHO Child Growth Standards (CGS), and the acceptability test was measured using the 5-point facial hedonic scale. The study found that the mean WAZ and BAZ had significantly increased from baseline to endpoint across all groups. Moreover, the prevalence of underweight has also significantly declined from baseline to endpoint in all groups, and the prevalence of stunting significantly declined from baseline to endpoint in the CocoM group only. Lastly, the three milk products were rated as generally acceptable. Overall, the findings indicate that coconut milk consumption could be beneficial for improving a child's WAZ and BAZ, as well as improving the nutritional status of underweight and stunted schoolchildren. CocoM and CDMB were found to be equally beneficial to child nutrition as cow's milk. Hence, the present study suggests that CocoM and CDMB could be also provided in school-based feeding programs with the aim of targeting child undernutrition.

The arithmetic dilemma when defining thinness, overweight and obesity in stunted populations

Background: Critical cut-off values of BMI-for-age z-scores (BAZ) are used to define “thinness”, “overweight” and “obesity”, but the validity of these cut-off values needs to be questioned in populations that are shorter or taller than the reference. We hypothesized that the prevalence of thinness, overweight, and obesity depends on population height and performed a random simulation.&#x0D; Methods: We created virtual child populations aged 2-10 years with normally distributed height expressed as height-for-age z-scores (HAZ) and weight expressed as weight-for-age z-score (WAZ), based on WHO growth standards and references, with a correlation r=0.7 between height and weight. We adjusted weight-for-height and calculated BAZ.&#x0D; Results: BAZ depends on height and age. In short children (mean HAZ=-2 to HAZ=-3), the prevalence of thinness falls to less than 1% in the youngest and rises up to 10% (mean HAZ=-2) and up to 13% (mean HAZ=-3) at age 10 years. The prevalence of obesity rises to up to 7% in the shortest and youngest and falls close to zero at age 10. Short young children and tall older children are more prone to be misclassified as overweight.&#x0D; Conclusions: The prevalence of thinness, overweight and obesity depends on height and age. The coexistence of being short and being overweight – currently referred to as “double burden of malnutrition” – needs consideration as to what extent this condition is a health issue or reflects calculation artefacts. The arithmetic dilemma particularly affects young children in short populations. We suggest abstaining from defining “thinness”, “overweight”, or “obesity” by BMI z-scores. Different states of under- and malnutrition should rather be classified by direct or indirect measures of body fat.

The association of cesarean section with overweight and neurodevelopment of Chinese children aged 1-5 months.

ObjectiveThe purpose of this survey was to explore the association of delivery mode with overweight and neurodevelopment of Chinese infants aged 1–5 months.Materials and methodsThis study was based on a cross-sectional survey. Data for this study were obtained from the Children’s Nutrition and Health System Survey in China which was conducted from 2019 to 2020. Characteristics of parents and children and the delivery mode were obtained using interview-administered questionnaires. Body mass index-for age z-score (BMI z) was calculated using World Health Organization (WHO) child growth standards. Children’s neurodevelopment was assessed by a trained child health care physician using the Child Psychological Development Scale. The association of delivery mode with infant overweight was analyzed using a multivariable logistic regression model. We conducted a multivariable linear regression model to explore the relationship between delivery modes with neurodevelopment.ResultsIn total, the present analysis included 1,347 children aged 1–5 months, 35.61% were born via cesarean section, of which 15.21% were overweight. After adjustment for infant characteristics and parental factors, the cesarean section was significantly related with the likehood of being overweight [OR = 1.95; 95% confidence interval (CI): 1.27 to 2.98]. Children born via cesarean section had a 3.41-point decrease in gross motor development (β = −3.41; 95% CI: −5.77 to −1.05), a 3.65-point decrease in fine motor development (β = −3.65; 95% CI: −6.03 to −1.28), and a 2.96-point in language development (β = −2.96; 95% CI: −5.20 to −0.73), a 1.65-point in total development (β = −1.65; 95% CI: −3.17 to −0.14) compared with those who were vaginal birth.ConclusionIn our study population, cesarean section was associated with overweight and neurodevelopment outcomes. The cesarean section might increase the likehood of infant overweight, and might decrease the developmental scores of gross motor, fine motor and language. Further studies should be conducted to verify the associations and explore the possible mechanisms.