National Center For Health Statistics Reference Research Articles

Study of anthropometric profile of working (labour) adolescent girls of urban slums of India

Introduction: Adolescence is often described as a phase of life that begins in biology and ends in society. Adolescence is the developmental phase between childhood and adulthood with specific psychological attributes. In India, the adolescent population constitute 22.8% of the total population. There are around 239 million adolescents in India in the age group of 10-19 years presently. Our aim is to assess the anthropometric profile of working adolescent girls of slum area. Method: Anthropometric data were collected using predesigned proforma of 696 working adolescent girls aged 10-19years by door to door survey in three randomly selected slums of Bilaspur, Chhattisgarh, India. The height, weight and body mass index of the working adolescent were compared with NCHS and Indian reference populations. Result: Analysis of the cases revealed that the maximum number (45.40%) of adolescents were in 10-13years age group and minimum (27.01%) were in 17-19 years age group. In 14-16years 27.58% girls. The difference of mean weight of present study with NCHS standard 50th percentile of weight in various age group ranges from 11.16 to 18.5 kgs. Height of all the girls were below 50th percentile. Difference of present study’s mean height and NCHS 50th percentile in different age group ranges from11.7cms to 20.8cms, the average body mass index was below 15 in 10-12 years age group but was above 15 in 13-19 years age group. Difference of mean BMI of present study with NCHS Standard for different age group ranges from2.15 to 3.57. Discussion: The anthropometric height, weight and BMI data of working adolescent of slum area were lower than Indian as well as NCHS standards. All the girls in the present study had weight and height less than 50th percentile of the National Center for Health Statistics (NCHS), Department of Health, Education and Welfare (DHEW), U.S.A. Standards.

Diagnostic Performance of Waist Circumference Measurements for Predicting Cardiometabolic Risk in Mexican Children

The accumulation of abdominal fat is associated with cardiometabolic abnormalities. Waist circumference (WC) measurements allow an indirect evaluation of abdominal adiposity. However, controversy exists over which WC reference values are the most suitable for identifying the pediatric population at risk. The aim of the study was to evaluate the ability of various WC indices to identify abdominal obesity as diagnostic tools for predicting cardiometabolic risk in Mexican children and adolescents. Anthropometric measurements were performed and biochemical profiles determined in a crosssectional study that included 366 children and adolescents. Four parameters were used to evaluate abdominal obesity in our study group: (1) WC >90th percentile, according to the Fernández reference in a Mexican-American population measured by the National Center for Health Statistics (NCHS) technique; (2) WC >90th percentile, according to the Klünder reference in a Mexican population (measured by the World Health Organization [WHO] technique); (3) waist-to-height ratio (WHtR) >0.5 according to WHO; and (4) WHtR >0.5 according to NCHS. The ability of each of the indices to discriminate cardiometabolic abnormalities (fasting plasma glucose, dyslipidemia, and hypertension) was assessed. WHtR >0.5 according to WHO or NCHS references showed greater sensitivity to detect metabolic abnormalities compared to percentile reference parameters (74.3 to 100% vs. 59.0 to 88.9%; P<.05). However, the percentiles displayed more specificity to identify these alterations (46.2 to 62.2 vs. 21.3 to 46.9; P<.05). Area under the curve analysis showed that WHtR >0.5 can more readily detect hypertriglyceridemia (0.642), hypoalphalipoproteinemia (0.700), and a combination of two or more metabolic abnormalities (0.661), whereas WC >90th percentile, according to Klünder, better detected hyperglycemia (0.555). WHtR >0.5 is a sensitive measure to identify pediatric patients with cardiometabolic alterations, despite its low specificity, and is a useful diagnostic tool to detect populations at risk. Based on the results of this study, we recommend preferential use of the Klünder waist circumference references over the Fernández method in Mexican pediatric populations. AUC = area under the curve BMI = body mass index HDL = high-density lipoprotein IDF = International Diabetes Federation LDL = low-density lipoprotein MS = metabolic syndrome NCHS = National Center for Health Statistics ROC = receiver operating characteristic WC = waist circumference WHO = World Health Organization WHtR = waist-to-height ratio.

Implications of the WHO Child Growth Standards in rural Honduras

The present study analysed the impact of using the 2006 WHO Child Growth Standards ('the WHO standards') compared with the 1977 National Center for Health Statistics (NCHS) international growth reference ('the NCHS reference') on the calculated prevalence of chronic malnutrition in children aged 6·0-59·9 months. Anthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland-Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories. The study was conducted in thirteen rural villages within Honduras's department of Intibucá. Children aged 6·0-59·9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study. The WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24·0-35·9 months and WHZ among males aged >24·0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender. The choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously.

A comparison of the National Center for Health Statistics and new World Health Organization growth references for school-age children and adolescents with the use of data from 11 low-income countries

In 2007 new World Health Organization (WHO) growth references for children aged 5-19 y were introduced to replace the National Center for Health Statistics (NCHS) references. This study aimed to compare the prevalence of stunting, wasting, and thinness estimated by the NCHS and WHO growth references. NCHS and WHO height-for-age z scores were calculated with the use of cross-sectional data from 20,605 schoolchildren aged 5-17 y in 11 low-income countries. The differences in the percentage of stunted children were estimated for each year of age and sex. The z scores of body mass index-for-age and weight-for-height were calculated with the use of the WHO and NCHS references, respectively, to compare differences in the prevalence of thinness and wasting. No systematic differences in mean z scores of height-for-age were observed between the WHO and NCHS growth references. However, z scores of height-for-age varied by sex and age, particularly during early adolescence. In children for whom weight-for-height could be calculated, the estimated prevalence of thinness (WHO reference) was consistently higher than the prevalence of wasting (NCHS reference) by as much as 9% in girls and 18% in boys. In undernourished populations, the application of the WHO (2007) references may result in differences in the prevalence of stunting for each sex compared with results shown when the NCHS references are used as well as a higher estimated prevalence of thinness than of wasting. An awareness of these differences is important for comparative studies or the evaluation of programs. For school-age children and adolescents across all ranges of anthropometric status, the same growth references should be applied when such studies are undertaken.

Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards: a secondary data analysis

ObjectivesTo determine wasting prevalence among infants aged under 6 months and describe the effects of new case definitions based on WHO growth standards.DesignSecondary data analysis of demographic and health survey...

Use of the new World Health Organization child growth standards to describe longitudinal growth of breastfed rural Bangladeshi infants and young children.

Although the National Center for Health Statistics (NCHS) reference has been widely used, in 2006 the World Health Organization (WHO) released new standards for assessing growth of infants and children worldwide. To assess and compare the growth of breastfed rural Bangladeshi infants and young children based on the new WHO child growth standards and the NCHS reference. We followed 1343 children in the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) study from birth to 24 months of age. Weights and lengths of the children were measured monthly during infancy and quarterly in the second year of life. Anthropometric indices were calculated using both WHO standards and the NCHS reference. The growth pattern and estimates of undernutrition based on the WHO standards and the NCHS reference were compared. The mean birthweight was 2697 +/- 401 g, with 30% weighing <2500 g. The growth pattern of the MINIMat children more closely tracked the WHO standards than it did the NCHS reference. The rates of stunting based on the WHO standards were higher than the rates based on the NCHS reference throughout the first 24 months. The rates of underweight and wasting based on the WHO standards were significantly different from those based on the NCHS reference. This comparison confirms that use of the NCHS reference misidentifies undernutrition and the timing of growth faltering in infants and young children, which was a key rationale for constructing the new WHO standards. The new WHO child growth standards provide a benchmark for assessing the growth of breastfed infants and children.

Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference

To compare estimates of under-nutrition among pre-school Pakistani children using the WHO growth standard and the National Center for Health Statistics (NCHS) reference. Prevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared. The data are from two cross-sectional surveys conducted in the early 1990s, the time frame for setting the baseline for the Millennium Development Goals: (i) National Health Survey of Pakistan (NHSP) assessed the health status of a nationally representative sample and (ii) Thatta Health System Research Project (THSRP) was a survey in Thatta, a rural district of Sindh Province. In all, 1533 and 1051 children aged 0-35 months from national and Thatta surveys, respectively. WHO standard gave a significantly higher prevalence of stunting for both national [36.7 (95 % CI 33.2, 40.2)] and Thatta surveys [52.9 (95 % CI 48.9, 56.9)] compared to the NCHS reference [national: 29.1 (95 % CI 25.9, 32.2) and Thatta: 44.8 (95 % CI 41.1, 48.5), respectively]. It also gave significantly higher prevalence of wasting for the Thatta survey [22.9 (95 % CI 20.3, 25.5)] compared to the NCHS reference [15.7 (95 % CI 13.5, 17.8)]. Differences due to choice of standard were pronounced during infancy and for severely wasted and severely stunted children. Pakistan should switch to the robustly constructed and up-to-date WHO growth standard for assessing under-nutrition. New growth charts should be introduced along with training of health workers. This has implications for nutritional intervention programmes, for resetting the country's targets for Millennium Development Goal 1 and for monitoring nutritional trends.

Prognostic Accuracy of WHO Growth Standards to Predict Mortality in a Large-Scale Nutritional Program in Niger

BackgroundImportant differences exist in the diagnosis of malnutrition when comparing the 2006 World Health Organization (WHO) Child Growth Standards and the 1977 National Center for Health Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here, we assessed the accuracy of the WHO standards and the NCHS reference in predicting death in a population of malnourished children in a large nutritional program in Niger.Methods and FindingsWe analyzed data from 64,484 children aged 6–59 mo admitted with malnutrition (<80% weight-for-height percentage of the median [WH]% [NCHS] and/or mid-upper arm circumference [MUAC] <110 mm and/or presence of edema) in 2006 into the Médecins Sans Frontières (MSF) nutritional program in Maradi, Niger. Sensitivity and specificity of weight-for-height in terms of Z score (WHZ) and WH% for both WHO standards and NCHS reference were calculated using mortality as the gold standard. Sensitivity and specificity of MUAC were also calculated. The receiver operating characteristic (ROC) curve was traced for these cutoffs and its area under curve (AUC) estimated. In predicting mortality, WHZ (NCHS) and WH% (NCHS) showed AUC values of 0.63 (95% confidence interval [CI] 0.60–0.66) and 0.71 (CI 0.68–0.74), respectively. WHZ (WHO) and WH% (WHO) appeared to provide higher accuracy with AUC values of 0.76 (CI 0.75–0.80) and 0.77 (CI 0.75–0.80), respectively. The relationship between MUAC and mortality risk appeared to be relatively weak, with AUC = 0.63 (CI 0.60–0.67). Analyses stratified by sex and age yielded similar results.ConclusionsThese results suggest that in this population of children being treated for malnutrition, WH indicators calculated using WHO standards were more accurate for predicting mortality risk than those calculated using the NCHS reference. The findings are valid for a population of already malnourished children and are not necessarily generalizable to a population of children being screened for malnutrition. Future work is needed to assess which criteria are best for admission purposes to identify children most likely to benefit from therapeutic or supplementary feeding programs.

Crescimento físico e estado nutricional de crianças e adolescentes da região de Cotinguiba, Sergipe

OBJETIVO: Investigar o crescimento físico e o estado nutricional de crianças e adolescentes da região de Cotinguiba, Sergipe. MÉTODOS: Trata-se de um estudo transversal, realizado com 1.257 escolares de sete a 14 anos. Mediram-se o peso corporal e a estatura. O estado nutricional foi definido conforme as recomendações propostas pela International Obesity Task Force, de acordo com o índice de massa corpórea (IMC), segundo idade e sexo. Foram classificados com desnutrição os escolares com IMC entre 16 e 18,5kg/m² e com excesso de peso aqueles com IMC igual ou superior a 25kg/m². RESULTADOS: Um suposto pico de crescimento em estatura foi verificado aos 11 e 12 anos para os sexos feminino e masculino, respectivamente. Para o peso corporal, o pico ocorreu aos 11 anos de idade, para ambos os sexos. As curvas do National Center for Health Statistics (NCHS) foram estatisticamente superiores em todas as idades e em ambos os sexos para peso corporal e estatura, com exceção da idade de nove anos para o sexo feminino. Verificou-se que 21,7% dos escolares apresentaram desnutrição (18,5% em meninos e 24,6% em meninas) e 6,8% apresentaram excesso de peso (5,1% em meninos e 8,4% em meninas), com diferenças significativas entre os sexos. CONCLUSÕES: O crescimento das crianças e adolescentes da região de Cotinguiba não acompanha as curvas de referência do NCHS. A prevalência elevada de desnutrição evidencia a necessidade de um acompanhamento longitudinal do crescimento desta população e da implementação de estratégias de intervenção para reduzir tais proporções, que indicam se tratar de um problema de Saúde Pública.

Implication of New WHO Growth Standards on Identification of Risk Factors and Estimated Prevalence of Malnutrition in Rural Malawian Infants

BackgroundThe World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified.Methodology/Principal FindingsData were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0–4 months and 11–15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards.Conclusions/SignificanceDifferences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population's nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.

WHO 2006 child growth standards: implications for the prevalence of stunting and underweight-for-age in a birth cohort of Gabonese children in comparison to the Centers for Disease Control and Prevention 2000 growth charts and the National Center for Health Statistics 1978 growth references

To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references. Prospective birth cohort in Lambaréné, Gabon. Two hundred and eighty-nine children from birth to 15 months of age. Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below -2 SD of the corresponding reference median (Z score < or = -2) were classified as stunted or underweight-for-age, respectively. With the new WHO 2006 standards a higher proportion (4.0%) of 3-month-old infants were underweight compared with the CDC (1.0%) or the NCHS (0.7%) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20%) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.

Algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO Child Growth Standards

BackgroundThe child growth standards released by the World Health Organization (WHO) in 2006 have several technical advantages over the previous 1977 National Center for Health Statistics (NCHS)/WHO reference and are recommended for international comparisons and secular trend analysis of child malnutrition. To obtain comparable data over time, earlier surveys should be reanalyzed using the WHO standards; however, reanalysis is impossible for older surveys since the raw data are not available. This paper provides algorithms for converting estimates of child malnutrition based on the NCHS reference into estimates based on the WHO standards.MethodsSixty-eight surveys from the WHO Global Database on Child Growth and Malnutrition were analyzed using the WHO standards to derive estimates of underweight, stunting, wasting and overweight. The prevalences based on the NCHS reference were taken directly from the database. National/regional estimates with a minimum sample size of 400 children were used to develop the algorithms. For each indicator, a simple linear regression model was fitted, using the logit of WHO and NCHS estimates as, respectively, dependent and independent variables. The resulting algorithms were validated using a different set of surveys, on the basis of which the point estimate and 95% confidence interval (CI) of the predicted WHO prevalence were compared to the observed prevalence.ResultsIn total, 271 data points were used to develop the algorithms. The correlation coefficients (R2) were all greater than 0.90, indicating that most of the variability of the dependent variable is explained by the fitted model. The average difference between the predicted WHO estimate and the observed value was <0.5% for stunting, wasting and overweight. For underweight, the mean difference was 0.8%. The proportion of the 95% CI of the predicted estimate containing the observed prevalence was above 90% for all four indicators. The algorithms performed equally well for surveys without the entire age coverage 0 to 60 months.ConclusionTo obtain comparable data concerning child malnutrition, individual survey data should be analyzed using the WHO standards. When the raw data are not available, the algorithms presented here provide a highly accurate tool for converting existing NCHS estimates into WHO estimates.

Nutritional Status and its Correlates in Equatorial Guinean Preschool Children: Results from a Nationally Representative Survey

In Equatorial Guinea, as a result of the recent growth of the oil industry, there is an opportunity to address important public health problems through public and private initiatives. To propose effective nutrition and public health strategies, it is important first to have reliable information on the nutritional status of the population and the underlying factors affecting it. To assess the nutritional status and the prevalence of anemia among Equatoguinean children in a nationally representative sample and to identify the risk factors associated with the nutritional problems detected. The study was a cross-sectional survey using a multistaged, stratified, cluster-selected sample. The survey included a sociodemographic, health, and dietary questionnaire and measurement of hematocrit and anthropometric features, from which nutritional indicators based on the National Center for Health Statistics (NCHS) reference and the World Health Organization (WHO) standards were calculated. Logistic regression models were used for the multivariate analysis. A total of 552 children aged 0 to 60 months were surveyed. The overall prevalence of stunting (< -2 height-for-age z-scores [HAZ]) was 29.7% based on the NCHS reference and 35.2% based on WHO standards; the risk factors associated with stunting were age (p < .0001), low socioeconomic status (p = .01), and fishing by a member of the household (p = .003) The prevalence of mild anemia (hemoglobin < 110 g/L) was 69.3%, and that of moderate or severe anemia (hemoglobin < 80 g/L) was 8.3%. The only significant risk factor associated with moderate to severe anemia was low household socioeducational level (p = .01). Stunting and anemia are public health problems in Equatorial Guinea. Integrated strategies, including fighting poverty and improving maternal education, should be undertaken.

Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes

To compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes. Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Respectively 4787, 10 381 and 226 infants and children. Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.

Nutritional status of Terena indian children from Mato Grosso do Sul, Brazil: follow up of weight and height and current prevalence of anemia

This study of Terena Indian children less than 10 years old was undertaken in order to compare weight and height in 1995 and 2002 and to evaluate anemia prevalence in 2002. This was a cross-sectional study of the Limão Verde and Córrego Seco tribes, located in Aquidauana, Mato Gosso do Sul, Brazil. The study enrolled all 253 children who were less than 10 years old in 1995 and 244 who were under 10 in 2002. Their nutritional status was evaluated comparing weight and height with the NCHS (National Center for Health Statistics) reference values (Epi-Info version 6.2). Hemoglobin was assayed using a portable photometer. The percentages of children with weight for age deficit (z score < -2 standard deviations) were 4 and 2.9% in 1995 and 2002 respectively. Percentages of weight for height deficits were 3.6 and 0.8% respectively. Percentages of height for age deficits were 15 and 11.1% respectively. The median z scores for weight, age and weight, and height showed a statistically significant increase during the period between 1995 and 2002 in infants. Between 24 and 60 months, there were increments in median z scores for weight for age and height for age. There was no statistically significant decrease in any of the anthropometric indicators, with reference to z scores. The prevalence rates of anemia were 86.1% for infants 6 to 24 months old (n = 43), 50.8% for those 24 to 60 months (n = 65) and 40.7% for children aged 60 to 120 months (n = 59). Weight and height both increased during period from 1995 to 2002. Anemia was highly prevalent, calling for immediate corrective measures.

Body mass index, overweight and obesity among Kuwaiti intermediate school adolescents aged 10–14 years

The purpose of this cross-sectional study was to assess the levels of overweight and obesity among Kuwaiti intermediate school adolescents aged 10-14 y. The study comprised a multistage stratified random sample of 14659 adolescents (7205 males and 7454 females), which constitutes approximately 17% of the target population of this school level. Weights and heights of the adolescents were measured, from which the body mass index (BMI), which is the weight in kilograms divided by the height in meters squared (kg/m2), was calculated. Overweight and obesity were defined as BMI >85th and >95th centiles, respectively, of the National Center for Health Statistics (NCHS) reference data. The overall prevalence of overweight and obesity among males were 30.0 and 14.7%, respectively (P<0.001). The overall prevalence of overweight and obesity among females were 31.8 and 13.1%, respectively (P<0.001 and P<0.01). There was no consistent rise or decline in overweight and obesity in both genders with respect to age. However, the overall prevalence of overweight was lower in males than in females but obesity was higher in males than in females. When compared to the NCHS reference population, the BMI of Kuwaiti adolescents exceeded that of the Americans in each centile category > or = 50th centile. Health education programmes should be instituted to control this syndrome in order to prevent future risk of obesity-related diseases.

Growth and nutritional status of Khasi boys in Northeast India relating to exogamous marriages and socioeconomic classes.

The Khasis are one of the matrilineal tribes of Meghalaya in Northeast India. They belong to the Indo-Mongoloid racial stock, and speak the Monkhmer language of the Austro-Asiatic group. They have their own traditional religion (Niam Khasi), but about 65% of them have converted to Christianity. A few Khasi members have also embraced Islam through matrimonial relationship with immigrant Muslim males. The present study was based on a cross-sectional sample of 1,351 urban Khasi boys aged 3-18 years belonging to these three religious groups, with a view to understanding the effects of socioeconomic factors on growth and nutritional status, using anthropometric variables such as weight and height. The findings showed that about 60%, 29%, and 6% of these boys were below -2 Z-scores of the US National Center for Health Statistics (NCHS) references in respect of weight for age, height for age, and body mass index for age, respectively. The logistic regression coefficient (beta +/- standard error) indicated that the prevalence of low weight for age (below -2 Z-scores of the NCHS references) was positively associated with age (0.088 +/- 0.014, P<0.0001), while it was inversely associated with household income (-1.216 +/- 0.030, P<0.0001). Likewise, low height for age Z-score was negatively associated with household income (-1.056 +/- 0.130, P<0.0001), although such a relationship was not significant in the case of low body mass index for age (-0.169 +/- 0.229, P>0.05). There were also significant differences between religious groups in respect of anthropometric variables. Allowing for household income, the ANCOVA test indicated that Muslim Khasi boys, who were the offspring of intermarriages between Khasi females and immigrant Muslim males, were significantly heavier and taller than Christian and Niam Khasi boys almost across ages. From about 3-10 years of age, Muslim Khasi boys were, on average, comparable to the 5th and 25th percentiles of the NCHS references of height and weight, respectively. Although it looks as though genetic mechanisms like heterosis and/or gene flow might also be associated with the larger body size in Muslim boys, such a conjecture could only be substantiated or refuted by further studies concerning genetic and more socioeconomic data on both immigrant and nonimmigrant populations.

Human growth in southern Zambia: a first study of Tonga children predating the Kariba Dam (1957-1958).

During the late 1950s the Kariba hydro-electric dam was constructed on the border of Zambia and Zimbabwe forcing the relocation of 57,000 people, mainly Tonga. As part of a larger study to assess the effects of the relocation, research into the human biology of the Tonga people was conducted. The research reported here provides a basis for comparison with long-term follow-up data on growth and physical status of Gwembe Tonga to determine the effects of resettlement. The sample consists of 303 schoolchildren, 7 to 13 years, from two schools that were not relocated and three schools that were to be relocated. Homogeneity of the two groups led us to combine them as a single baseline sample before relocation. Comparisons with NCHS (National Center for Health Statistics) reference data and with contemporary urban data from southern Zambia indicate sub-optimal nutritional status. After ages 6 and 7, height-for-age and weight-for-age Z-scores of boys decline steadily towards -2.0 SD throughout the 12th year, whereas mean Z-scores of girls decline markedly from 8 years on. Mean HAZ (Height-for-age-Z-score) of girls falls below -2.0 SD by 11 years and approaches -3.0 SD by 13 years. Thirty-nine percent of males and 47% of females in the baseline sample showed effects of moderate or severe protein energy malnutrition at the time of relocation. Because these children were from a school sample, gender differences in opportunity to attend school may be a factor in what appears to be gender bias, favoring the status of boys. This sample provides a baseline for assessing the long-term impact of forced relocation on the Gwembe Tonga.

The National Center for Health Statistics reference and the growth of Indian adolescent boys

Few studies describing the growth of adolescents exist because of the difficulties in interpreting anthropometric data in this age group. We describe the growth of adolescent boys from West Bengal, India, and assess the adequacy of using the National Center for Health Statistics (NCHS) reference data. A cross-sectional anthropometric survey was conducted in 818 Bengali boys from middle-class families. Anthropometric measurements were taken on each subject's birthday (+/-3 d) by use of standard measuring techniques. The NCHS reference data on height and body mass index (BMI) were used to estimate age-specific prevalences of stunting, thinness, and overweight. BMI was also assessed by using British, Dutch, and French reference data. The biological parameters of the adolescent growth spurt were estimated by using the Preece-Baines growth model. With use of the 5th percentile of the NCHS reference data, the prevalence of thinness was approximately 5 times (50.5%) that of stunting (11.2%). The median curves of the 3 European references lay between the Indian and NCHS samples and also yielded high prevalences of thinness when applied to the study sample. The prevalence of being at risk of overweight was low (4.2%). Mean age at peak height velocity was 13.0 y and peak height velocity was 7.0 cm/y. The NCHS reference data seem inadequate for this sample. Consideration should be given to developing appropriate reference data based on healthy adolescent populations from different ethnic groups. Issues of maturation-related variation in assessing growth during adolescence should be given particular attention.

The growth and feeding patterns of 9 to 12 month old Chinese Canadian infants

The growth of infants and children in China has been reported to be below that of international reference standards. Both environmental and genetic factors are hypothesized to be determinants of this observed growth pattern. This study, utilizing a cross sectional design, examined the growth and feeding patterns of a sample of Chinese Canadian infants in Toronto at 9 (n = 28), 10 (n = 33), 11 (n = 35) and 12 (n = 34) months of age. These infants achieved heights as described by the National Center for Health Statistics (NCHS) standard. However, their weight and weight for height scores were below NCHS medians (p < 0.05). Although no explanation for the overall lower body weights of this sample of infants was found, feeding practices contributed to weight variance. A longer duration of breastfeeding was associated with lighter infants (p < 0.05). Conversely, a longer duration of feeding of formula was associated with heavier infants (p < 0.05). By or at 4 months, introduction of complementary foods in general, as well as specific complementary foods (home-prepared carbohydrates, vegetables and fruits) were associated with higher weight and weight for height scores (p < 0.05). It was concluded that Chinese Canadian infants in Toronto have the potential at birth to achieve lengths equivalent to the NCHS reference median at nine to 12 months of age.