NCHS Reference Research Articles

Body Mass Index of selected Overweight and Obese Indian Adolescents in Madurai district, Tamil Nadu, India

Childhood obesity is an important predisposing factor for most non-communicable diseases. Irrespective of the age and gender, the prevalence rates of overweight and obesity has attained alarming levels not only in developed countries but also in developing countries among all socio-economic groups. The prevalence of overweight and obesity has reached alarming levels, affecting virtually both developed and developing countries of all socio-economic groups, irrespective of their age and gender. Hence, the present study was aimed to identify the anthropometric measurements of selected overweight and obese school-going adolescents from different schools from Madurai district Tamil Nadu, India. A total of 514 adolescents (312 Girls and 202 Boys) aged 13-18 years participated from government and private schools. Mean height, weight and BMI were calculated and compared with (National centre for Health Statistics) NCHS standard references. The mean height, weight and BMI were found to be increasing as the age increases of both genders. Body Mass Index of Girls (34.18 – 35.24)was found to be higher than boys (33.49 – 32.89) of the same age group. The School-going adolescents of both genders, in general, have short stature at all ages as compared to NCHS reference data. The prevalence of Overweight 95 (18.48%) and obese 315 (61.28%) was found to be higher in Nuclear families, but there was no statistical association between family type and BMI (X2 = 2.575, p > .05). A significant relationship was found between the Body Mass Index of the adolescents and Father’s Educational qualification (p=.00) and Mother’s Occupation (p=.008). Nutrition education can play an important part in reducing the incidence of overweight/obesity and its associated complications.Extensive trials with a healthy school environment as an intervention may pave the way for developing new strategies to reduce the overweight and obesity in school-going adolescents.

Comparison of Anthropometric Indicators That Assess Nutritional Status From Infancy to Old Age and Proposal of Percentiles for a Regional Sample of Chile.

Objectives: Anthropometric variables are used to evaluate health, dietary status, disease risks, and changes in body composition. The purpose of this study was to compare weight, height, and Body Mass Index (BMI) with American references from the National Center for Health Statistics (NCHS-2012), using BMI and Tri-Ponderal Mass Index (TMI) to propose percentiles for evaluating nutritional status of children, adolescents, and adults, ages 5–80 years old.Methods: A descriptive cross-sectional study was conducted in 15,436 (8,070 males and 7,366 females) children, youths and adults in the Maule region (Chile). The age range ranged from 5.0 to ~80 years of age. Weight and height were assessed. Body mass index BMI and tri-ponderal mass index (TMI) were calculated. The LMS method was used to generate percentiles.Results: The results illustrated that children were heavier and had more BMI during childhood compared to the NCHS references. During adolescence, reference values were greater until approximately ages 70–79. For height, children were relatively similar to those of the NCHS references, but during adolescence, differences became evident. Adolescence until approximately age 80, the population showed lower values for height. Percentiles were calculated using BMI and TMI by age range and sex. Differences occurred between the American NCHS references and the population with regard to the anthropometric variables of weight, height, and in BMI.Conclusion: Discrepancies with the American NCHS reference were verified in the anthropometric variables of weight, height and BMI. Reference percentiles of BMI and TMI were developed for the evaluation of the nutritional status of the regional population of Maule (Chile). Its use is suggested in clinical and epidemiological contexts.

Nutritional Status and Associated Factors Among Preschool Children in Bahir Dar City Administration, Northern Ethiopia: A Cross-sectional Study

The issue of child malnutrition is decisive as its characteristics are not restricted to the boundary of childhood but rather persist into adulthood. It is also a sober public health problem in which the recent report in the country showed 25% of children were underweight, 9% wasted and 38% stunted. However, underlying variations of these nutritional indicators and determinant factors among localities are poorly understood. Therefore, the main objective of the study is to assess the prevalence of child malnutrition, their causes, and related factors. A cross-sectional study was conducted in Bahir Dar on a total of 615 preschool-age children from February to May 2018. A multistage systematic sampling method was employed to collect quantitative data using a structured questionnaire and anthropometric measurements. The information was processed using Epi-Info 3.5.4 software and exported to SPSS 20 for analysis. NCHS reference population was used to convert height and weight measurements into Z-scores. Bivariate and multivariate logistic regression analysis techniques were employed to identify associated factors with nutritional status. A P-value of less than 0.05 was considered as statistically significant. The study indicated 7% of the children were wasted, 30.9% stunted, and 18.7% underweight. The bivariate and multivariate logistic regression analysis showed that family income [AOR=.233 at 95% CI (.085-.637)], number of under-five children [AOR=2.618 at 95% CI (1.751-9.124)], source of water [AOR=2.852 at 95% CI (1.029-7.901)], paternal education [AOR=4.19 at 95% CI (1.298-13.527)], maternal education [AOR=2.740 at 95% CI (1.193-6.294)], and family head [AOR=.421 at 95% CI (.233-.762)], were positively associated with underweight. Chronic nutritional problems (stunting) and underweight were highly prevalent in Bahir Dar compared to the urban areas of neighbouring countries while the acute nutritional problem was at an intermediate level. To intervene in this problem, a community-based nutrition program should be established. Additionally, nutritional education should get a high emphasis to improve the nutritional status of children.

Bioimpedance index for measurement of total body water in severely malnourished children: Assessing the effect of nutritional oedema

Restoration of body composition indicates successful management of severe acute malnutrition (SAM). Bioimpedance (BI) index (height(2)/resistance) is used to predict total body water (TBW) but its performance in SAM, especially with oedema, requires further investigation. Children with SAM (mid-arm circumference <11.0cm or weight-for-height <70% of median of NCHS reference and/or nutritional oedema) admitted to Jimma University Hospital were included. Tetrapolar-whole-body impedance (Z), resistance (R) and reactance (Xc) were measured at 50 and 200kHzs. Pre- and post-deuterium dose saliva samples were analysed using isotope-ratio mass spectrometry. TBW was regressed on H(2)/Z. Xc and R were height (H)-indexed, and Xc/H plotted against R/H. Thirty five children (16 non-oedematous and 19 oedematous) with median (interquartile range) age of 42 (26-54) months were studied. Height-for-age z-score (mean±SD) was low in both non-oedematous (-3.9±2.8) and oedematous (-3.6±1.7) children. Oedematous children had lower BI parameters than non-oedematous (p<0.001) and hence higher H(2)/Z for a given amount of TBW. At both 50 and 200kHz, association between H(2)/Z and TBW was stronger in non-oedematous children than oedematous (60% higher coefficient of determination and 20% lower standard error of estimate). Intercepts and regression estimates at 50 and 200kHz were similar, in both oedematous and non-oedematous children. In children with oedematous SAM, BI index was weak in predicting TBW. Moreover, predicted TBWs at 200kHz and 50kHz did not differ and hence BI measurement at 50kHz is still practical for TBW estimation.

Nutritional status among boys and girls of a central Indian Town (Sagar)

The prevalence of undernutrition is a significant area of concern in many developing countries, where it is a major public health problem. The aim of the study was to assess the prevalence of undernutrition among school-going boys and girls of central Indian city Sagar, MP. A total of 612 individuals (312 girls and 300 boys) aged 5–18 years were examined and compared to the NCHS reference data. The nutritional status was assessed using following anthropometric indicators: body height and weight, body mass index (BMI) and composite index of anthropometric failure (CIAF). It was found that girls were heavier (1 kg) and taller (2–5 cm) than boys up to 15 and 13 years of age, respectively. After that, boys became taller with 1 to 13 cm. The mean BMI of boys was higher to girls up to 10 year of age after that the trend was reversed. Comparison of the present findings with NCHS reference data revealed that Indian girls and boys were lagging behind. The difference in body weight between the reference data and the present sample was around 5 to 6 kg. The pattern of difference in body height revealed small amount during early childhood (6.6.cm and 9.6 cm in girls and boys 5 years of age). This difference more than doubled at the age of 14 years in girls 16.7 cm and in boys 17.5 cm (p&lt;0.01). Similar pattern was found for BMI with 6.5 kg/m2 and 6.3 kg/m2 in 14 years old girls and 16 years old boys (p&lt;0.01). Z-score values of weight-for-age, height-for-age and BMI-for-age revealed that that boys were more likely to be stunted than girls whereas girls were more likely to be underweight and undernourished than boys. In terms of CIAF 10.6% girls and 10% boys were undernourished. The results of the present study indicate that there is great need for implementation of health programmes to eliminate gender inequalities and improve children’s health.

Prevalence of overweight and obesity among secondary school children aged 14 to 18 years (china).

Prevalence of overweight and obesity in adolescents has been increasing during recent decades. The present study aimed to assess the prevalence of obesity in 14-18 years old Anhui Secondary school children, and provide more comprehensive guidelines for intervention programs. This cross-sectional study was conducted among 4788 children in secondary school, and date from the routine health survey was analyzed. Trained health workers took anthropometric measures, height and weight, at the school. Definition of children overweight and obesity children was based on the international age-and sex-specific body mass index reference standards proposed by the International Obesity Task Force and National Center for Health Statistics. According to the IOTF standard the prevalence of overweight (including obesity) and obesity revealed decreasing trend with age in male (overweight, from 17.3% at 14-y to 5.3% at 18-y; obesity, from 3.8% at 14-y to 2.3% at 18-y). Depending on the NCHS references used, the overall prevalence of overweight (including obesity) and obesity in male aged 14 to 18 decreases from 16.4% to 11.7% and from 4.6% to 2.8%, respectively. The overweight (including obesity) and obesity from 14 to 18 years old have a decreasing trend, and more attention should be taken to male students in China. These findings suggest secondary school and government need to design appropriate guidelines to keep healthy for adolescents in China.

Prevalence of malnutrition among pre-school children in South-east Nigeria.

BackgroundMalnutrition can be defined as a state of nutrition where the weight for age, height for age and weight for height indices are below -2 Z-score of the NCHS reference. It has posed a great economic burden to the developing world.ObjectivesThe objective of this study is to assess the prevalence of malnutrition among pre-school children in abakiliki in Ebonyi state of Nigeria.MethodsThis is a cross-sectional studies that assess the prevalence of malnutrition and associated factors among children aged 1-5 years attending nursery and primary schools. Nutritional assessment was done using anthropometry and clinical examination.ResultsA total of 616 children aged one to 5 years were enrolled into this study. Three hundred and sixty-seven (59.6%) were males while 249 (40.4%) were females. Sixty of the 616 children (9.7%) had acute malnutrition based on WHZ-score. Moderate acute malnutrition (MAM) was present in 33 children (5.3%) while 27 (4.4%) had severe acute malnutrition.ConclusionsThe prevalence of global and severe acute malnutrition using z-score is 9.7% and 4.4% respectively while that of stunting is 9.9% with a male preponderance.

BERAT DAN PANJANG BAYI SERTA NILAI Z SKORBAYI DENGAN ASI PREDOMINAN DAN PARSIAL BERDASARKAN STANDAR WHO 2005 DAN NCHS\WHO

New WHO standard introduce to implemented in every country including Indonesia. The population of children to develop new standard comes from good economic status and low mobility. Three quarters infant were exclusive/predominantly breastfed for at least four month. In Indonesia, predominantly and partially breastfed most practiced than exclusive breastfeeding. To compare the growth of infantsaccording to WHO new standard and NCHSreference. Methods: Analyzed using secondary data of cohort prospective research of “the influence early supplementation infant feeding to first four month infant growth”. Developing curve of infant weight and length attainment for predominant and partially breastfed; also developing curve Z score (weight for age, weight for length and length for age) for predominant and partially breastfed. Both curves development are using new WHO standard and NCHS reference. During the first four month, the weight and length deviation of infant with predominantly and partially breastfed using new who standard larger than NCHS, and infant with predominantly breastfed better than partially breastfed. The Z score curve for weight for age, length for age and weight for age simultaneously as a pattern of new WHO standard, but since birth until 4 month age the number of Z score for those indicators lower than WHO new standard. New WHO standard anthropometry more representative to infant growth than NCHS reference. Keywords : Predominant breastfed infants, partially breastfed infants, growth curve, New WHO standard, NCHSreference

KAJI ULANG STATUS GIZI ANAK 0-59 BULAN (BERAT BADAN MENURUT UMUR) MENGGUNAKAN DATA NASIONAL: SUSENAS 1989-2005 PERBANDINGAN STANDAR NCHS/WHO DAN RUJUKAN WHO 2005

REASSESSMENT OF NUTRITIONAL STATUS (WEIGHT OF AGE) FOR CHILDREN 0-59 MONTHS USING NATIONAL DATA SUSENAS 1989-2005 COMPARISON OF WHO STANDARDS AND NCHS REFERENCE In April 2006, the World Health Organization has launched new standards for assessment growth and development of children 0 to 5 years of age. This new standards should be adopted in all countries. Nationally, Indonesia has been collecting anthropometric data for children under five since 1989 up to 2005 through periodic socio-economic national survey (SUSENAS). The nutritional status based on weight for age using NCHS reference has been assessed to monitor the change of underweight prevalence, especially at provincial and national level. The new standards need to be applied for reassessing the underweight prevalence as part of adoption process. The primary source of data is the 1989-2005 Susenas’ Surveys, both the household data, and the individual data, along with the nutrition module. Weight for Age data on nutritional status is described in Z scores from both the NCHS international reference and new WHO standards. Descriptive analyses were carried out reviewing the trend of underweight prevalence from 1989 to 2005, mean weight of children under five both for sexes, the prevalence of underweight across the provinces and by age groups as well both sexes, mean z-scores by age and quintiles, and distribution by quintiles. The results from reassessment showed that the prevalence of moderate underweight generally higher using new WHO standard compared to NCHS/WHO referenceduring the first half infancy 0-5 months and lower for the age above 6 months. However, the prevalence of severe underweight generally higher based on WHO standard compared to NCHS/WHO reference. Differences in prevalence between WHO standard and NCHS reference vary by location (urban, rural), economic status depend, age group, sex, or other population characteristics. Keywords : comparison, reassessment, underweight prevalence

Relationship between head lice (Pediculus humanus capitis) infestation and nutritional status of children

The prevalence of head lice (Pediculus humanus capitis) infestation and malnutrition affect among the children (1 to 7 years) in the area of Mirpur Bihari Camp, Dhaka was observed. A total of 300 children were examined during February 2011 to January 2012, and among them 59.67% prevalence of head lice was observed. The height and weight for age was compared following 50th percentile or standard deviation score (SD?score) of WHO/ NCHS reference standard. In case of WAZ (weight for age using Z?score value) of boys, moderate malnutrition was found in 2, 3, and 5 years age group and mild malnutrition was found in 1, 4, 6 and 7 years age group. In case of WHZ (weight for height of boys), mild malnutrition was found in age group 2, 3 and 5 years. In better growth children, 56.67% were infested by head lice, 56% in medium growth children and the highest 65.46% among the children with mild growth. The intensity of infestation was mostly mild and moderate. DOI: http://dx.doi.org/10.3329/dujbs.v23i2.20091 Dhaka Univ. J. Biol. Sci. 23(2): 119-125, 2014

Nutritional Status and Risk Factors of Malnutrition among 0-24 Months Old Children Living in Mezam Division, North West Region, Cameroon

Introduction: Childhood malnutrition especially under nutrition is one of the most frequent causes of child morbidity and mortality. The consequences of malnutrition are more apparent in adulthood; it results in poor physical development and diminished cognitive abilities. Objective: To evaluate the nutritional status of supposedly healthy children aged 0 to 2 years old, attending vaccination clinics in Mezam division, North West Region, Cameroon. Methods: It was a descriptive survey using structured questionnaires, which covered socioeconomic and demographic information, breastfeeding practices, socio-cultural and economic factors and anthropometric data. Anthropometric measurements were taken (weight, height, head circumference). The total number of children was 990 (561 girls and 429 boys) all from diverse ethnic groups and Backgrounds. The anthropometric indicator used was the weight-for-age. The nutritional status of these children was evaluated with respect to a number of factors which are: age range, the sex of the children, milk feeding, socio-economic and demographic factors. The results obtained were expressed in percentages. Results: Comparison of the growth patterns of the study population with that of the NCHS references revealed that none of the children grew exactly according to the NCHS references. The prevalence rate of both under nutrition and over nutrition among the 0-2 year’s old children living in Mezam division was high. Children aged 0 to 6 months were more affected by under nutrition while those aged 6-12 months were more affected by over nutrition. Risk factors of under nutrition in these infants were as a result of factors such as: Nature of parents’ profession, parents’ educational level, inappropriate child feeding practices such as exclusive breastfeeding practiced incorrectly and mixed feeding started too early. Conclusion: The study revealed a high prevalence rate of both under nutrition and over nutrition among children aged 0-2 year’s old living in the Mezam division.

Prevalence of Severe Acute Malnutrition in Children Aged 6 -60 Months Admitted at Mother of Christ Specialist Hospital Ogui, Enugu, Nigeria

Background: Prevalence of severe acute malnutrition in children aged 6 - 60 months in mother of Christ hospital Ogui Enugu was studied. The study was aimed: to determine the social demographic profile of severely malnourished children and/or parents of children with severe acute malnutrition, to determine the risk factors for severe acute malnutrition in admitted children with Severe Acute Malnutrition (SAM) and to know the prevalence of wasting, stunting and under-weight of children from 6 - 60months. Methodology: Random selection was used to select the population studied. The data collected include the patients' mothers' biography, patients anthropometry, biochemical results and family size. The NCHS reference standard were used to determined the nutritional status of the children.SPSS version 16 was used to determine the descriptive statistics (percentages and frequencies).Result: The result of the survey revealed that there was a relationship between education attainment of mothers and child's conditional status which was significant (p < 0.05). Prevalence of severe acute malnutrition occurs mainly in families that have limited access to nutritious food and are living in unhygienic condition, which increases risk of repeated infections. Malnutrition was common in the first and second year of life as a result of inadequate breastfeeding of the child and high rate of infection. The study revealed that large households have significant (P< 0.05) influence on the nutritional status of the children than smaller household. Conclusion: In this study results indicated that malnutrition is a problem among children in the area. The prevalence of malnutrition such as wasting, stunting and underweight was high within the ages of 0-11 months and 12- 17 months. Child feeding practices were inadequate. Mother's characteristics and household feeding characteristics appear to influence children's nutritional status. Effort to improve feeding practices and to relieve the constraints to the adoption of exclusive breastfeeding and optimal feeding practices will have significant effects on child nutritional status in the population.

PP.31 Relationship Between Birth Weight and Nutritional Status in Preschool Children

BackgroundThe intrauterine period has been considered as a very sensitive period in which nutritional and/or hormones changes appear to play an essential role in the subsequent control of body weight.ObjectivesClassify...

Protecting child health and nutrition status with ready-to-use food in addition to food assistance in urban Chad: a cost-effectiveness analysis

BackgroundDespite growing interest in use of lipid nutrient supplements for preventing child malnutrition and morbidity, there is inconclusive evidence on the effectiveness, and no evidence on the cost-effectiveness of this strategy.MethodsA cost effectiveness analysis was conducted comparing costs and outcomes of two arms of a cluster randomized controlled trial implemented in eastern Chad during the 2010 hunger gap by Action contre la Faim France and Ghent University. This trial assessed the effect on child malnutrition and morbidity of a 5-month general distribution of staple rations, or staple rations plus a ready-to-use supplementary food (RUSF). RUSF was distributed to households with a child aged 6–36 months who was not acutely malnourished (weight-for-height > = 80% of the NCHS reference median, and absence of bilateral pitting edema), to prevent acute malnutrition in these children. While the addition of RUSF to a staple ration did not result in significant reduction in wasting rates, cost-effectiveness was assessed using successful secondary outcomes of cases of diarrhea and anemia (hemoglobin <110 g/L) averted among children receiving RUSF.Total costs of the program and incremental costs of RUSF and related management and logistics were estimated using accounting records and key informant interviews, and include costs to institutions and communities. An activity-based costing methodology was applied and incremental costs were calculated per episode of diarrhea and case of anemia averted.ResultsAdding RUSF to a general food distribution increased total costs by 23%, resulting in an additional cost per child of 374 EUR, and an incremental cost per episode of diarrhea averted of 1,083 EUR and per case of anemia averted of 3,627 EUR.ConclusionsAdding RUSF to a staple ration was less cost-effective than other standard intervention options for averting diarrhea and anemia. This strategy holds potential to address a broad array of health and nutrition outcomes in emergency settings where infrastructure is weak and other intervention options are infeasible in the short-term. However, further research is needed to establish the contexts in which RUSF is most effective and cost-effective in preventing acute malnutrition and morbidity among vulnerable children, compared to other options.

Agreement in height for age between growth references: Caldas, Colombia. 2006-2009

different anthropometric references have been proposed and even used in Colombia. However, there are few previous studies reporting results when these references are used and there is no consensus about the ideal reference to be adopted. The objective of this study was to evaluate the concordance between three different anthropometric references in the assessment of height for age in a population under 17 years of age that attended the nutritional program at CONFAMILIARES, Caldas, Colombia, between 2006 and 2009. a descriptive study of 31.961 children under 17 years attending the nutrition program CONFAMILIARES, Caldas, Colombia between 2006 and 2009. The variables were the height for age and sex. Anthropometric classification with references from the National Center for Health Statistics of the United States (NCHS) and the World Health Organization (WHO) was carried out with Anthro and the Centers for Disease Control (CDC) with EpiInfo 6.04. Z score was calculated differentiated by sex. Kappa coefficient was estimated to assess the correlation between anthropometric categories and classified it with cutoff Altman DG. the highest concordance was found between the NCHS reference and WHO (girls: 0,854; children: 0,899, p = 0,000), followed by the CDC versus the NCHS (girls: 0,787; children: 0,860, p = 0,000) and the CDC compared with WHO (girls: 0,754; children: 0,829, p = 0,000). according to the results could be used any of the three growth references for assessing the height for age in this population.

Effect of selected dietary regimens on recovery from moderate acute malnutrition in young Malian children

Moderate acute malnutrition (MAM) remains a major public health concern and research is needed on optimal dietary treatment regimens. We randomly assigned 12 rural health centers in Dioila Health District, Mali to provide 1 of 4 dietary regimens approximating WHO recommended nutrient profiles: 1) lipid‐based, ready‐to‐use supplementary food (Plumpy'Sup, PS); 2) special corn soy blend for MAM (CSB++); 3) locally processed, fortified food (Misola); or 4) locally milled flours and micronutrient powder. 1284 non‐edematous children aged 6–35 mo with initial arm circumference (MUAC) &lt;12.5 and ≥11.0 cm or weight‐for‐length Z‐score (WLZ) &lt;‐2.0 WHO standard and ≥70 % NCHS reference median were offered ~500 kcal/d of assigned diet in addition to home food intake for 12 wks. Among 1121 children (87.3%) who completed the study, the mean±SD change in weight from baseline was greater with PS than all 3 other regimens, which did not differ from each other (1.15±0.57 kg, 0.96±0.55 kg, 0.96±0.53 kg, 0.91±0.54 kg for respective study groups, p&lt;0.001 ANOVA). MUAC changes followed a similar pattern, but length did not differ significantly among groups. Recovery from MAM (WLZ&gt;‐2.0, MUAC&gt;12.5cm) was highest with PS compared with the 3 other regimens (71%, 56%, 59%, 53% for respective groups, p&lt;0.001 Scheffe). PS is more effective than the other dietary regimens, but benefits must be considered in relation to product costs and availability. This study was supported by UNICEF and WFP.Grant Funding Source: UNICEF and WFP

Patterns of stunting and wasting: potential explanatory factors.

We investigated the causes of stunting and wasting using nationally representative data on preschool children from India (2005-2006, N = 41,306) and Guatemala (2008-2009, N = 10,317). We estimated stunting and wasting using the 2006 WHO standard and the 1976 WHO/National Center for Health Statistics (NCHS) reference. India and Guatemala had high levels of stunting; wasting was common in India but rare in Guatemala. Use of the WHO standard (based on breast-fed children) increased the prevalence of stunting in both countries but dramatically changed the pattern of wasting by age in India. In Indian children 0-5 mo of age, wasting more than tripled, from 8% to 30%, leading to the highest prevalence of wasting. Using the NCHS reference, the lowest and highest prevalence among Indian children occurred in children 0-5 and 12-23 mo, respectively. Also, we showed that household wealth and the condition of women were related to both stunting and wasting; review of the literature on wasting failed to identify factors that were not also related to stunting (e.g., seasonality, infections, and intrauterine growth retardation). Possible explanations for high levels of wasting in India include the poor status of women, the "thin-fat" infant phenotype, chronic dietary insufficiency, poor dietary quality, marked seasonality, and poor levels of sanitation. Use of the WHO standard calls for urgent attention to improving prenatal and infant nutrition and uncovers an alarming level of wasting in the young infant in India that use of the NCHS growth reference (based on bottle-fed infants) had masked.

Using the WHO 2006 child growth standard to assess the growth and nutritional status of rural south Indian infants

Background: The WHO 2006 child growth standard is advocated in India, although the conformity of the growth of Indian infants to the WHO standard has only been assessed at cross-sectional points.Aim: To assess the implications of using the WHO standard in rural India and to investigate the factors responsible for any departure from optimal growth, as shown in the WHO standard.Subjects and methods: Mixed-effects models were applied to serial weight and length data from 384 rural south Indian infants. Unadjusted and adjusted (for, among other things, breastfeeding and maternal education) estimates were converted to Z-scores and the risks of underweight, wasting and stunting using the WHO standard compared to the NCHS 1977 child growth reference were calculated.Results: Weight growth was more similar to the WHO standard than the NCHS reference and in late infancy the WHO standard was less likely to classify underweight (RR at 15 months = 0.45; 95% CI = 0.31–0.65). Adjusting the serial data shifted the curves 0.25 Z-scores closer to the median of either chart; variations in household socioeconomic status and morbidity were largely responsible for this shift.Conclusion: In late infancy, the WHO standard will allow a more focused intervention effort and use of resources for targeting programmes at infants most at risk of malnutrition.

Socio-economic and demographic factors affecting the Composite Index of Anthropometric Failure (CIAF)

Background: The present cross-sectional study evaluates the utility of the Composite Index of Anthropometric Failure (CIAF) over conventional nutritional indices for nutritional assessment. It also assesses the impact of various socio-economic and demographic factors on the CIAF.Subjects and methods: Height, weight, age, socio-economic and demographic data were recorded from 3444 children (1682 boys; 1762 girls) aged 1–12 years and residing in Darjeeling district, West Bengal, India. The conventional anthropometric indices and CIAF were compared with the NCHS reference data to assess prevalence of under-nutrition. A multinomial logistic regression was used to assess the impact of different socio-economic and demographic variables on the CIAF.Results: Prevalence of under-nutrition was observed to be 21.5% (wasting), 43.3% (stunting) and 52.0% (underweight). This increased to 63.6% using the CIAF. The multinomial logistic regression odds showed that children suffering from double and multiple failures were significantly associated with the socio-economic and demographic variables.Conclusion: The CIAF provides more precision in identifying the nutritionally vulnerable segment of the population. The disaggregation of CIAF has an adequate potential to enhance the efficacy of a nutritional intervention programme by identifying double or multiple failures.

Nutritional status and growth of indigenous Xavante children, Central Brazil.

BackgroundThe aim of this study was to characterize the nutritional status of Xavante Indian children less than 10 years of age in Central Brazil and to evaluate the hypothesis of an association between child nutrition and socioeconomic differentiation in this population.MethodsA cross-sectional study was conducted in July 2006 that included all children under the age of 10 from the Xavante village Pimentel Barbosa in Mato Grosso, Brazil. The data collected included weight, height, and sociodemographic information. Sociodemographic data were used to generate two indices ("income" and "wealth") and to determine the proportion of adults in each household. Descriptive analyses were performed for weight-for-age (W/A), height-for-age (H/A), and weight-for-height (W/H) using the NCHS and the WHO growth references. Univariate and multivariate analyses were conducted using H/A and W/A as a response variables.ResultsOf a total of 246 children under the age of ten residing in the village, 232 (94.3%) were evaluated. Following the NCHS reference, 5.6% of children under the age of ten presented low W/A and 14.7% presented low H/A. Among children under the age of five, deficit percentages for weight and height were 4.5% and 29.9%, respectively, following the WHO curves. Among children < 2 years of age, H/A index variability was found to be directly related to child's age and inversely related to the proportion of adults in the household. Maternal BMI was positively associated with growth for children from 2 to 4 years of age, explaining 11.5% of the z-score variability for the H/A index. For children 5 years of age and older, the wealth index and maternal height were positively associated with H/A. No significant associations were found using W/A as the dependent variable.ConclusionThis study demonstrated that undernutrition, in particular linear growth deficit, is a notable health issue for Xavante children. These findings contrast with the nutritional profile observed among Brazilian children nationally, which is characterized by a sharp decline in child undernutrition in recent decades, even in the poorest regions of the country. This discrepancy calls attention to the persistent health disparities that exist between indigenous and non-indigenous people in Brazil.