Height-for-age Z-score Research Articles

Nutritional and Obesity Status of Children and Adolescents with ADHD: a case-control study

Objective: Due to their prone to obesity and unbalanced nutrient intake this study was carried out to evaluate the daily energy and nutrient intake and obesity status of children and adolescents with attention deficit hyperactivity disorder (ADHD). Methods: The study was conducted on a total of 390 children (169 ADHD and 221 control groups) between the ages of 6-17 years. Body weight and height were measured and height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and BMI-z-score (BMIZ) were calculated. 24-hour dietary recalls of the participants were recorded, and energy and nutrients intake were analysed. The ratio of meeting daily energy and nutrients adequacy according to age and gender was calculated. Results: The HAZ values of the children with a mean age of 10±2 years were within the normal range in most of both groups. The ratio of overweight-obese children was 43.8% in the ADHD group and 39.8% in the control group, respectively. The ratio of energy from fat was high in both groups (ADHD: 39%, control: 41%) (p <0.05). It was found that folic acid and thiamine were sufficient in both groups, pyridoxine was consumed in borderline excess, other vitamins were consumed in excess. All minerals except sodium were sufficient and sodium was consumed more. Folic acid and water consumption were found to be less in children with ADHD (p <0.05). Conclusion: Overweight and obese rates are common among children and adolescents with ADHD, and their eating habits are similar to those of their healthy peers. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 171-179

Calibration of Bioelectrical Impedance Analysis Against Deuterium Dilution for Body Composition Assessment in Stunted Ugandan Children

BackgroundBIA represents an important tool in body composition (BC) assessment, especially in low-income settings in which simple and affordable options are preferred. There is a particular need to measure BC in stunted children, in which cases population-specific BIA estimating equations are lacking. ObjectivesWe calibrated an equation to estimate body composition from BIA using deuterium dilution (2H) as the criterion method in stunted children. MethodsWe measured BC with 2H and performed BIA in stunted Ugandan children (n = 50). Multiple linear regression models were constructed to predict 2H-derived FFM from BIA-derived whole-body impedance and other relevant predictors. Model performance was expressed as adjusted R2 and RMSE. Prediction errors were also calculated. ResultsParticipants were aged 16–59 mo, of whom 46% were girls, and their median (IQR) height-for-age z-score (HAZ) was −2.58 (−2.92 to −2.37) according to the WHO growth standards. Impedance index (height2/impedance measured at 50 kHz) alone explained 89.2% variation in FFM and had an RMSE of 583 g (precision error 6.5%). The final model contained age, sex, impedance index, and height-for-age z-score as predictors and explained 94.5% variation in FFM with an RMSE of 402 g (precision error 4.5%). ConclusionsWe present a BIA calibration equation for a group of stunted children with a relatively low prediction error. This may help evaluate the efficacy of nutritional supplementation in large-scale trials in the same population.

Association between Leptin, Adiponectin Levels, and Nutritional Status in Children with Down Syndrome

Background: Children with Down Syndrome (DS) have been associated with obesity. Leptin and adiponectin were also significant predictors of obesity and its comorbidity in DS. However, there was limited data regarding leptin and adiponectin in children with DS, particularly who were undernutrition. This study aimed to seek the role of leptin levels, adiponectin levels, and nutritional status in children with DS.
 Methods: This cross-sectional study was conducted on 40 children with DS aged 1 - 5 years. Height and weight were measured, and then the growth was interpreted using a DS growth chart. The Weight for Height Z-Score (WHZ) and Height for Age Z-Score (HAZ) were determined, and Mid-Upper Arm Circumference (MUAC) was measured. Leptin and adiponectin serum were analyzed using the enzyme-linked immunosorbent assay (ELISA) method. Mann-Whitney test was done to compare leptin and adiponectin levels in normal and wasted groups, while Spearman’s analysis was carried out to correlate laboratory results and anthropometric parameters.
 Results: Forty children participated (23 males, 17 females) with a median age was 25.5 months. Ten out of 40 children with DS (25%) were wasted and leptin was significantly lower in wasted compared to normal children. In addition, leptin was significantly correlated with WHZ (r = 0.415; p = 0.008), and MUAC (r = 0.427; p = 0.006), while adiponectin did not significantly correlate with those anthropometric variables in both wasted or non-wasted groups.
 Conclusion: Leptin is associated with WHZ and MUAC, and it decreases in wasted children with DS.

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.

Impact of air pollution on stunting among children in Africa

BackgroundUndernutrition is a global public health crisis, causing nearly half of deaths for children under age 5 years. Little is known regarding the impact of air pollution in-utero and early childhood on health outcomes related to undernutrition. The aim of our study is to evaluate the association of prenatal and early-life exposure to PM2.5 and child malnutrition as captured by the height-for-age z-score (HAZ), and stunting in 32 countries in Africa. We also evaluated critical windows of susceptibility during pregnancy to each environmental risk.MethodsWe linked nationally representative anthropometric data from 58 Demographic and Health Surveys (DHS) (n = 264,207 children < 5 years of age) with the average in-utero PM2.5 concentrations derived from satellite imagery. We then estimated associations between PM2.5 and stunting and HAZ after controlling for child, mother and household factors, and trends in time and seasonality.ResultsWe observed lower HAZ and increased stunting with higher in-utero PM2.5 exposure, with statistically significant associations observed for stunting (OR: 1.016 (95% CI: 1.002, 1.030), for a 10 μg/m3 increase). The associations observed were robust to various model specifications. Wald tests revealed that sex, wealth quintile and urban/rural were not significant effect modifiers of these associations. When evaluating associations between trimester-specific PM2.5 levels, we observed that associations between PM2.5 and stunting was the largest.ConclusionsThis is one of the first studies for the African continent to investigate in-utero and early-life exposure to PM2.5 is an important marker of childhood undernutrition. Our results highlight that PM2.5 concentrations need to be urgently mitigated to help address undernutrition in children on the continent.

Factors associated with stunting among children 0 to 59 months of age in Angola: A cross-sectional study using the 2015-2016 Demographic and Health Survey.

Stunting among children under five years of age is a serious public health problem globally, with life-long consequences to health, well-being, and productivity. Stunted growth has complex and multifactorial causes, reflecting the interaction of a broad range of conditions that determine child health. The Angola 2015-2016 Demographic and Health Survey (DHS) collected nationally representative anthropometry for 6,359 children 0 to 59 months of age in Angola, and ascertained exposure to a wide range of child, parental, socio-economic, and geographic variables. This study used a cross-sectional design to identify exposures associated with stunting among children 0 to 59 months of age in Angola, while considering the multifactorial and multi-level causes of stunting. Main outcome was prevalence of stunting, defined as proportion of children with height-for-age Z-score (HAZ) two or more standard deviations below the median. Prevalence of stunting was associated with individual, household, and area-level exposure variables, including child age and sex, birth order, birthweight, diarrhea, maternal and paternal age and education, source of water, sanitary system, and province. In conclusion, prevalence of stunting in Angola is associated with several factors previously described in the literature. Stunting is associated with exposures at the distal, intermediate, and proximal levels, in line with the framework on the causes of childhood malnutrition. This study identifies opportunities for interventions at multiple levels to decrease prevalence of stunting among children in Angola. Main limitations of this study are the potential for survival bias and residual confounding.

Drivers of Stunting Reduction in Yogyakarta, Indonesia: A Case Study.

Chronic malnutrition in children is a severe global health concern. In Yogyakarta, the number of children who are too short for their age has dropped dramatically over the past few decades. To perform an analysis of trends, policies, and programs; and an assessment of government, community, household, and individual drivers of the stunting reduction in Yogyakarta, Indonesia. Using a mixed-methods approach, there were three types of research: (1) analysis of quantitative data, (2) evaluation of stunting policy, and (3) focus group discussions and in-depth interviews to collect qualitative data. The prevalence of stunting has decreased from year to year. Mean height-for-age z-scores (HAZ) improved by 0.22 SDs from 2013 to 2021. Male and female toddlers aged <20 months have relatively the same body length as the WHO median, but it is lower for children >20 months old. The COVID-19 pandemic has contributed to an increase in stunting-concurrent wasting. Nutrition-specific and -sensitive interventions have been carried out with coverage that continues to increase from year to year, although in 2020, or at the beginning of the COVID-19 pandemic, the coverage of specific interventions decreased. The government has committed to tackling stunting by implementing the five pillars of stunting prevention and the eight convergent stunting actions. As the drivers of stunting reduction, national and community stakeholders and mothers, at the village level, cited a combination of poverty reduction, years of formal education, prevention of early marriage, access to food, enhanced knowledge and perception, and increased access to sanitation and hygiene. Nutrition-specific and -sensitive sector improvements have been crucial for decreasing stunting in Yogyakarta, particularly in the areas of poverty reduction, food access, preventing child marriage, sanitation, education, and increasing knowledge and perception.

Isolated growth hormone deficiency and amenorrhea – Case report

Growth hormone (GH) deficiency is the most common hypopituitarism disorder. We highlight the challenges to its diagnosis and management in the setting of a developing country. A 14-year-old came with a chief complaint of inability to menstruate. Menarche was at 12-years old, lasted 7 days, soaking 2 pads/day which discontinued shortly after. Thelarche was at 12-years-old and her breast is at Tanner stage 3. Her axillary and pubic hair are at Tanner stage 1. Height was 120 cm, weight 34.8 kg, height for age z-score<-3. Her lab results were normal for estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin. Bone age was suitable for age. Magnetic resonance imaging revealed pituitary gland hypoplasia (5.3 mm). A hormonal panel 3 years prior showed abnormally low GH level but normal cortisol and thyroid hormone levels. She was diagnosed with isolated growth hormone deficiency (IGHD) with delayed puberty. She was treated with medroxyprogesterone tablets once daily, after which her menstruation restarted. However, due to her economic background, she declined genetic tests, discontinued her medication and amenorrhea recurred. Amenorrhea present after a brief menarche should alert gynaecologists of a possible multi-hormone disorder with an underlying structural abnormality. IGHD may be due to a structural abnormality, such as pituitary gland hypoplasia. Unfortunately, economic reasons prevented the patient from receiving optimal treatment. IGHD rarely presents with a gynaecological complaint. Hormonal and genetic tests along with imaging should be undertaken. Growth hormone supplementation is the treatment of choice.

Nutritional knowledge and practices of mothers/caregivers and its impact on the nutritional status of children 6–59 months in Sefwi Wiawso Municipality, Western-North Region, Ghana

BackgroundGood maternal/caregiver nutrition knowledge protects the child from events that lead to low weight-for-age z-score (WAZ) and low height-for-age z-score (HAZ). Indicators of good child nutritional status have traditionally been low in cocoa-growing areas. This paper aimed to explore the relationship between maternal nutrition knowledge and practices and its effect on the nutritional status of children 6–59 months in the Sefwi Wiawso municipality; a predominant cocoa-growing area in Ghana. MethodologyA cross-sectional study design was used to assess nutrition knowledge, nutritional practices of mothers and dietary adequacy and nutritional status of their children using 24-hour dietary recall and anthropometric measures. ResultsA total of 226 caregiver-child pairs were recruited for the study. The level of nutritional knowledge was average (61.5%) among caregivers/mothers. Most caregivers (92.3%) initiated breastfeeding within 1 hour of giving birth. A total of 66% of mothers practiced exclusive breastfeeding. Complementary feeding was initiated at 6 months in 83.6% of the cases. The prevalence of underweight, wasting, and stunting were 8.29%, 10.23%, and 16.74% respectively. There was no significant association between mother/caregiver's nutrition knowledge and child malnutrition status although the risk of wasting reduced with increasing nutritional knowledge of caregivers (p = 0.118). ConclusionThere was no association between maternal nutrition knowledge and the nutritional status of children even though wasting showed a pattern of decrease with increasing nutritional knowledge. The prevalence of malnutrition in children in the study was comparatively lower than the national average. Underweight was statistically significantly higher in children whose mothers/caregivers were farmers hence appropriate nutrition education with a focus on infant and young child feeding practices should be promoted during antennal care and child welfare clinic services within these communities. Family planning services targeted particularly at teenage girls should be instituted to prevent teenage pregnancies as malnutrition is more likely to occur in children born to teenage mothers.

Differences Family Support and Posyandu Visit Frequency Between Stunted and Non Stunted 12-59 Months Old Toddler

Stunting are common at the age of 12-59 months. Some things that can affect the growth of toddler are family, parenting patterns, health services and environmental conditions. Family support is very important for children especially for their nutritional status. An example of health services for toddlers is Posyandu. Posyandu has benefits for society include monitoring the growth of toddlers so they do not suffer from stunting. The aim of the study was to determine differences family support and Posyandu visit frequency between stunted and non stunted 12-59 months old toddlers at Tambakrejo village Pemalang regency. This is a cross sectional study. The research subjects were toddlers 12-59 months old in Tambakrejo village. Stunted was determined by height for age z-score &lt;-2SD. Independent t-test dan Mann Whitney test was conducted to determine differences family support and Posyandu visit frequency between stunted and non stunted toddler. Family support score in the stunted toddler group was 35,77 and Posyandu visit frequency was 5,40 times. Family support score in the non stunted toddler group was 54,27 dan Posyandu visit frequency was 8,97 times. There was a significant difference family support and Posyandu visit frequency between stunted and non stunted toddlers. Non stunted toddlers have better family support compared to stunted toddlers. Posyandu visit frequency of stunted toddlers is lower than non stunted toddlers.

Dietary diversity is associated with nutrient adequacy, blood biomarkers and anthropometric status among preschool children in poor ethnic minority area of Northwest China.

This study aimed to evaluate the status of dietary diversity, nutrient adequacy, blood biomarkers of nutrients, and anthropometric status, as well as to determine the predictors of dietary diversity score (DDS) and mean adequacy ratio (MAR) among preschool children in poor ethnic minority areas of northwest China. A total of 578 healthy preschool children aged 3-6 from 17 kindergartens were selected to assess dietary intake, anthropometric status (height-for-age z-score (HAZ), weight-for-age z-score (WAZ), weight-for-height z-score (WHZ), and blood biomarkers. DDS and nutrient adequacy ratio (NAR) were adopted to assess dietary diversity and micronutrient adequacy, respectively. The mean DDS (ranging from 1 to 9) was relatively low (4.67 ± 1.56). Most participants consumed starchy staples, but few participants consumed organ meat. DDS was associated with serum potassium, serum iron, WAZ, HAZ, all NARs, and MAR (all p < 0.05). Living in urban areas (β = 0.158), higher household wealth (β = 0.116), and more caregivers' nutritional knowledge (β = 0.022) were positively associated with DDS (all p < 0.01), while living in urban areas (β = 0.031), higher education of caregivers (β = 0.0.027), and higher DDS (β = 0.049) were positively associated with MAR (all p < 0.01). In conclusion, dietary diversity was associated with nutrient adequacy and other health outcomes. Nutritional education and poverty alleviation are integral to improving the nutritional status of preschool children.

The impact of Nepal's earthquake on the health status of rural children

AbstractWe study the impact of Nepal's 2015 earthquake on the health status of children aged 0–5 years. Using a difference‐in‐differences approach we find that the earthquake decreased height‐for‐age z‐scores (HAZ) and that this effect is largely driven by females, who experienced an average decline of −0.763 standard deviations in their HAZ. Further, we find that females in the 0–3 years age group and in the least wealthy households are the most vulnerable. This is particularly unfortunate, as the first 3 years of life can impact long‐term health and well‐being, and female undernutrition contributes to the intergenerational transmission of poverty and ill health.

52 Underweight in the first 2 years of life and growth in later childhood

Abstract Background Underweight occurs when caloric intake is insufficient to maintain growth. While it has long been assumed that underweight in the first 2 years of life is associated with lower growth potential in later childhood, longer term growth outcomes in high income countries are unclear. Objectives The primary objective was to evaluate the relationship between underweight in the first 2 years of life and body mass index z-score (zBMI) in later childhood. Secondly, we examined the relationship between underweight in the first 2 years of life and weight-for-age z-score (WAZ) and height-for-age z-score (HAZ) in later childhood, and how sex and the zBMI growth trajectory in the first 2 years of life modify these associations. Design/Methods This was a prospective cohort study conducted through The Applied Research Group for Kids (TARGetKids!) practice-based research network. Healthy children 0-10 years of age were included. The primary exposure was underweight in the first 2 years of life using zBMI &amp;lt;-2 as per the World Health Organization (WHO). The primary outcome was zBMI, and secondary outcomes were WAZ and HAZ between 2 and 10 years of age. Linear mixed effects models were used for the primary and secondary analysis to take into account multiple growth measures over time. Interaction terms for sex, and the zBMI growth trajectory in the first 2 years of life were used to explore effect modification. Results Among the 5,803 children included in the primary analysis, the mean age was 4.07 months, and 52.2% were male at baseline. In adjusted models, underweight in the first 2 years of life was associated with lower zBMI, lower WAZ, and higher odds of underweight at 2, 5, and 10 years of age (p &amp;lt;0.0001). Underweight in the first 2 years was associated with a lower HAZ at 2 years of age (p&amp;lt;0.0001), but not 5 (p=0.08), or 10 years of age (p=0.8). Females with underweight had lower zBMI and WAZ at 5 and 10 years of age, and lower HAZ at 10 years of age compared to males with underweight (p&amp;lt;0.05). Children with underweight and lower growth trajectory in the first 2 years had lower zBMI, WAZ, HAZ, and higher odds of underweight at 2, 5, and 10 years of age compared to children who did not have underweight (p&amp;lt;0.05). Children with underweight and high growth trajectory in the first 2 years had similar zBMI, WAZ, higher HAZ and lower odds of overweight at 10 years of age (p&amp;lt;0.05), compared to children who did not have underweight. Conclusion Underweight in the first 2 years of life was associated with lower growth in later childhood. These relationships were amplified for females and children with underweight who had low growth trajectory in the first 2 years of life and were attenuated among children with underweight who had high growth trajectory in the first 2 years of life.

Household air pollution and childhood stunting in China: A prospective cohort study.

Exposure to air pollution, especially indoor air pollution, was associated with an increased risk of childhood stunting. However, few longitudinal studies have explored the long-term impacts of indoor air pollution from household solid fuel use on child growth. We aimed to investigate the association between household air pollution (HAP) from solid fuel use and childhood stunting in Chinese children. The longitudinal data from the Chinese Family Panel Study over 2010-2018 were included in this study with a total of 6,013 children aged 0-15 years enrolled at baseline. Exposure to HAP was measured as solid fuel use for cooking, while solid fuel was defined as coal and firewood/straw according to the questionnaire survey. Stunting was defined as-2SD below the height-for-age z-score (HAZ) of the reference children. Logistic regression and Cox proportional hazards models with time-varying exposures were employed to estimate the association between childhood stunting and HAP exposure. At baseline, children with exposure to HAP from combusting solid fuels had a relatively higher risk of stunting [OR (95%CI): 1.42 (1.24-1.63)]. Among children without stunning at baseline, those living in households with solid fuel use had a higher stunting risk over an 8-year follow-up [HR (95%CI): 2.05 (1.64-2.57)]. The risk of childhood stunting was increased for those with HAP exposure from firewood/straw combustion or with longer exposure duration [HR (95%CI): 2.21 (1.74-2.79) and 3.01 (2.23-4.08), respectively]. Meanwhile, this risk was significantly decreased among children from households switching from solid fuels to clean fuels [HR (95%CI): 0.53 (0.39-0.70)]. Solid fuel use was suggested to be a mediator of the relationship between poor socioeconomic factors (i.e., household income and parental education level) and childhood stunning, with a mediation effect ranging from 11.25 to 14.26%. HAP exposure from solid fuel use was associated with childhood stunting. Poor parental education and low household income might be socioeconomic factors contributing to solid fuel use. Therefore, household energy policies to facilitate access to clean fuels are urgently needed, especially for low-income and low-educated households.

Feeding Practices and Nutritional Status of Children under Five Years Attending at Selected Child Welfare Centre, Dhaka Cantonment

Introduction: Malnutrition is one of the catastrophes on human life and a major public health problem. Children below five years of age are at-risk population and hence malnutrition is the leading cause for morbidity and mortality among them. Feeding practices play a pivotal role in determining the nutritional status of Children. Objectives: To find the nutritional status of under-five children and to assess whether infant feeding practices are correlated with nutritional status. Materials and Methods: This cross-sectional study was carried out from 01 March to 30 June 2012 among 110 conveniently and randomly selected children and their mothers as respondents attending selected child welfare centre (CWC) of Dhaka Cantonment. An electronic weighing scale, a standard height scale and a predesigned structured questionnaire were used. All data were analyzed by SPSS. Association was assessed with Chi square test. The prevalence of malnutrition was assessed by different indices of nutritional status based on Weight for Age Zscore (WAZ), Height for Age Z-score (HAZ) and Weight for Height Z -Score (WHZ). Results: Mean age of study population was 31.3±16 months. Out of total 110 mothers as respondents 62 (56.4%) mothers fed their child colostrum. Majority of the mothers (81.7.0%) exclusively breastfed their child. Most of the mothers (59.1%) did not provide proper complementary feeding and 37.3% mother fed their child pre lacteal feeding. Total underweight children were 32 (29%), total stunted children were 44(40.0%) and total wasted children were 26(23.6%). The prevalence of Stunting was higher among children who had not exclusively breastfed. This study showed that the relationship of pre-lacteal feeding and complementary feeding with WAZ, HAZ and WAZ were statistically significant. Conclusion: This study might serve as an initiative to identify the influences of feeding practices on children’s nutritional status to promote and protect the optimal feeding practices for improving nutritional status of children under five years. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 54-56

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.

Establishing Height-for-Age Z-Score Growth Reference Curves and Stunting Prevalence in Children and Adolescents in Pakistan.

Height-for-age Z-score (HAZ) curves are widely used for detecting children with stunting. The aim of this study was to provide smoothed HAZ growth reference values and their curves for Pakistani children and adolescents aged 2–18 years. The prevalence of stunting in Pakistani children was determined. A total of 10,668 healthy Pakistani participants were included. Information related to age, sex, city of residence and height (cm) was used. Age- and sex-specific smoothed HAZ growth reference values and associated graphs were obtained using the lambda-mu-sigma (LMS) method. The prevalence of stunting was calculated by applying WHO 2007 and USCDC 2000 height-for-age references and local reference of the study population. In both sexes, the smoothed HAZ curves increased with age. For 2 and 3 years of age, the height values of the girls were greater than those of the boys. The boys were then taller than the girls. Comparing our median height (z = 0) growth reference data from WHO, USCDC and corresponding data from other countries, Pakistani children and adolescents have significantly different reference values than their counterparts in the reference group. A marked overestimation of the prevalence of stunting was observed (10.8% and 17.9% according to WHO and USCDC, respectively) compared to the local reference (3.0%). It is recommended that the prevalence of stunting in children and adolescents is determined by applying local height growth references to plan health strategies and treatments in the local population.

Analysis of physical growth of preterm infants with different intrauterine growth patterns in Haikou

Objective: To analyze the physical growth of preterm infants with different intrauterine growth patterns. Methods: A total of 10 856 preterm infants who were born in various districts of Haikou City from October 1st, 2015 to June 1st, 2021 and received regular health care and management were retrospectively enrolled. The preterm infants were divided into appropriate for gestational age (AGA), small for gestational age (SGA) and large for gestational age (LGA) groups according to different intrauterine growth patterns. The general characteristics of preterm infants in different groups were compared by H test (Kruskal and Wallis) or Chi-squared test. And the developmental curves were plotted by local regression (LOESS) with their physical growth indexes. Results: Of the 10 856 preterm infants, 6 317 were boys and 4 539 were girls. The gestational age at birth was 35 (34, 36) weeks, and the birth weight was 2.5 (2.1, 2.8) kg. There were 754 (6.9%) SGA, 9 301 (85.7%) AGA, and 801 (7.4%) LGA preterm infants. All preterm infants were followed up until 18 months of corrected age. The birth weight of the SGA group was lower than that of the AGA and LGA groups (Z=2 274.93, P<0.001). The proportion of exclusive breastfeeding at the first health care interview was higher in the AGA group (68.6% (6 378/9 301)) than in the SGA group (62.9% (474/754)) (χ2=13.82, P=0.003). The LOESS curving fitting showed that the weight and height of the preterm infants in all the 3 groups increased rapidly during 0-6 months of corrected age. The regression prediction values of weight for age Z-score (WAZ), height for age Z-score (HAZ) and weight for height Z-score (WHZ) were around 0 s, while the regression prediction values of these three indicators in SGA were all below 0 s but greater than -1 s. The rates of low birth weight, growth retardation and wasting during 0-17 months of corrected age were 0.3% (16/4 838)-1.9% (47/2 506), 0.4% (18/4 838) -2.4% (51/2 124), and 2.1% (88/4 135) -4.4% (214/4 838) in AGA groups, and 0 (0/296) -1.0% (2/199), 0 (0/341) -1.6% (3/186) and 1.0% (2/199) -2.6% (9/341) in LGA group, whereas 7.6% (25/330) -16.8% (28/167), 5.2% (17/330)-10.6%(32/303) and 3.9% (3/77) -12.6% (21/167) in SGA group. In addition, the monthly growth of weight and height of preterm infants in all the 3 groups decreased with the increasing age, and the monthly weight gain. The length increment was 4.0 cm/month during corrected 0-2 month of age and 2.4 cm/month during corrected 2-5 month of age in the SGA preterm infants. Conclusions: Most of the preterm infants could have an appropriate catch-up growth, but the growth and development in the SGA preterm infants lags behind that of their AGA and LGA peers. The physical growth of SGA premature infants should be paid more attention to, to timely correct the growth deviations.

Do unwanted children face growth penalties in resource poor environments? Evidence from Roma Settlements in Serbia.

In a high fertility context, research on the relationship between parental investment, unwanted births and child nutritional outcomes is limited. The implications may be especially relevant for children coming from the most disadvantaged backgrounds and at increased risk of nutritional deprivation. This study assessed the association between maternal investment, unwanted births disaggregated into mistimed and unwanted children, and child nutritional outcomes in a poor population of Serbian Roma. Multiple Indicator Cluster Surveys rounds 5 and 6 data for Serbian Roma settlements were used to account for the association between two measures of maternal investment: weight at birth and parity, and mistimed and unwanted children, and children height-for-age z-score (HAZ), weight-for-age z score (WAZ) and weight-for- height z-score (WHZ). The sample included 130 children aged 0-24 months. The child variables were age, gender, and birth order, while maternal independent variables included age, literacy and access to improved toilet facility as proxies for socioeconomic status. Children born with low birth weight (lower maternal investment in utero) face a significant deficit in terms of their nutritional outcomes, measured by HAZ and WAZ. The effect was aggravated for height if the child was unwanted while there was a positive relationship between access to improved toilet facility and WHZ. Unwanted children were of higher birth order, with older, higher parity mothers than mistimed children. Many of the Roma children may be at risk of undernutrition, however, Roma children who received lower maternal investment in utero, unwanted and living in poorest households may face additional risk.

Impact of Shigella infections and inflammation early in life on child growth and school-aged cognitive outcomes: Findings from three birth cohorts over eight years.

BackgroundShigella infections cause inflammation, which has been hypothesized to mediate the associations between Shigella and child development outcomes among children in low-resource settings. We aimed to assess whether early life inflammation and Shigella infections affect school-aged growth and cognitive outcomes from 6–8 years of age.Methodology/principal findingsWe conducted follow-up assessments of anthropometry, reasoning skills, and verbal fluency in 451 children at 6–8 years of age in the Brazil, Tanzania, and South Africa sites of MAL-ED, a longitudinal birth cohort study. We estimated the associations between Shigella burden and inflammation with linear growth at 2, 5, and 6–8 years of age, and with the cognitive test scores using linear regression and adjusting for potential confounding variables. We also assessed whether inflammation mediated the associations between Shigella and school-aged outcomes using a regression-based approach to mediation analysis. A high prevalence of Shigella was associated with a 0.32 (95% CI: 0.08, 0.56) z-score lower height-for-age z-score (HAZ) at 6–8 years compared to a low prevalence of Shigella. Intestinal inflammation had a smaller association with HAZ at 6–8 years. Shigella burden had small and consistently negative associations with cognitive outcomes in Brazil and Tanzania, but not South Africa, and the estimates were not statistically significant. Systemic inflammation was strongly associated with lower verbal fluency scores in Brazil (semantic fluency z-score difference: -0.57, 95% CI: -1.05, -0.10; phonemic fluency z-score difference: -0.48, 95% CI: -0.93, -0.03). There was no evidence that intestinal inflammation mediated the association between Shigella and HAZ or cognitive outcomes.Conclusions/significanceWhile Shigella infections were consistently associated with long-term deficits in linear growth, the estimates of the negative associations between Shigella and cognitive outcomes were imprecise and only observed in the Brazil and Tanzania sites. Systemic inflammation was strongly associated with lower semantic and phonemic fluency scores in Brazil only, highlighting the site-specificity of effects.