Health Organization Child Growth Standards Research Articles

Analysis of overweight/obese pediatric patients with acute myeloid leukemia: a report from the Japanese Pediatric Leukemia/Lymphoma Study Group AML-05 study.

The dosage of chemotherapy drugs for overweight/obese children with acute myeloid leukemia (AML) has been empirically reduced based on ideal body weight (BW) in Japan to reduce the risk of adverse events. We investigated the associations between pre-therapeutic body mass index (BMI) and clinical outcomes among children with AML. A total of 280 children were divided into two groups based on the World Health Organization Child Growth Standards: a healthy-weight group (n=254), and an overweight/obese group (n=26). If BW exceeded 1.2 times the standard BW of Japanese children, the dosage of chemotherapy drugs was calculated using 1.2 times the standard BW. The dosage of chemotherapy drugs was reduced during at least one chemotherapy cycle in 24 of 26 patients (92.3%) in the overweight/obese group, compared with zero patients in the healthy-weight group. Overall/event-free survival, cumulative incidence of relapse, and treatment-related mortality (TRM) did not differ between the overweight/obese and healthy weight groups. However, the frequency of bacteremia was higher in the overweight/obese group (80.8 vs. 52.4%, P=0.006). This indicates that TRM may increase when chemotherapy drug dosage is not corrected in overweight/obese patients. Drug reduction is a potential treatment strategy.

Prevalence and predictive factors associated with stunting in preschool children in a governorate of Iraq: a community-based cross-sectional study.

The prevalence and risk factors of stunting in various geographical regions have been well investigated. However, not enough data exists regarding the communities in Iraq. This study investigated the prevalence and risk factors of stunting in preschool children in Halabja governorate. The required data for the study was collected through a structured questionnaire form from the children's parents. Then, the height and weight of the children were measured. According to the World Health Organization Child Growth Standards and using the WHO Anthro Survey Analyser software, children were classified as "stunted" when their height-for-age z-score was below two standard deviations. A total of 646 children were included, of which 310 (48%) were male and 336 (52%) were female. The gestational age of 556 (86%) children was 9 months, while 84 (13%) were born between 7-9 months, and 6 (1%) were born in 7 months. Regarding feeding during the first 2 years of life, 229 children (35.4%) were exclusively breastfed, 93 (14.4%) were bottle-fed, and 324 (50.2%) had mixed feeding. The prevalence of stunting was 7.9% in the sample pool, with 4.6% of females and 3.3% of males. Among stunted children, 6.35% were term babies, and 1.55% were preterm babies. None of the studied factors had a significant association with stunting. The prevalence of stunting in the studied population was 7.9%. However, we could not find any significant association between the studied factors and stunting. Thus, the factors that may significantly affect stunting in our area of study, especially the historical chemical warfare side effects, need to be more extensively investigated in future studies.

Temporal trends in growth of boys adopted from Russia

Introduction: The objective of this study is to contribute data on the temporal trends in weight, height, body mass index (BMI) and head circumference (HC) in boys adopted from Russia. Material and methods: Prospective observational study on an initial cohort of 139 Russian boys adopted in Spain between 2001 and 2013. Adverse history was collected by reviewing pre-adoption medical records. Anthropometric parameters were measured and recorded in a standardized way. The measurements obtained were compared with the World Health Organization child growth standards, calculating the corresponding z-scores (Z) and percentiles for age and sex. Results: Main history: preterm (32.4%), low birth weight (26.6%), prenatal alcohol exposure (19.4%), abandonment at birth (56.1%), abuse/neglect (49.3%). Initial post-arrival evaluation, 3 (1.7) years: weight Z, -1.24; height Z, -2.34; HC Z, -1.27. Significant catch-up growth (Z increase) in the first year: weight, +0.73; height, +1.05; HC, +0.6; in the second year: height, +0.58. Longitudinal growth pattern. Weight: from age 5 years, no relevant differences were observed. Height: at age 6 years a relevant delay persisted, from ages 7 to 11 years a gradual increase was observed, and from ages 12 to 17 years a gradual decrease, no showing relevant differences. BMI: showed that the degree of height delay was always higher than that of weight, balancing after age 14 years. HC: at age 5 years, there was no longer a relevant difference. Conclusions: These findings suggest that, despite the important delay of weight, HC, and especially height at the time of adoption, and the various adverse factors for growth that they presented, international adoption led to a substantial recovery of all anthropometric parameters, showing plasticity in the physical growth of these children.

Prenatal exposure to Per- and polyfluoroalkyl substances and adiposity measures of children at 4 and 6 years: A prospective birth cohort in China

There is growing evidence that prenatal exposure to Per- and polyfluoroalkyl substances (PFAS) was associated with childhood obesity, but evidence on multiple adiposity measures including arm circumference (AC), and waist circumference (WC) among Chinese children is limited. We investigated the associations of prenatal exposure to PFAS with adiposity measures of children at 4 and 6 years of age in the Shanghai-Minhang Birth Cohort Study. A total of 573 mother-child pairs with maternal PFAS concentrations and at least one measurement of adiposity measures of children were included in the present study. Eleven PFAS were assessed in maternal fasting blood samples. Information on children's weight, height, AC, and WC was collected at follow-ups. Weight for age Z score (WAZ), body mass index for age Z score (BMIz), and children overweight were calculated based on the World Health Organization Child Growth Standards. Multivariate linear regression, Poisson regression with robust error variance, and Bayesian Kernel Machine Regression (BKMR) models were used to examine the associations of prenatal exposure to PFAS with children's adiposity measures. Eight PFAS with detection rates above 85 % were included in the analyses. In the multivariate linear regression models, maternal PFNA concentrations were associated with a greater AC (β = 0.29, 95 % Confidence Interval (CI): 0.04–0.55) in 4-year-old children and with an increase in WAZ (β = 0.26, 95 % CI: 0.06–0.46), BMIz (β = 0.31, 95 % CI: 0.09–0.53), AC (β = 0.49, 95 % CI: 0.08–0.90), and WC (β = 1.47, 95 % CI: 0.41–2.52) in 6-year-old children. We also observed the associations of maternal concentrations of PFOS, PFNA, PFUdA, and PFTrDA with the increased risk of children overweight in 6-year-old children. BKMR models further supported the findings from multivariate linear regression and Poisson regression models, and identified PFNA as the most important contributor. Moreover, the associations described above were generally more pronounced in girls. In conclusion, prenatal exposure to PFAS was associated with an increased risk of children's adiposity with a sex-specific manner, and PFNA contributed most to the associations after controlling for the effect of co-exposure to other PFAS compounds, especially among girls at 6 years of age.

Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status

Although concern is frequently expressed regarding the potential impact of baby food pouch use and Baby-Led Weaning (BLW) on infant health, research is scarce. Data on pouch use, BLW, energy intake, eating behaviour and body mass index (BMI) were obtained for 625 infants aged 7–10 months in the First Foods New Zealand study. Frequent pouch use was defined as ≥5 times/week during the past month. Traditional spoon-feeding (TSF), “partial” BLW and “full” BLW referred to the relative proportions of spoon-feeding versus infant self-feeding, assessed at 6 months (retrospectively) and current age. Daily energy intake was determined using two 24-h dietary recalls, and caregivers reported on a variety of eating behaviours. Researchers measured infant length and weight, and BMI z-scores were calculated (World Health Organization Child Growth Standards). In total, 28% of infants consumed food from pouches frequently. Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; −19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4), food fussiness (0.3; 0.1, 0.4) and selective/restrictive eating (0.3; 0.2, 0.5). Compared to TSF, full BLW was associated with greater daily energy intake (BLW at 6 months: mean difference 150 kJ/day; 95% CI 4, 297; BLW at current age: 180 kJ/day; 62, 299) and with a range of eating behaviours, including greater satiety responsiveness, but not BMI z-score (6 months: 0.06 (−0.18, 0.30); current age: 0.06 (−0.13, 0.26)). In conclusion, neither feeding approach was associated with weight in infants, despite BLW being associated with greater energy intake compared with TSF. However, infants who consumed pouches frequently displayed higher food fussiness and more selective eating.

Height and body mass index trajectories from 1975 to 2015 and prevalence of stunting, underweight and obesity in 2016 among children in Chinese cities: findings from five rounds of a national survey

BackgroundA more comprehensive assessment of growth and nutrition in children is required in China due to rapid socioeconomic processes. We aimed to investigate height and body mass index (BMI) trajectories from 1975 to 2015 and the prevalence of stunting and obesity in 2016 among children in Chinese cities.MethodsA total of 904,263 children from birth to 6.9 years were collected from a series of nationally representative surveys in China. Height and BMI trajectories and prevalence of stunting, underweight, overweight and obesity were assessed.ResultsThe average height level of Chinese urban children under 7 years presented a positive secular trend from 1975 to 2015; however, a slowing tendency occurred in 2005‒2015. An apparent increase was observed at the 5th, 50th and 95th percentiles of BMI in urban children aged 3 years and older, with a more prominent increase at the 95th percentile. The total prevalence of stunting and underweight under 7 years was 1.4% and 2.0%, respectively. The total prevalence of overweight and obesity under 7 years was 12.6% and 4.3%, respectively, with 12.7% and 4.9% for boys, 12.6% and 3.6% for girls, 12.1% and 4.0% in urban areas and 13.1% and 4.5% in suburban rural areas.ConclusionsThe average height level of Chinese urban children has reached World Health Organization child growth standards since 2005 and presented a slowing tendency in secular trend in 2005‒2015. More attention and efforts and public health interventions should be urgently made to combat overweight and obesity among preschool children.6vUvDz8DH1EFmJqaqHYybhVideo

Comparison of two child growth standards in assessing the nutritional status of children under 6 years of age

Objective: To compare the application of China growth standard for children under 7 years of age (China standards) and World Health Organization child growth standards (WHO standards) in evaluating the prevalence of malnutrition in children aged 0-<6 years in China. Methods: The research data came from the national special program for science & technology basic resources investigation of China, named "2019-2021 survey and application of China's nutrition and health system for children aged 0-18 years". Multi-stage stratified random sampling was used to recruit 28 districts (regions) in 14 provinces, autonomous regions or municipalities across the country. Children (n=38 848) were physically measured and questionnaires were conducted in the guardians of the children. The indicators of stunting, underweight, wasting, overweight and obesity were evaluated by China standards and WHO standards respectively. Chi-square test was used to comparing the prevalence of each nutritional status between the two standards, as well as the comparison between the two standards by gender and age. Results: Among the 38 848 children, 19 650 were boys (50.6%) and 19 198 were girls (49.4%), 19 480 urban children (50.1%) and 19 368 rural children (49.9%). The stunting, underweight and wasting cases in the study population were 2 090 children (5.4%), 1 354 children (3.5%) and 1 276 children (3.3%) according to the China standards, and 1 474 children (3.8%), 701 children (1.8%) and 824 children (2.1%) according to the WHO standards, respectively; the above rates according to the China standards were slightly higher than those to the WHO standards (χ2=111.59, 213.14, and 99.99, all P<0.001). The overweight and obesity cases in the study population were 2 186 children (5.6%) and 1 153 children (3.0%) according to the China standards, and 2 210 children (5.7%) and 1 186 children (3.1%) according to the WHO standards, with no statistically significant differences (χ2=0.14 and 0.48, P=0.709 and 0.488, respectively). Compared to the results based on WHO standards, the China standards showed a lower prevalence of overweight and obesity in boys (χ2=14.95 and 5.85, P<0.001 and =0.016, respectively), and higher prevalence of overweight in girls (χ2=12.60, P<0.001); but there was no statistically significant differences in girls' obesity prevalence between the two standards (χ2=2.62, P=0.106). Conclusions: In general, the prevalence of malnutrition among children aged 0-<6 years based on China standards is slightly higher than that on WHO standards. To evaluate the nutritional status of children, it is advisable to select appropriate child growth standards based on work requirements, norms or research objectives.

Conserved Covarying Gut Microbial Network in Preterm Infants and Childhood Growth During the First 5 Years of Life: A Prospective Cohort Study

BackgroundLongitudinally conserved microbe-microbe interactions may provide insights to understand the complex dynamic system of early-life gut microbiota among preterm infants. ObjectivesWe aimed to profile the covarying network of gut microbiota among preterm infants and investigate its potential influence on host growth (2–5 y). MethodsWe collected time-series stool samples (n = 717 from children and n = 116 from mothers) among 51 preterm and 51 full-term infants from birth up to 5 y of age and among 53 mothers. The included infants underwent time-series measurements of early-life gut microbiota (0–5 y) and growth (2–5 y) from June 2014 to April 2017. The covarying taxa that exhibited consistent covariation from day 1 to year 5 were defined as conserved features in the development of gut microbiota. Childrens’ height-for-age z score (HAZ) and weight-for-age z score were calculated according to World Health Organization Child Growth Standards. ResultsWe observed distinct dynamic patterns of both microbial alpha and beta diversity comparing preterm infants with full-term controls during the very early stage (<3 mo). Moreover, we identified a covarying network containing 10 taxa as a conserved gut microbial feature of these preterm infants from birth to 5 y old. This covarying network was distinctive between preterm and full-term infants before 3 mo of age (P < 0.001) and tended to be similar as the infants grew up. Several covarying taxa of the network during early life (<3 mo) were associated with childhood growth (2–5 y) (eg, Clostridium_sensu_stricto_1 with HAZ, β = -0.32, q < 0.01), and the human milk feeding duration was a main modulating factor. ConclusionsPreterm born children possess conserved and distinct covarying microbiota during very early life, which may have a profound influence on their growth later in life.This trial was registered at clinicaltrials.gov as NCT03373721.

Nutritional status of children and its association with parental smoking in Uttar Pradesh

Background: Exposure to passive smoke due to smoking affects foetus and children. Previous studies have linked this exposure to an increased risk of malnutrition, infant death, respiratory illness and other disorders among infants. The investigation was made to explore the association between stunting of growth and children under 5 years of age who are underweight and are exposed to parental smoking. Exposure to second hand or passive smoke, has adverse impact during pregnancy on the mother as well as the baby. This could include cases of premature birth, birth defects or infant death and respiratory problems among the children. This study discusses the current evidence regarding the effects of parental smoking on their children's health in Uttar Pradesh. Methods: Parental smoking, and child anthropometry (undernutrition) were examined in a stratified, two-stage cluster sample of 232,920 kids under the age of 5 from National Family Health Survey (2015-16), out of which 35,766 were selected in the study from Uttar Pradesh. Prominent outcomes were that of stunting of growth and a proclivity in children towards remaining underweight. Results: Prevalence of parental smoking was found in 38.28% of households in Uttar Pradesh. Using the new World Health Organization child growth standards, prevalence of stunted growth, and underweight children was found in 39.34%, 31.15% of the households respectively. After adjusting for potential confounders parental (couple) smoking was associated with increased risk of stunting (AOR 1.17, 95%CI 1.0-1.37, p&lt;0.05), and underweight children (AOR 1.09, 95%CI 0.93-1.28). Conclusion: In Uttar Pradesh, parental smoking is associated with birth factors nutritional status and may divert household funds from food and other necessities towards smoking habits. Parental smoking was also associated with increased risk of stunting of growth and underweight children in the children. The result also suggests that strategies to prevent passive smoke exposure in young children to minimize tobacco smoke exposure are an urgent public and child health priority

Maternal weight, blood lipids, and the offspring weight trajectories during infancy and early childhood in twin pregnancies.

The intrauterine environment has a profound and long-lasting influence on the health of the offspring. However, its impact on the postnatal catch-up growth of twin children remains unclarified. Therefore, this study aimed to explore the maternal factors in pregnancy associated with twin offspring growth. This study included 3142 live twin children born to 1571 mothers from the Beijing Birth Cohort Study conducted from 2016 to 2021 in Beijing, China. Original and corrected weight-for-age standard deviation scores of the twin offspring from birth to 36months of age were calculated according to the World Health Organization Child Growth Standards. The corresponding weight trajectories were identified by the latent trajectory model. Maternal factors in pregnancy associated with the weight trajectories of the twin offspring were examined after adjustment for potential confounders. Five weight trajectories of the twin children were identified, with 4.9% (154/3142) exhibiting insufficient catch-up growth, 30.6% (961/3142), and 46.8% (1469/3142) showing adequate catch-up growth from different birth weights, and 15.0% (472/3142) and 2.7% (86/3142) showing various degrees of excessive catch-up growth. Maternal short stature [adjusted odds ratio (OR) = 0.691, 95% confidence interval (CI) = 0.563-0.848, P = 0.0004] and lower total gestational weight gain (GWG) (adjusted OR = 0.774, 95% CI = 0.616-0.972, P = 0.03) were associated with insufficient catch-up growth of the offspring. Maternal stature (adjusted OR = 1.331, 95% CI = 1.168-1.518, P < 0.001), higher pre-pregnancy body mass index (BMI) (adjusted OR = 1.230, 95% CI = 1.090-1.387, P < 0.001), total GWG (adjusted OR = 1.207, 95% CI = 1.068-1.364, P = 0.002), GWG rate (adjusted OR = 1.165, 95% CI = 1.027-1.321, P = 0.02), total cholesterol (TC) (adjusted OR = 1.150, 95% CI = 1.018-1.300, P = 0.03) and low-density lipoprotein-cholesterol (LDL-C) (adjusted OR = 1.177, 95% CI = 1.041-1.330) in early pregnancy were associated with excessive growth of the offspring. The pattern of weight trajectories was similar between monochorionic and dichorionic twins. Maternal height, pre-pregnancy BMI, GWG, TC and LDL-C in early pregnancy were positively associated with excess growth in dichorionic twins, yet a similar association was observed only between maternal height and postnatal growth in monochorionic twins. This study identified the effect of maternal stature, weight status, and blood lipid profiles during pregnancy on postnatal weight trajectories of the twin offspring, thereby providing a basis for twin pregnancy management to improve the long-term health of the offspring.

Sosialisasi Penggunaan Aplikasi Pemantauan Kasus Stunting di Desa Kemuning Lor Kabupaten Jember

In 2016, around 22.9% or 154.8 million children worldwide suffered from stunting at the age of under 5 years. Stunting is defined as the length or height below the standard. Stunting is measured by a z-score of height and age of more than 2 standard deviations which is below the World Health Organization (WHO) Child Growth Standards. Based on the results of observations on November 25, 2022 in Kemuning Lor Village, the community service team found that cadres and mothers could be said to be of productive age with an average of already having smartphones which were underutilized in monitoring the nutritional status of toddlers. In community service activities, an application was developed that is useful in reducing and monitoring the number of stunting cases in Kemuning Lor Village, Jember Regency. The implementation methods carried out in this community service activity are literature (literary study), location surveys, application design and outreach. As for the results of this community service activity, 90% of posyandu cadres feel helped by the baby nutrition monitoring application. In the future this application will be integrated from each region so that stunting cases in Jember Regency can be monitored through one application.

Weight-for-age z-scores of Japanese children using the World Health Organization Child Growth Standards.

Weight-for-age z-scores of Japanese children using the World Health Organization Child Growth Standards.

Gestational exposure to organophosphate esters and infant anthropometric measures in the first 4 weeks after birth.

Few studies have examined whether gestational exposure to organophosphate esters (OPEs), widely used chemicals with potential endocrine-disrupting potency and developmental toxicity, is associated with impaired infant growth. We analyzed data from 329 mother-infant pairs in the Health Outcomes and Measures of the Environment (HOME) Study (2003-2006, Cincinnati, Ohio, USA). We quantified concentrations of four OPE metabolites in maternal urine collected at 16 and 26 weeks of gestation, and at delivery. We calculated z-scores using 2006 World Health Organization (WHO) child growth standards for the 4-week anthropometric measures (weight, length, and head circumference), the ponderal index, and weekly growth rates. We used multiple informant models to examine window-specific associations between individual OPE metabolites and anthropometric outcomes. We further modeled OPEs as a mixture for window-specific associations with 4-week anthropometric outcomes using mean field variational Bayesian inference procedure for lagged kernel machine regression (MFVB-LKMR). We stratified the models by infant sex. Diphenyl phosphate (DPHP) in mothers at 16 weeks, and bis(2-chloroethyl) phosphate (BCEP) and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) at delivery were positively associated with z-scores of weight, length, and head circumference in all infants at 4 weeks of age. After stratifying by infant sex, positive associations were only observed in males for DPHP at 16 weeks and BCEP at delivery and in females for BDCIPP at delivery. Negative associations not present in all infants were observed in males for di-n-butyl phosphate (DNBP) at 26 weeks of gestation with weight z-score and DPHP at delivery with head circumference z-score. Results were generally similar using MFVB-LKMR models with more conservative 95 % credible intervals. We did not identify consistent associations of gestational OPE metabolite concentrations with the ponderal index and weekly growth rates. In this cohort, exposure to OPEs during gestation was associated with altered infant anthropometry at 4 weeks after birth.

Accuracy of Fully Automated 3D Imaging System for Child Anthropometry in a Low-Resource Setting: Effectiveness Evaluation in Malakal, South Sudan.

Adoption of 3D imaging systems in humanitarian settings requires accuracy comparable with manual measurement notwithstanding additional constraints associated with austere settings. This study aimed to evaluate the accuracy of child stature and mid-upper arm circumference (MUAC) measurements produced by the AutoAnthro 3D imaging system (third generation) developed by Body Surface Translations Inc. A study of device accuracy was embedded within a 2-stage cluster survey at the Malakal Protection of Civilians site in South Sudan conducted between September 2021 and October 2021. All children aged 6 to 59 months within selected households were eligible. For each child, manual measurements were obtained by 2 anthropometrists following the protocol used in the 2006 World Health Organization Child Growth Standards study. Scans were then captured by a different enumerator using a Samsung Galaxy 8 phone loaded with a custom software, AutoAnthro, and an Intel RealSense 3D scanner. The scans were processed using a fully automated algorithm. A multivariate logistic regression model was fit to evaluate the adjusted odds of achieving a successful scan. The accuracy of the measurements was visually assessed using Bland-Altman plots and quantified using average bias, limits of agreement (LoAs), and the 95% precision interval for individual differences. Key informant interviews were conducted remotely with survey enumerators and Body Surface Translations Inc developers to understand challenges in beta testing, training, data acquisition and transmission. Manual measurements were obtained for 539 eligible children, and scan-derived measurements were successfully processed for 234 (43.4%) of them. Caregivers of at least 10.4% (56/539) of the children refused consent for scan capture; additional scans were unsuccessfully transmitted to the server. Neither the demographic characteristics of the children (age and sex), stature, nor MUAC were associated with availability of scan-derived measurements; team was significantly associated (P<.001). The average bias of scan-derived measurements in cm was -0.5 (95% CI -2.0 to 1.0) for stature and 0.7 (95% CI 0.4-1.0) for MUAC. For stature, the 95% LoA was -23.9 cm to 22.9 cm. For MUAC, the 95% LoA was -4.0 cm to 5.4 cm. All accuracy metrics varied considerably by team. The COVID-19 pandemic-related physical distancing and travel policies limited testing to validate the device algorithm and prevented developers from conducting in-person training and field oversight, negatively affecting the quality of scan capture, processing, and transmission. Scan-derived measurements were not sufficiently accurate for the widespread adoption of the current technology. Although the software shows promise, further investments in the software algorithms are needed to address issues with scan transmission and extreme field contexts as well as to enable improved field supervision. Differences in accuracy by team provide evidence that investment in training may also improve performance.

Development of a Zimbabwean child growth curve and its comparison with the World Health Organization child growth standards.

BackgroundThere is limited research that describes the growth trajectories of African children. The development of World Health Organization (WHO) growth standards considered a sample of children who lived in environments optimum for human growth.AimThis study aimed to develop weight-for-age and height-for-age growth curves from the Zimbabwean 2018 National Nutrition Survey and compare them with the WHO growth standards.SettingStudy participants were recruited from all districts in Zimbabwe.MethodsHeight-for-age and weight-for-age data collected from 32 248 children were used to develop the Zimbabwean references. Smooth growth curves (height, weight and body mass index [BMI]-for-age) were estimated with the Lambda Mu Sigma (LMS) method and compared with the WHO growth standards.ResultsZimbabwean children were shorter and weighed less in comparison with the WHO growth standards. The –2 standard deviation (s.d.) Z-score curves (height-for-age) for Zimbabwean children (boys and girls) were below the –1 s.d. Z-score curves of the WHO growth standards. The Zimbabwean Z-scores (BMI-for-age) values above –1 s.d. were significantly higher in comparison with the corresponding WHO growth standards.ConclusionUtilising the WHO growth standards would diagnose a higher proportion of Zimbabwean children as stunted whilst underestimating the proportion at risk of obesity. The WHO growth standards lack a consideration of the geographical, economic, political and environmental constraints existing between countries.

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.

Adverse childhood experiences, bullying, inflammation and BMI in 10-year-old children: The biological embodiment.

Exposure to adversity during the first years of life might already be biologically embedded well before adult life. Thus, the impact of different stressful experiences needs to be explored. This study aims to examine if the association between being victimized (adverse childhood experiences—ACEs and bullying) and (hs-) C-Reactive Protein (CRP) is explained by the influence of adversity on the body mass index (BMI) of the child. We included children from the Portuguese birth cohort Generation XXI (n = 3712) that at 10 years of age completed a questionnaire on the exposure to ACEs and bullying victimization, assessed by an adaptation from the original ACEs study and an adaptation of The Bully Scale Survey, respectively. Following an overnight fast, a venous blood sample was collected by trained nurses and hs-CRP was assayed in fresh blood samples. Weight and height were measured with the child in underwear and bare feet. Weight was measured to the nearest one-tenth of a kilogram with the use of a digital scale (Tanita), and height was measured to the nearest one-tenth of a centimetre with the use of a wall stadiometer (seca®). BMI was calculated as the value of weight (kg) over squared height (m), and computed as an age- and sex-specific BMI standard deviation (SD) score (z-score), according to the World Health Organization Child Growth Standards (5–19 years). Regression coefficients and respective 95% Confidence Interval [β(95%CI)] were computed using path analysis. We observed that ACEs had a positive total effect on hs-CRP at the age of 10 years (β = 0.06; 95%CI: -0.02; 0.15). A direct effect (β = 0.02; 95%CI: -0.01; 0.06) accounted for 66.1% of the association between ACEs and hs-CRP. A positive total effect of bullying victimization on hs-CRP (β = 0.20; 95%CI: 0.06; 0.34) was observed. A direct effect (β = 0.08; 95%CI: -0.05; 0.21) accounted for 40.0% of the association, while an indirect effect through BMI (β = 0.12; 95%CI: 0.06; 0.18) explained 60.0% of the pathway between bullying victimization and hs-CRP. Results suggest that there might be different mechanisms involved in the biological embedding of childhood experiences. BMI seems to explain a great part of the association between exposure to bullying victimization and hs-CRP at 10 years of age. Further research is still needed to better understand the mechanisms explaining the emergence and persistence of health poorer outcomes later in life for victims of abuse.

Association Between Longitudinal Changes in Body Mass Index (BMI) and Body Fat With Cardiometabolic Risk Factors in Indian Children and Adolescents

ObjectivesTo evaluate the associations between longitudinal changes in body mass index (BMI) and body fat mass (FM%) with cardiometabolic risk factors in school-aged children and adolescents from South India.MethodsThis prospective school-based study comprised 4,289 children and adolescents (44.2% male) aged 5–17y participating in the PEACH-II and III studies in Bengaluru, India. Anthropometry and FM% (BOD POD, Cosmed; 5.2.0) were measured twice with a median age gap of 2.8y. Waist circumference (WC), systolic/diastolic blood pressure, HbA1c, and lipid profile were measured at endline. BMI-for-age z-scores were calculated using the World Health Organization Child Growth Standards, and were used to define overweight (≥+1 SD to < +2 SD) and obesity (≥+2 SD). Linear regression was used to examine the associations between longitudinal changes in BMI-for-age z-scores and FM% with cardiometabolic risk factors, after adjusting for parental BMI, socioeconomic status, age of menarche, inflammation (c-reactive protein), physical activity and night sleep duration.ResultsThe prevalence of overweight/obesity and mean FM% increased from 15.2% to 20.5%, and 19.5% to 21.7%, respectively during follow-up. Overall, 43.8% and 15.5% of the participants had high triglycerides (TG, ≥200 mg/dL), and elevated HbA1C (≥5.7%), while 40.9% had low HDL (< 40 mg/dL); a total of 69.1% of participants had ≥ 1 abnormal biomarker(s). Increment in BMI for-age z-score of 1SD overtime was significantly associated with higher WC (β: 2.9, [SE:0.20] cm), TG (8.4, [1.3] mg/dL), HbA1c (0.17, [0.06] %), total cholesterol (1.6, [0.56] mg/dL), and lower HDL (−1.3, [0.26] mg/dL). Longitudinal increment in FM% was associated with higher WC (0.3, [0.03] cm), TG (1.2, [0.15] mg/dL) and total cholesterol (0.4, [0.1] mg/dL).ConclusionsThe burden of overweight/obesity and FM% substantially increased in this population of South Indian children and adolescents overtime, and were associated with cardiometabolic risk factors. Regular monitoring of BMI and body composition can help to identify children at risk of developing cardiovascular diseases. Appropriate dietary and lifestyle interventions for children at risk are needed in India, where chronic diseases and associated deaths are increasing at alarming rate in young and older adults.Funding SourcesFunded by Indian Council of Medical Research.

Effect of Moringa Oliefera Supplementation During Pregnancy on Nutritional Status in Children 2–5 Years Old in Indonesia: A-Follow-Up Study

Objectiveso examine the effects of prenatal Moringa oliefera extract (EG) or powder (PG), compared to iron-folic acid (IFA) supplementation during pregnancy on nutritional status of children aged 2–5 years in Indonesia.MethodsParticipants were children (2–5 y) born to pregnant women who participated in a randomized controlled trial. In the parent trial, pregnant women were randomized to receive Moringa oliefera extract (EG) or powder (PG), or iron-folic acid (IFA), twice weekly during pregnancy beginning in the third trimester. Capillary blood samples were collected in children lby a trained phlebotomist. Whole blood samples were analyzed for hemoglobin (Hb) via portable hemoglobinometer (HemoCue Hb 201 + analyser, Helsinborg, Sweden). Hepcidin concentrations were measured by ELISA (ELISA Technique, BT LAB, Shanghai, China) and lactic acid was measured via RT-PCR. Anemia was defined as hemoglobin concentrations of < 11.0 g/dL. Height-for-age (HAZ) Z-scores were calculated using the World Health Organization (WHO) Child Growth Standards and used to define stunting (HAZ < −2 SD). Multivariate analyses were conducted to determine the effect of a the interventions on outcomes.ResultsThe prevalence of stunting at baseline in EG was 42 (28.8) lower than PG and IFA [59 (40.4) and 45 (30.8)]. The prevalence of stunting (HAZ < −2) was lower at each time point (i.e., 2–3 y; 3–4 y; 4–5 y) during follow-up in the EG group, compared to PG or IFA groups (P < 0.05), and the number of stunted cases significantly decreased during follow-up in the EG group, compared to the PG or IFA groups (P < 0.05). The quantity of lactobacillus lactic acid bacteria was significantly higher in the EG group compared to the other groups at 2–3 y (6.88 log CFU/gram vs. 6.57; 5.94 log CFU/gram; P < 0.05). Hepcidin concentrations were significantly higher in EG groups than PG or IFA (1.85 ng/mL vs 1.38; 0.9 ng/mL, although there were no differences in hemoglobin concentrations between intervention groups.ConclusionsFindings suggest that Moringa oleifera extract supplementation during pregnancy was associated with lower prevalence of stunting in children in this population.Funding SourcesFunding in research is supported by Directorate General of Higher Education, Research, and Technology, Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia.

Longitudinal Changes in Waist Circumference and Waist-to-Height Ratio in Children and Adolescents in Southern India

ObjectivesWaist-to-height ratio has been proposed as a surrogate indicator to screen for abdominal obesity in children. The objective of this analysis was to examine longitudinal changes in waist circumference and waist-to-height ratio in school-aged children and adolescents in Southern India.MethodsParticipants were 3,955 children and adolescents (6–16 y) participating in a prospective school-based study in Bangalore, India (PEACH-II and III). Anthropometry, including weight, height, and waist circumference (WC), were collected at baseline and endline, with a median follow up of 2.9 years [IQR: 2.0–4.0 y]. Elevated waist circumference was defined as ≥75th percentile, based on age- and sex-specific percentile curves developed for this population. Waist-to-height ratio (WHtR) was calculated as waist circumference (cm) divided by height (cm), and elevated WHtR was defined as ≥0.5. Body mass index (BMI)-for-age z-scores were calculated using the World Health Organization (WHO) Child Growth Standards, to define overweight (≥+1 to < +2 SD) and obesity (≥+2 SD). Paired t-tests and McNemar test were used to examine changes in WC and WHtR during follow-up.ResultsAt baseline, a total of 11.4% participants were overweight and 4.1% were obese. The prevalence of elevated WC increased from 15.4% to 27.1% during follow-up (P < 0.001), with an average increase of 9.92 [SD: 8.46] cm. The prevalence of elevated WC increased from 9.2% to 26.3% (P < 0.001) among children who were normal weight at baseline, and 60.0% to 75.3% (P < 0.001) among children who were overweight. The prevalence of elevated WHtR increased from 9.6% to 20.5% during follow-up (P < 0.001), with the greatest increases in children who were normal weight (2.9% to 17.6% [P < 0.001]) or overweight (42.0% to 62.5% [P < 0.001]) at baseline.ConclusionsThe prevalence of elevated WC and WHtR was substantial in this population and increased over time. Findings suggest that WHtR, which is easy to measure and interpret, could be used in addition to WC during routine school-based examination to screen for risk of overweight and central adiposity.Funding SourcesPartially funded by Indian Council of Medical Research (ICMR); Fulbright Commission and National Research and Development Agency (ANID) of Chile fellowship (XEPM).