International Reference Population Research Articles

The effect of maternal employment on the nutritional status of pre-school children

Background: Children contribute to the vital human potential and impart strength to the national economy and development. The major determinants of the nutritional status of these children were age, household income, number of children in the family, duration among them, education of the parents, poor personal hygiene, unsatisfactory environmental conditions, and poor sanitary facilities. Aim and Objective: The aim of this study was to assess the effect of maternal employment on the nutritional status of pre-school children. Materials and Methods: Weight and height of children were measured using digital weighing machine and stadiometer respectively. Data were stored on the WHO Anthro software package that was used in calculating anthropometric indices. The program uses figures from the national center for health statistics and centers for disease control and prevention, Atlanta (NCHS/CDC) as an international reference population. A questionnaire is used to assess the employment status of mother. Results: Children those who have had employed mothers showed 11% stunted (P = 0.4616), 30.3% (P < 0.0001) wasting, and 31.8% (P < 0.0001) underweight compared to unemployed mothers of middle-class family. Conclusion: In middle-class families, women work outside to fulfill their basic needs, but they fail to provide care to their children. It has been proved that financial crisis as well as lack of care leads to malnutrition in children those who have employed mothers when compared to unemployed mothers among middle class families.

Norm Scores of the Box and Block Test for Children Ages 3–10 Years

This study provides new norm scores for the Box and Block Test for gross manual dexterity in children ages 3-10 yr. Two hundred fifteen Dutch children performed the Box and Block Test separately with each hand. We found an age effect for the scores; older children obtained higher scores than younger children. Concurrent validity was assessed by means of comparison with the manual dexterity subtests of the Movement Assessment Battery for Children-2; correlations were significant. Intraclass correlation coefficients for test-retest and interrater reliability measures were .85 and .99, respectively. The Box and Block Test is an easy, feasible, valid, and reliable measurement for gross manual dexterity in young children. The obtained norms can be used in clinical settings to compare the gross manual dexterity of atypically developing children with that of age-related peers and to evaluate efficacy of interventions. A larger international reference population is needed to increase generalizability.

Changes in Human Development in Developing Countries: An Empirical Assessment

AbstractBased on data from the World Bank and the United Nations Development Programme, a sample of 29 developing economies was used. The finding is that cross-country changes in human development may be explained by per capita GDP growth, the length of land boundaries, the percentage of children under age 5 whose weight is more than two standard deviations below the median for the international reference population ages 0-59 months, the under-5 mortality rate, the ratio of girls to boys in primary and secondary education, the prevalence of HIV, the national average distance to the capital city, and the income share held by the lowest 10% of population. As observed, the coefficient estimates of three independent variables do not have the anticipated sign due to the severe degree of multicollinearity among statistically significant explanatory variables. Data for all variables are from the 2010 World Development Indicators and the 2009 Human Development Report. The least-squares estimation technique in a multivariate linear regression was applied. As noted, the severe degree of multicollinearity among explanatory variables may have caused their coefficient estimates to have the wrong sign.

Malaria and Under-Nutrition: A Community Based Study Among Under-Five Children at Risk of Malaria, South-West Ethiopia

BackgroundThe interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia.MethodsThis cross-sectional study was undertaken during March–February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden).ResultsSignificant proportion (40.4%) of under-five children were stunted (height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1–2.0)].ConclusionIn this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia.

BMI percentile curves for Chinese children aged 7–18 years, in comparison with the WHO and the US Centers for Disease Control and Prevention references

To establish BMI percentile curves that describe the contemporary BMI distribution among Chinese children, and to compare their BMI percentile curves with those in two recently developed international references: the WHO and the US Centers for Disease Control and Prevention (US CDC) growth references. A cross-sectional national survey. Thirty provinces, municipalities and autonomous regions in China. Nationally representative sample of 232 140 school students aged 7-18 years. BMI percentile curves were established using the LMS method, and were compared with the percentiles of the WHO and the US CDC references. BMI distributions and growth patterns in Chinese children were dramatically different from those in the two international reference populations. Compared with the international reference populations, younger Chinese boys (7-12 years of age) had higher values of the percentiles above the median and lower values of the percentiles below the median, suggesting that they had larger proportions of extreme BMI values in both directions. Chinese girls and older Chinese boys (15-18 years of age) had substantially lower BMI percentiles than their counterparts in the reference populations, particularly those high percentiles among older age groups. The present study described the unique patterns of BMI curves at the national level, and these curves are useful as a reference for comparing different regions and for monitoring changes over time in Chinese children. Higher proportions of children with extreme values in both directions indicate that China is currently facing both an increasing level of obesity and a high level of undernutrition, simultaneously.

Detection of testosterone administration based on the carbon isotope ratio profiling of endogenous steroids: international reference populations of professional soccer players

Detection of testosterone administration based on the carbon isotope ratio profiling of endogenous steroids: international reference populations of professional soccer players

Detection of testosterone administration based on the carbon isotope ratio profiling of endogenous steroids: international reference populations of professional soccer players

Background and objectives:The determination of the carbon isotope ratio in androgen metabolites has been previously shown to be a reliable, direct method to detect testosterone misuse in the context of...

Acompanhamento Individualizado ou Tratamento em Grupo: Qual das Intervenções é mais Eficaz na Obesidade Infanto-Juvenil?

Objetivos: Comparar a eficácia do tratamento individualizado (consulta) e do tratamento em grupo em conjunto com o individual no que diz respeito à obesidade infanto-juvenil. Metodologia: O trabalho foi realizado em 2 locais distintos, Clínica Integrada de saúde UNIARA, ambulatório de Nutrição e outra clínica-escola. Nos dois locais há um tratamento individualizado com consultas, porém, na Clínica UNIARA o tratamento se faz também com atendimentos em grupo. O público-alvo foi composto por crianças e adolescentes de ambos os sexos que participaram dos atendimentos, porém, só foram incluídos na amostragem apenas os pacientes que estavam acima do percentil 85 para IMC, de acordo com a população de referência internacional (NCHS, 2000), constituindo assim uma amostra de 58 indivíduos. A escolha dos prontuários ocorreu de forma aleatória em ambos os locais. Resultados: O programa mais efetivo na modificação positiva nos hábitos alimentares foi o acompanhamento em grupo em conjunto com o tratamento individualizado, onde 20 pacientes (68,96%) apresentaram algumas mudanças de comportamento alimentar, já no tratamento individualizado, 11 pacientes (37,93%) apresentaram alguma modificação dos hábitos alimentares existentes antes do tratamento. Constatou-se que houve uma redução do índice de obesidade de 24% para os pacientes acompanhados em grupo, entretanto, os dois tipos de tratamento foram favoráveis a mudanças de hábitos alimentares e redução de peso. Os achados evidenciaram que a estratégia de atendimento individualizado unido ao grupo é uma alternativa para o tratamento do excesso de peso.

Measuring malnutrition -The role of Z scores and the composite index of anthropometric failure (CIAF)

<b>Background : </b> The current WHO recommendation is to use the Z-Score or SD system to grade undernutrition which allows us to measure all the three indices and express the results in terms of Z scores or standard deviation units from the median of the international reference population.<br><b> Objectives : </b> To estimate the prevalence of undernutrition among under-five children in Coimbatore slums, using the Z-Score system of classification and the recently constructed Composite Index of Anthropometric Failure (CIAF). 2. To compare the Z-Score system with the Indian Academy of Pediatrics (IAP) classification of undernutrition. <br><b> Methods : </b> Nutritional assessment was done using anthropometry and clinical examination. Children were weighed and measured as per the WHO guidelines on Anthropometry. Epi-Info 2002 software package was used to calculate the Z scores and for statistical analysis.<br><b> Results : </b> Only 31.4% of the children studied were normal; 68.6% were in a state of Anthropometric Failure. As per the Z score system, 49.6% were underweight (21.7% severely); 48.4% were stunted (20.3% severely) and 20.2% were wasted (6.9% severely). Whereas, as per IAP criteria, 51.4% were undernourished and 3.2% were severely undernourished. Using Underweight (low weight-for-age) as the only criterion for identifying undernourished children (as done in the Integrated Child Development Services currently) may underestimate the true prevalence of undernutrition, by as much as 21.9%. <br><b> Conclusions : </b> More widespread use of the Z-Score system is recommended for identifying all the facets of undernutrition. Estimates of the true prevalence of undernutrition must incorporate a composite index of anthropometric failure.

Physical growth and nutritional status of Brazilian indian populations

This paper reviews the literature on the physical growth of native populations from Brazil. Studies aiming at relating the physical growth patterns of these populations to their nutritional status are relatively recent and still do not provide a comprehensive picture of the situation. Compared to non-indigenous Brazilian children and international reference populations (NCHS), indigenous children are short and light for their age, although they maintain their body proportionality, as evaluated by weight for height. These findings could be interpreted as an indication of high rates of chronic protein-energy undernutrition. At least for some groups, data derived from health surveys provide further indication of the existence of marginal nutrition. It is pointed out, however, that international reference curves may not be appropriate for evaluating the physical growth of specific populations, which may be the case of Brazilian indigenous children. It is also pointed out that changes in subsistence practices and in health profiles due to the acculturation process may contribute to the deterioration of nutritional status of indigenous peoples.

The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications.

For decades nutritional surveys have been conducted using various definitions, indicators and reference populations to classify child malnutrition. The World Health Organization (WHO) Global Database on Child Growth and Malnutrition was initiated in 1986 with the objective to collect, standardize, and disseminate child anthropometric data using a standard format. The database includes population-based surveys that fulfil a set of criteria. Data are checked for validity and consistency and raw data sets are analysed following a standard procedure to obtain comparable results. Prevalences of wasting, stunting, under- and overweight in preschool children are presented using z-scores based on the National Center for Health Statistics (NCHS)/WHO international reference population. New surveys are included on a continuous basis and updates are published bimonthly on the database's web site. To date, the database contains child anthropometric information derived from 846 surveys. With 412 national surveys from 138 countries and 434 sub-national surveys from 155 countries, the database covers 99% and 64% of the under 5 year olds in developing and developed countries, respectively. This wealth of information enables international comparison of nutritional data, helps identifying populations in need, evaluating nutritional and other public health interventions, monitoring trends in child growth, and raising political awareness of nutritional problems. The 15 years experience of the database can be regarded as a success story of international collaboration in standardizing child growth data. We recommend this model for monitoring other nutritional health conditions that as yet lack comparable data.

Predicting obesity in early adulthood from childhood and parental obesity.

To determine the degree of tracking of adiposity from childhood to early adulthood, and the risk of overweight in early adulthood associated with overweight in childhood and parental weight status in a cohort of children born in the mid-1970s. Longitudinal observational study. Approximately 155 healthy boys and girls born in Adelaide, South Australia, 1975-1976 and their parents. Height and weight of subjects at 2 y, annually from 4 to 8 y, biennially from 11 to 15 y and at 20 y, and of parents when subjects were aged 8 y. Body mass index (BMI) of subjects converted to standard deviation scores and prevalence of overweight and obesity determined using worldwide definitions. Parents classified as overweight if BMI> or =25 kg/m(2). Tracking estimated as Pearson's correlation coefficient. Risk ratio used to describe the association between weight status at each age and parental weight status and weight status at 20 y and weight status at each earlier age, both unadjusted and adjusted for parental weight status. The prevalence of overweight/obesity increased with age and was higher than that reported in international reference populations. Tracking of BMI was established from 6 y onwards to 20 y at r-values >0.6, suggesting that BMI from 6 y is a good indicator of later BMI. Tracking was stronger for shorter intervals and for those subjects with both parents overweight compared with those with only one or neither parent overweight. Weight status at an earlier age was a more important predictor of weight status at 20 y than parental weight status, and risk of overweight at 20 y increased further with increasing weight status of parents. Strategies for prevention of overweight and targeted interventions for prevention of the progression of overweight to obesity are urgently required in school-aged children in order to stem the epidemic of overweight in the adult population.

Ehrenberg Law-Like Relationship and Anthropometry

SummaryEhrenberg presented the simple law-like relationship log(w) = 0.8h + 0.4 ± 0.04 between the weight and height of children aged 5–13 years. Several researchers have confirmed that this relationship holds, irrespective of the child's ethnic, racial, gender and social class. In anthropometry, a weight–height relationship is used to measure the nutritional status of children. For this purpose, the World Health Organization have adopted the National Center for Health Statistics population as the international reference population. The relationship between the World Health Organization–National Center for Health Statistics anthropometric standards and Ehrenberg law-like relationship is examined. Differences between the weight-for-height relationship in anthropometry and the law-like relationship between weight and height for children are small and can be attributable to functional differences. It is found that an Ehrenberg law-like relationship can be extended to include children who are under 5 years old. Criteria for using the law-like relationship to assess the nutritional status of these children are thus suggested. The criteria are evaluated using anthropometric data of a sample of 513 children from a rural district of Botswana. The results indicate that the proposed method of using the law-like relationship to assess nutritional status is much simpler and at least as reliable as the existing methods in anthropometry.

Growth in indigenous and nonindigenous Chilean schoolchildren from 3 poverty strata.

This study sought to determine whether the short stature of Mapuche children, an indigenous group in Chile, reflects poverty or genetic heritage and whether the international reference population, derived from studies of US children of mostly European origin, is appropriate for assessing growth failure in indigenous peoples of the Americas. The study assessed 768 schoolchildren of Mapuche and non-Mapuche ancestry, aged 6 to 9 years, living under conditions of extreme, medium, and low poverty. Growth retardation was strongly related to poverty in both ethnic groups. Within poverty levels, there were no significant differences in stature between ethnic groups, and in low-poverty areas in Santiago, the capital city, mean stature was only slightly less than in the reference population. Poverty, not ancestry, explains the short stature of Mapuche children, and use of the international reference to assess growth in this population is appropriate.

Bone mineral density in pre-and post-menopausal women with affective disorder treated with long-term l-thyroxine augmentation

Background: Augmentation with TSH-suppressive l-thyroxine (T4) has been shown to improve the course of illness in otherwise refractory affective disorders. This collaborative study investigates whether T4 augmentation for a minimum of 12 months decreases bone mineral density (BMD) in 26 pre- and post-menopausal women with affective disorder. Methods: We measured BMD at the femoral neck, Ward’s triangle, trochanter and lumbar vertebrae (L1–L4) in 13 premenopausal and 13 postmenopausal women with affective disorder using dual energy X-ray absorptiometry. BMD was expressed as g/cm 2 and as a Z-score, calculated using bone density data from the international reference population standard. Results: The Z-scores for the pre- and post-menopausal women were within the reference range of the age and sex matched population standard. BMD for the composite group also did not differ either from the population standard. BMD in the lumbar spine and hip did not differ significantly between the pre- and post-menopausal groups. However, there were a relatively high number of postmenopausal patients with BMDs one S.D. lower than the population standard. Limitations: This is a cross-sectional study with a relatively small sample size. Conclusions: The study demonstrates that T4 augmentation treatment does not reduce BMD to a clinically significant degree in many women with affective disorder. However, the resilience of bone structure to T4 treatment may vary with site and menopausal status. This study underscores the need for regular assessment of BMD during adjunctive thyroid treatments for affective disorder, especially in postmenopausal women.

The isolation and mapping of 19 tetranucleotide microsatellite markers in the chicken.

Microsatellites consisting of tetranucleotide repeats are more easily, and consequently efficiently, scored than loci consisting of dinucleotides. However, they are much less frequent in the genome. A hybridisation selection protocol was therefore employed to generate a chicken genomic library enriched for inserts containing the tetranucleotide repeat motif (TTTC)n. Forty-five new microsatellite sequences were isolated that mainly consisted of perfect repeats of the tetranucleotide (TTTC) motif. Nineteen markers were mapped in one or both of the East Lansing and Compton international chicken reference populations.

MALNUTRITION AMONG YOUNG CHILDREN IN SQUATTER SETTLEMENTS OF KARACHI - A CONTINUING HEALTH PROBLEM

POS18 In order to assess the growth and nutritional status as part of the baseline survey of the Urban Health Program in squatter settlement of Karachi conducted by the Community Health Sciences Department of AKU, we went to each house in the area and conducted anthropometric measurements on children under five years of age who were present at home at the time of interview. We recorded height and weight of 5231 children born in the period 1-59 months preceding the survey. Among them 51% were males and 49% were females. We assessed the nutritional status of these children in terms of weight for age (general malnutrition), height for age (stunting) and weight for height(wasting) using the international reference population of the United States National Center for Health Statistics (NCHS) and the Center for Disease Control (CDC), as recommended by WHO. We evaluated the nutritional status by calculating the extent to which the anthropometric measurements deviated from measurements for the reference population of children as defined by NCHS/CDC. Overall, 42 % of the total children were underweight whereas 12.6 % were severely underweight for their age. On average, 49% of children under five years of age were stunted while 25.5% were severely stunted. The prevalence of wasting was 12.5% while severe wasting was found to be 2.6%. There was no significant difference between the sexes. Survey findings are consistent with other nutritional surveys and indicates that malnutrition remains a major public health problem in Pakistan. Both stunting and wasting are indications of long term malnutrition and disease related to poverty and under-development within the population.

Mapping chicken genes using preferential amplification of specific alleles.

To map the chicken genome, an international reference population was developed at our laboratory (East Lansing, MI) using an F2 backcross between inbred jungle fowl (JF) and inbred white leghorns (WL). To augment the number of type I genes on the East Lansing (E) map, segregation of the JF-specific allele was followed using preferential amplification of specific alleles (PASA) in polymerase chain reactions (PCR). Among 15 functional genes that were added to the E map, agrin and mannose-6-phosphate receptor genes were found to occur in conserved syntenic groups. Using this PCR-based approach, six conserved groups spanning more than 243 centimorgans (cM) in the chicken were syntenic with human and mouse.

Secular trends in the growth of children aged 0-6 years in a rural Nigerian community.

Cross-sectional anthropometric measurements were taken between 1987 and 1990 in 673 children aged 0-6 years in Imesi Ile village, Nigeria. The height and weight curves obtained fall behind corresponding growth curves in the same community three decades previously. Mid-upper arm circumference values indicated moderate to severe malnutrition in 25.8% of children aged 1-5 years. The heights of 67.1% and weights of 59.7% of the children fell below the third percentile of a Nigerian equivalent of an international reference population standard. Possible reasons for deterioration of the nutritional status of children in the community include the prevailing adverse socio-economic conditions, changes in child rearing practices over the years, persistence of unsatisfactory living conditions and failure to sustain the implementation of innovative programmes previously introduced into the community. It is suggested that present programmes aimed at promoting the health of rural communities should be reviewed to improve sustainability and should be backed up by measures to improve socio-economic and living conditions.

Child health outcomes among central American refugees and immigrants in Belize

The purpose of this study was to investigate the effect of international migration, including refugee status, upon child health outcomes. Data were drawn from a survey conducted in 1989 in three settlements in Belize, Central America, that have a high proportion of refugees and economic immigrants living side-by-side with the local population. In two of the settlements, the entire population of mothers with children under 6 was interviewed; in the third settlement a two-thirds random sample was interviewed. Health history data were obtained for 255 children of 134 mothers, from whom sociodemographic data were also collected. The majority of children were born to Salvadoran or Guatemalan mothers, but native and naturalized Belizeans in the survey communities were included for comparison purposes. Migration, the exposure variable, was characterized by mother's residency/refugee legal status, nationality, and duration of time in country. Socioeconomic and proximate control variables were included as suggested by the Mosley-Chen framework. Despite normal birthweight averaging 3374 g, a large proportion of children are at the lowest percentiles of the weight-for-age curves (44% below the tenth percentile for the international reference population). A high incidence of diarrheal and respiratory illnesses (30% and 47% of children, respectively, having frequent episodes), and 50% of children with measles vaccination appropriate for age, indicate a population with high potential morbidity. Logistic regression was used to model the effects of migration on weight-for-age and frequency of diarrheal and respiratory tract episodes independent of socioeconomic and proximate factors, as suggested by the Mosley-Chen framework. Once these socioeconomic and proximate variables were controlled for, migration contributed little to the models. It appears that the poverty of migrants—irrespective of legal status, origin, or length of time in country—may override migration. Also, study findings suggest that the children of refugees and immigrants have intense health needs even in a relatively benign social environment, as do the children of native Belizeans. The study affirmed the utility of the Mosley-Chen framework, and further tests in other migration contexts are suggested. Current efforts of government and non-governmental programs to direct public health measures towards whole settlements rather than to groups defined by legal status should be supported. Policies that decrease socioeconomic marginalization by integrating refugees and immigrants into the local labor force, educational facilities, and health services may contribute to improved child health.