Weight-for-height Z-score Research Articles

The role of body mass index-for-age in the assessment of acute malnutrition and obesity in Moroccan hospitalized children

The aim of the present study was to examine the accuracy of body mass index-for-age (BMI-Z), mid-upper arm circumference (MUAC), and MUAC z-score (MUAC-Z) in assessing the acute malnutrition as well as the BMI-Z in assessing obesity in Moroccan hospitalized children aged from 1 month to 5 years. This is a longitudinal observational study carried out on 337 children. Weight, height/length, and MUAC related to sex and age were determined at admission and exported to World Health Organization (WHO) Anthro software for conversion to sex-age specific z-score indices. Weighted Cohen’s Kappa test was used to assess the concordance between weight-for-height z-score (WFH-Z), BMI-Z, MUAC-Z, and MUAC in screening for acute malnutrition defined as WFH-Z 3SD. The area under the receiver operating characteristic (ROC) area under the curve (AUC) was used to assess the performance of the anthropometric indexes in screening for acute malnutrition. We found high malnutrition prevalence as reflected by wasting (12.17%), stunting (13.35%), overweighting risk (24.64%), overweighting (11.39%), and low malnutrition prevalence as indicated by underweighting (4.75%) and obesity (3.56%). The BMI-Z showed perfect agreement to diagnose acute malnutrition (Kappa = 0.872) and obesity (Kappa = 0.827) with higher sensitivity and specificity indexes as well as higher positive predictive and negative predictive values. The AUC of the BMI-Z revealed very outstanding diagnostic accuracy to assess acute malnutrition (AUC = 0.98) and obesity (AUC = 0.99) in comparison to those of MUAC (AUC = 0.75) and MUAC-Z (AUC = 0.69). The results of the present study suggest that BMI-Z could be a good alternative indicator to assess acute malnutrition and obesity in hospitalized children aged from 1 month to 5 years.

Effect of water, sanitation and hygiene interventions alone and combined with nutrition on child growth in low and middle income countries: a systematic review and meta-analysis

ObjectiveThis study aimed to provide clarification on the benefits of water, sanitation and hygiene (WASH) alone separately and combined with nutrition in improving child growth outcomes.DesignSystematic review and meta-analysis.MethodsWe conducted...

Feeding Difficulty and Its Association with Growth and Development Among Young Children in China

Abstract Objectives To profile the current status of feeding difficulty, and to investigate its association with growth and development of Chinese young children. Methods A cross-sectional survey named YI Study was conducted among children aged 1 to 3 years in four cities (Beijing, Ningbo, Shenyang and Xuchang) of China in 2019. Feeding-related information and anthropometry indicators including height, weight, head circumference (HC) and mid-upper arm circumference (MUAC) were collected by trained interviewers. Feeding difficulty was evaluated by the Montreal Children's Hospital Feeding Scale (MCHFS), which is a brief 14 item-7point Likert parental report tool to assess about feeding and growth. Children with a total score of at least one standard deviation above the mean were marked as having feeding difficulty. The weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), BMI-for-age Z-score (BAZ), HC-for-age Z-score (HCZ), and MUAC-for-age Z-score (MUACZ) were calculated using the WHO Anthro software. Binary logistic regression and Multiple linear regression were used to explore the risk factors of feeding difficulty and its association with anthropometry parameters. Results Of the 376 children included, the total score of MCHFS was 34.26 ± 12.66. Among all the 14 items, the item with the highest (3.33 ± 1.99) and lowest (1.67 ± 1.25) score was “acting up/making a big fuss” and “Gagging/spiting/vomiting with certain types of food”, respectively. After adjustment for age, gender, area, family monthly income and physical activity, results of binary logistic regression showed that children with early addition of complementary food (early than 6 months, P = 0.027), self-reported pickiness (P < 0.001) or food allergy (P = 0.024) were more likely to suffer from feeding difficulty. Multiple linear regression showed that feeding difficulty was negatively associated with WHZ (β = −0.299, P = 0.022), HAZ (β = −0.434, P = 0.004), WAZ (β = −0.424, P < 0.001), HCZ (β = −0.542, P < 0.001) and MUACZ (β = −0.517, P < 0.001), expect BAZ. Conclusions Using MCHFS, feeding difficulty was detected among Chinese young children, which may be related to their growth and development to some extent. Funding Sources This study was supported by the Inner Mongolia Yili Industrial Group Co. Ltd.

Impact of sickle cell disease on presentation and progression of paediatric HIV: a retrospective cohort study.

HIV and sickle cell disease (SCD) are significant causes of morbidity and mortality in sub-Saharan Africa. Given their separate roles in immune dysregulation, our objective was to characterise the impact that SCD has on the presentation and progression of paediatric HIV. The study was a retrospective cohort study (study period 2004-2018). Cases of HIV+and SCD-afflicted patients (HIV+/SCD+) were obtained via electronic chart review from a paediatric HIV clinic in Kampala, Uganda and matched 1:3 with HIV+controls without SCD (HIV+/SCD-). Thirty-five HIV+/SCD+subjects and 95 HIV+/SCD- controls were analysed (39% female (51/130), age 3.6years (SD3.9)). At baseline, WHO clinical stage (64% total cohort Stage III/IV) and nutritional status (9.4% severe acute malnutrition) were similar for both groups, whereas HIV+/SCD+had higher though non-significant baseline CD4 count (1036 (SD713) vs 849 (SD638) cells/microlitre, P=0.20, two-tailed t-test). There were 19 deaths, 6 (17%) HIV+/SCD+and 13 (14%) HIV+/SCD-, with unadjusted/adjusted models showing no significant difference. Nutritional progression and clinical stage progression showed no significant differences between groups. Kaplan-Meier analysis showed a slower rate of treatment failures in the HIV+/SCD+cohort (P=0.11, log-rank survival test). Trajectory analysis showed that in the time period analysed, the HIV+/SCD+cohort showed a more rapid rise and higher total CD4 count (P=0.012, regression analysis). The study suggests that SCD does not adversely affect the progression of HIV in patients on ART. Further, HIV+/SCD+achieved higher CD4 counts and fewer HIV treatment failures, suggesting physiological effects due to SCD might mitigate HIV progression.

Thoracoscopic surgery for recurrent tracheoesophageal fistula after esophageal atresia repair.

We aimed to investigate the safety, feasibility, and outcomes of thoracoscopic surgery for recurrent tracheoesophageal fistula (rTEF) after esophageal atresia repair. The medical records and follow-up data of 31 patients who underwent thoracoscopic surgery for rTEF at a single institution were collected and reviewed. In total, 31 patients were enrolled with a median age of 7months (range: 3-30months) and a median weight of 6,000g (range: 4,000-12,000g) before reoperation. The median operation time for the entire series was 2.9hours (range: 1.5-7.5hours), and the median total hospitalization duration after surgery was 19days (range: 11-104days). One patient died of anastomotic leakage, a second rTEF, severe malnutrition, and thoracic infection; the mortality rate was 3.23% (1/31). Nine patients (9/31, 29.03%) had an uneventful recovery, and the incidences of postoperative anastomotic leakage, anastomotic stricture, and second rTEF were 25.81%, 61.29%, and 9.68%, respectively. After a median follow-up of 12months (range: 3-24months), 26 survivors resumed full oral feeding, 2 were tube fed, 2 required a combination of methods, and 4 patients experienced severe respiratory complications. In total, 9 patients had pathological gastroesophageal reflux, and 2 patients eventually underwent Nissen fundoplication. Of the 30 survivors with growth chart data, the median weight for age Z-score, height for age Z-score, and weight for height Z-score were-0.46 (range: -5.1 to 2.8), 0.75 (range: -2.7 to 4.7), and-1.14 (range: -6.8 to 3.0), respectively. Thoracoscopic surgical repair for rTEF is safe, feasible, and effective with acceptable mortality and morbidity.

Smartphone-Based Maternal Education for the Complementary Feeding of Undernourished Children Under 3 Years of Age in Food-Secure Communities: Randomised Controlled Trial in Urmia, Iran.

The mothers’ nutritional literacy is an important determinant of child malnourishment. We assessed the effect of a smartphone-based maternal nutritional education programme for the complementary feeding of undernourished children under 3 years of age in a food-secure middle-income community. The study used a randomised controlled trial design with one intervention arm and one control arm (n = 110; 1:1 ratio) and was performed at one well-child clinic in Urmia, Iran. An educational smartphone application was delivered to the intervention group for a 6-month period while the control group received treatment-as-usual (TAU) with regular check-ups of the child’s development at the well-child centre and the provision of standard nutritional information. The primary outcome measure was change in the indicator of acute undernourishment (i.e., wasting) which is the weight-for-height z-score (WHZ). Children in the smartphone group showed greater wasting status improvement (WHZ +0.65 (95% Confidence Interval (CI) ± 0.16)) than children in the TAU group (WHZ +0.31 (95% CI ± 0.21); p = 0.011) and greater reduction (89.6% vs. 51.5%; p = 0.016) of wasting caseness (i.e., WHZ < −2; yes/no). We conclude that smartphone-based maternal nutritional education in complementary feeding is more effective than TAU for reducing undernourishment among children under 3 years of age in food-secure communities.

Mid-upper arm circumference measurement for severe malnutrition screening in underfives

Background Severe malnutrition in Indonesia remains abundant. Severe malnutrition has been assessed by several methods, including mid–upper arm circumference (MUAC) and weight-for-height z-score (WHZ). As a screening method, MUAC is expected to be useful for identifying malnutrition in communities.&#x0D; Objective To determine whether MUAC measurements can be used for screening severe malnutrition at the community level in Indonesia.&#x0D; Method A cross-sectional study was conducted in 853 children aged 6 – 59 months who came to an integrated health service post (Posyandu) in Semarang, Central Java. Anthropometric measurements were performed by cadres and researchers and included MUAC and WHZ. Statistical analysis was done by McNemar test; results with P values &gt;0.05 indicated no significant difference. Sensitivity and specificity were determined by 2 x 2 tables. The MUAC cut-off values were determined by receiver-operating characteristic (ROC) curve.&#x0D; Results Eight hundred fifty-three out of 1,115 children met the inclusion criteria, consisting of 419 (49.1%) boys, with most over the age of 2 years (57.2%). Kappa test revealed good inter-rater reliability in measurements between the cadre and researchers (Kappa=0.726). There were significant differences between MUAC (by cadres) and below red line status as well as WHZ, between MUAC (by researchers) and WHZ, as well as MUAC (by cadre and researchers) with WHZ and height-for-age z-score/HAZ . Sensitivity, specificity, PPV, and NPV of MUAC (by cadre) were 12.5%, 99.9%, 75%, and 97.5%, respectively, while those by the researchers were 16.7%, 99.6%, 57%, and 97.6%, respectively. In this study, MUAC of 14 cm was the best cut-off for severe malnutrition.&#x0D; Conclusion The MUAC measurement of 14 cm can be used for screening severe malnutrition in underfives at community.

The new child food package is associated with reduced obesity risk among formula fed infants participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County, California, 2003\u20132016

BackgroundThe Special Supplemental Nutrition Program for Women, Infants and Children (WIC) changed the food packages provided to its participants in 2009, to better align them with the Dietary Guidelines for Americans. Previous research found that the 2009 WIC food package change was associated with reduced obesity risk, particularly among breastfed infants but also among those who were never breastfed. The objective of this study was to determine if the new child food package introduced in 2009, including more produce and whole grains for 1–4-year old children, was associated with healthier growth trajectories and reduced obesity risk at age 4 years among children who were exclusively formula fed during infancy.MethodsAdministrative data on WIC-participating children in Los Angeles County, 2003–2016, were used (N = 74,871), including repeated measures of weight and length (or height); child’s age, gender, and race/ethnicity; maternal education and language; and family poverty. Gender-stratified spline mixed models were used to examine weight-for-height z-score (WHZ) growth trajectories from 0 to 4 years and Poisson regression models were used to assess obesity (BMI-for-age > 95th percentile) at age 4. The main independent variable was duration of receipt (dose) of the new child package, categorized as 0, > 0 to < 1, 1 to < 2, 2 to < 3, 3 to < 4, and 4 years.ResultsWHZ growth trajectories were similar for children across new child package dose groups. Boys and girls who were fully formula fed during infancy but received the new child food package for 4 years had a 7% (RR = 0.93; 95%CI = 0.89–0.98) and a 6% (RR = 0.94; 95%CI = 0.89–0.99) lower obesity risk, respectively, compared to children who received the new child food package for 0 years. There were no differences in obesity risk for children receiving < 4 years of the new child package vs. 0 years.ConclusionsProviding healthy foods during childhood to children who were exclusively formula fed as infants was associated with modest improvements in obesity outcomes. While breastfeeding promotion should still be prioritized among WIC participants, providing healthy foods during childhood may provide health benefits to formula fed children, who comprise a sizeable proportion of children served by WIC.

The optimal mid-upper-arm circumference cutoffs to screen severe acute malnutrition in Vietnamese children

Severe acute malnutrition (SAM) remains a main cause of mortality among children under five years old. Vietnam needs further study to establish the optimal mid-upper-arm circumference (MUAC) cutoff for improving the accuracy of the MUAC indicator in screening SAM children aged 6–59 months. A survey was conducted at all 16 subdistricts across four provinces in Northern Midlands and mountainous areas. The data of 4,764 children showed that an optimal MUAC cutoff of 13.5 cm would allow the inclusion of 65% of children with weight-for-height z-scores (WHZs) below −3SD. A combination of MUAC and WHZ may achieve a higher impact on therapeutic feeding programs for SAM children. The MUAC cutoff of 13.5 cm (65% sensitivity and 72% specificity) should be used as the cutoff for improving and/or preventing SAM status among children under 5 in the Midlands and mountainous areas in Vietnam.

Assessment of Anthropometric Indices in Patients with Phenylketonuria.

Dietary phenylalanine restriction is the main treatment of phenylketonuria (PKU, OMIM 261600). There are a number of studies which have demonstrated growth retardation in these patients, and some are in contrast. This study was performed to assess the growth parameters of treated PKU patients. This cross-sectional study was performed between 2015 and 2017 to compare growth indices in PKU patients in our clinics with normal age and sex matched controls. Weight, height, head circumference (HC), weight for height and BMI (weight/height2) were measured and converted into Z-scores. We assessed differences between patients and controls' anthropometric indexes in all patients and separately in patients who were diagnosed by newborn screening program and patients who were diagnosed after presentation of clinical manifestations in comparison with age and sex-matched controls. Also, this difference was assessed separately in patients aged two years and less. Correlations between pretreatment plasma phenylalanine concentrations mean plasma phenylalanine concentrations and anthropometric parameters were analyzed in the patients. Overall, 209 under-treatment PKU patients (103 males, 106 females; mean age 9.29 ± 8.7 years) and 216 controls (109 males and 107 females; mean age 8.98 ± 8.62 years) matched in terms of age, sex and birth weight were enrolled in this study. In general, 130 patients were diagnosed by newborn screening and 79 were diagnosed when they became symptomatic before the screening program. A significant difference (p=0.000) was found only in HC z-score and weight for height z-score in comparison with the control group, when we assessed all patients. We did not find any significant differences in any of the anthropometric indexes between cases and controls who were aged 2 years old and less. Head circumference SDS and weight for height SDS were significantly different when patients and controls who were more than 2 years old were compared. Mean HC was significantly lower in patients, while BMI SDS, weight SDS, and weight for height SDS were significantly higher in PKU patients in comparison with the control group when patients who were diagnosed in newborn screening were assessed. Head circumference SDS, BMI, height SDS and difference between patients' height SDS and mid parental height SDS had significantly lower mean scores in comparison with those of the control group, while mean weight SDS was significantly higher compared to controls when patients who were diagnosed after clinical presentation were assessed. Mean phenylalanine was not correlated with anthropometric indices, while there was a correlation between pretreatment phenylalanine and HC. Disparities in anthropometric indexes changes observed in different studies may be due to diverse diet protocols, availability of various specific products and micronutrient substitutes.

Effectiveness of a locally produced ready-to-use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial.

This cluster randomised controlled trial tested the effectiveness of a locally produced, fish‐based, ready‐to‐use supplementary food (RUSF) to prevent growth faltering (decline in z‐scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn‐Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight‐for‐age z‐scores (WAZ; ‐0.02, 95%CI = ‐0.03 ‐ ‐0.01, P= 0.001) and height‐for‐age z‐scores (HAZ; ‐0.07, 95%CI = ‐0.09 ‐ ‐0.05, P < 0.001), and increased mid‐upper arm‐circumference (MUAC; 0.02cm, 95%CI = 0.01 ‐ 0.04, P = 0.010), but no statistically significant change in weight‐for‐height z‐scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 ‐ 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01‐0.06, P = 0.006; 0.04, 95%CI = 0.01‐0.08, P = 0.026; and 0.05cm, 95%CI = 0.02‐0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.

Influence of post-partum BMI change on childhood obesity and energy intake.

IntroductionAssociation between parent’s Body Mass Index (BMI) and their children, has been widely documented. Individual, familiar and structural factors play a role in this relation. We analyzed the association between maternal BMI change during the first year post-partum and their offspring’s growth-trajectories and energy intake in their first five years of life.ObjectiveCompare growth-trajectories and children’s caloric intake according to post-partum mother´s BMI classification.MethodsThe anthropometric assessment was taken in 935 mother-child pairs along the study period. Mothers were classified into four groups according to their BMI-trajectories in the post-partum. Children’s weight for height z-scores (WHZ) was compared among groups using random-effects regression models. A longitudinal comparison of children’s caloric intake by the maternal group was carried out.ResultsAt 42 months of age, infants from mothers that remained overweight during the first year post-partum had, on average, 0.61 SD higher WHZ than those from mothers who remained in a recommended BMI group (R-BMI) in the same period. At 60 months of age, children´s prevalence of obesity was almost twice in the maternal overweight group vs R-BMI group (14.2% and 7.3% respectively). Chances for a child of having an over caloric intake were 36.5% (95% IC: 6.6%, 74.8%) and significantly higher among children from overweight mothers than those from R-BMI mothers. The difference in children’s WHZ trajectory remained significant after adjusting for caloric intake, suggesting that contextual factors play a role in shaping children’s obesity. A concurrent ethnographic study with the study subjects provides suggestions as to what these factors might be, including changes in the food landscape.ConclusionChildren from overweight mothers tended to have a more caloric diet yielding a higher propensity to obesity. Contextual factors such as food landscape might contribute to childhood obesity beyond having an overweight mother. Pregnancy and post-partum is a window of opportunity for interventions to decrease the incidence of children’s overweight.

Association between feeding patterns and nutritional status of the under five children (6-59 months) in Mtwara Rural District, Tanzania

&#x0D; This study was conducted to determine the association between feeding pattern and nutritional status of the under-five children in Mtwara rural district. Nutritional assessment information was collected using three survey tools: food frequency survey, 24 hours diet survey and anthropometric assessment survey. Anthropometric measures of weight and height were used to assess the nutritional status and WHO Anthro Plus was used to compute the anthropometric data to obtain Height for Age Z-score, Weight for Age Z-score and Weight for Height Z-score. The questionnaire was administered to mothers / caregivers of 329 children aged 6 -59 months. The children’s feeding patterns were determined using the 24-hour dietary recall. Dietary diversity score was computed to understand the quality of the diet consumed by the children. Data were analyzed using IBM SPSS Statistics version 20.0 using descriptive statistics. Chi-square was used to determine the association between nutrition status and the independent variables including gender. The findings indicated 41% stunting rate, 18.8% underweight and 7.3% wasting implying poor nutrition. The cassava feeding frequencies varied among households and between and within the two children age groups, (6 – 10 months) and (11-59 months). Overall 87.23% of children (6-59 months) had a feeding frequency of 2 days, 3 days or 6 days in a week. The dietary diversity indicated an average IDDS of 2.5 implying poor diversity of consumed food groups which was similarly far below the target IDDS of 5 established for this study. The results however indicated no significant association (p ≥ 0.05) between cassava consumption pattern and prevalence of stunting, wasting and underweight and also between gender and nutrition status. The high prevalence rate of malnutrition could thus be attributed to a synergistic effect of several factors.&#x0D;

Total Dietary Intake and Health Risks Associated with Exposure to Aflatoxin B1, Ochratoxin A and Fuminisins of Children in Lao Cai Province, Vietnam.

The health burden of foodborne mycotoxins is considerable, but particularly for children due to their lower detoxification capacity, rapid growth and high intake of food in proportion to their weight. Through a Total Dietary Study approach, the objective was to estimate the dietary exposure and health risk caused by mycotoxins for children under 5 years living in the Lao Cai province in northern Vietnam. A total of 40 composite food samples representing 1008 individual food samples were processed and analyzed by ELISA for aflatoxin B1, ochratoxin A and fumonisins. Results showed that dietary exposure to aflatoxin B1, ochratoxin A and total fumonisins were 118.7 ng/kgbw/day, 52.6 ng/kg bw/day and 1250.0 ng/kg bw/day, respectively. Using a prevalence of hepatitis of 1%, the risk of liver cancer related to exposure of aflatoxin B1 was 12.1 cases/100,000 individual/year. Age-adjusted margin of exposure (MOE) of renal cancer associated with ochratoxin A was 127, while MOE of liver cancer associated with fumonisins was 542. Antropometric data show that 50.4% (60/119) of children were stunted, i.e. height/length for age z-scores (HAZ) below –2, and 3.4% (4/119) of children were classified as wasted, i.e. weight for height z-scores (WHZ) below –2. A significant negative relationship between dietary exposure to individual or mixture of mycotoxins and growth of children was observed indicating that the high mycotoxin intake contributed to stunning in the children studied.

A cross sectional study of growth of children with sickle cell disease, aged 2 to 5 years in Yaoundé, Cameroon

IntroductionGrowth of children affected by Sickle Cell Disease (SCD) is not well described in sub-Saharan Africa despite the high prevalence of the disease. Few data are available in this context and on the issue using the World Health Organization growth norms. We therefore conduct the present study with the aim of describing the growth of affected children aged less than 5 years. We also assessed correlation of anthropometric parameters with disease severity criteria.MethodsA cross-sectional study was conducted during a period of 8 months, at the Mother and Child Center of Yaoundé. The sample included 77 children with SCD aged 2 to 5 years old in steady state. Anthropometric measurements and socio-demographic data were collected and analyzed. All statistical tests were two-tailed with p<0.05 considered significant.ResultsMedian age of study population was 3.67 years. Low weight, height and weight for height Z-scores (<-2SD) were observed in 4%, 4%, and 5% of children, respectively. Projection of these parameters were stackable on WHO curves. Regression analysis indicated an association of low height-for-age and of low Body Mass Index (BMI)-for-age with age.ConclusionThis study demonstrates unexpectedly lower mean Z-score for weight, height and weight for height than reported while using WHO norms.

Association of long-term child growth and developmental outcomes with metformin vs insulin treatment for gestational diabetes

Importance Metformin is an emerging option for treating gestational diabetes (GDM). However, because metformin crosses the placenta, patients and clinicians are concerned with its long-term effect on child health. Objective To estimate the association of treating GDM with metformin vs insulin with child growth and development. Design, Setting, and Participants Population-based cohort study of New Zealand women treated with metformin or insulin for GDM from 2005 to 2012 and their children. This study linked national health care data to create a cohort of mothers and their children, including data from maternity care, pharmaceutical dispensing, hospitalizations, demographic records, and the B4 School Check (B4SC) preschool health assessment. Women treated pharmacologically with metformin or insulin during pregnancy were included. We excluded pregnancies with evidence of diabetes and deliveries prior to 2013. Liveborn infants were linked to their B4SC results. Data were analyzed between January 2017 and May 2018. Exposures Pharmacologic treatment for GDM with metformin or insulin, measured using pharmaceutical claims data. Main Outcomes and Measures Child growth (weight and height) and Strengths and Difficulties Questionnaire (SDQ) scores for behavioral development. All outcomes were derived from the B4SC screening program. Linear and log-binomial regression with inverse probability of treatment weighting was used to estimate the association of child growth and psychosocial outcomes with metformin vs insulin treatment for GDM. Results In both treatment groups, the mean (SD) maternal age was 32 (5) years. A large proportion of mothers who were treated with insulin identified as New Zealand European (867 [44.9%]) while 576 mothers who were treated with metformin (28.9%) identified as New Zealand European. Approximately one-third of mothers who were treated with metformin (n = 639) identified as Asian. We identified 3928 pregnancies treated with metformin (n = 1996) or insulin (n = 1932). After adjustment, we observed no meaningful difference in weight for heightzscores between children exposed to metformin compared with insulin (mean difference, –0.10; 95% CI, −0.20 to 0.01). Risk of being 85th percentile or greater for weight for height was similar between treatment groups (adjusted risk ratio, 0.92; 95% CI, 0.83-1.02). Mean SDQ scores were not meaningfully different between the treatment groups, Children of metformin-treated mothers were not significantly more likely to have parent-reported SDQ scores of 14 or more (adjusted risk ratio, 1.13; 95% CI, 0.88-1.46) than those of insulin-treated mothers. Conclusions and Relevance Our study compares long-term outcomes among school-aged children following maternal use of metformin vs insulin treatment for GDM. Children of metformin-treated mothers were indistinguishable on growth and developmental assessments from those of insulin-treated mothers. These results will help inform future GDM treatment guidelines.

POLA ASUH AKTIVITAS FISIK TERHADAP RISIKO KEJADIAN GIZI LEBIH PADA ANAK PRASEKOLAH DI KECAMATAN NGESREP DAN TEMBALANG, SEMARANG

The preschool period is identified as a critical period for the development of childhood overweight . Physical activity and food intake are factors that affect nutritional status. Physical activity of preschool child ren is affected by parents through physical activity parenting. The o bjective of this study was to analyze the impact of physical activity parenting practice among overweight preschool children. This research was a case-control study with preschool children as the subjects. The total subject was 40 and divided into case and control groups. Case group were selected based on z-score and matched with sex in control group. Nutritional status was measured based on weight-for-height z-score (WHZ) . Physical activity level was measured using the Preschool-Age Physical Activity Questionnaire (Pre-PAQ). Physical activity parenting practice was identified using the Preschooler Physical Activity Parenting Practice Questionnaire (PPAPP-Q). Food intake history was obtained using Semi Quantitative Food Frequency Questionnaire (SQFFQ). Data were analyzed using Chi-square, Fisher's Exact, and Logistic Regression. Result showed that physical activity parenting practice (p=0,011) and physical activity (p=0,004) were risk factor of overweight among preschool children. Children with inactive physical activity were 7.66 times more likely to become overweight. Children with parents applied parenting practices discourage toward physical activity were 6.16 times more likely to become overweight. Children need to always be active at least 120 minutes a day. Parents recommend to apply physical activity parenting to encourage them to be more active physically.

Examining Response to Treatment of Severe Acute Malnutrition in Children 6–59 Months Old in Afghanistan, Chad, Mali, and Niger (P12-002-19)

ObjectivesIdentify the most significant factors affecting the trajectory of recovery from severe acute malnutrition (SAM), as measured by average daily weight gain in each child 6–59 months of age who were diagnosed and treated for SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center.Hypothesis 1a:Children 6–59 months enrolled in SAM treatment have slower times to recovery and slower weight gain if they are admitted for treatment at a lower anthropometric cut-off admission (weight for height z-score < –4) than children admitted for treatment at a higher anthropometric cut-off (weight for height z-score ≥ –4).Hypothesis 1b: Older children (24–59 months) recover more quickly than younger children (6–23 months) controlling for ration size. MethodsA retrospective panel data analysis on children 6–59 months enrolled in standard outpatient treatment for severe acute malnutrition (SAM) between 2014 and 2016 was conducted. The study period was between September-December 2018. Children were exhaustively sampled. Children with edema, children with implausible z-scores for W/H (<–5 and >5) and H/A (<–6 and >6), children who were referred for inpatient therapeutic feeding to a stabilization center, and children from the same household, except in the case of twins, were eliminated from the analysis. There was one database per country. A total of 1384 children between 6–59 months were included in the analysis. ResultsThe most significant factors affecting the proportional weight gain include age at enrollment (P = 0.001, 95%CI = –0.00—0.00) and Weight for height z-score (WHZ) (P = 0.00, 95%CI = 0.04—0.05) in each child 6–59 months of age who were diagnosed with SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Sex of child did not significantly affect proportional weight gain (P = 0.404, 95%CI = –0.012–0.005). ConclusionsThe existing protocol to treat severe acute malnutrition should be modified to treat younger children and children who are admitted with a lower weight for height z-score due to different vulnerabilities. Funding SourcesThe research was conducted as part of a dissertation at The Friedman School of Nutrition Science and Policy at Tufts University. Data were obtained from World Vision.

Effects of Different Strategies for Delivering Supplemental Zinc on Selected Fecal Markers of Environmental Enteric Dysfunction Among Young Laotian Children (P04-012-19)

ObjectivesTo assess the impact of different strategies for delivering supplemental zinc on fecal myeloperoxidase (MPO), neopterin (NEO) and calprotectin (CAL) among young Laotian children and explore modifying effects of MPO, CAL and NEO on growth MethodsIn a double-blind controlled trial, children 6–23 mo of age were randomized to receive either daily preventive zinc tablets (PZ; 7 mg/d), daily micronutrient powder sachets (MNP; containing 10 mg zinc and 14 other micronutrients), therapeutic zinc supplements for diarrhea treatment (TZ; 20 mg/d for 10 days) or daily placebo powder and followed for ∼36 weeks. Stool samples were collected at baseline and endline. Fecal MPO, NEO and CAL were determined in a randomly selected sub-sample of 720 children using commercially available ELISA kits. Linear regression models were used to assess main and modifying effects while controlling for baseline value, age and district ResultsThe baseline prevalence of stunting was 39.3%, and there was no overall treatment effect on physical growth in the parent trial. At endline, geometric mean fecal MPO, NEO and CAL concentrations did not differ among the 4 groups (all P > 0.23). There was an effect modification by baseline concentrations of NEO and CAL on endline stunting (p for interaction = 0.01 and 0.02, respectively). Among children in the lowest quintile of NEO concentrations, there was a trend towards a higher stunting prevalence at endline in the TZ [47.1% (35.6, 58.7)] and the MNP [45.3% (32.7, 57.9)] groups compared to the PZ [33.6% (21.0, 46.3)] and the control [33.9% (22.8, 44.9)] groups. Similar results were found among children in the lowest quintile of CAL concentrations. Moreover, baseline concentration of CAL, modified the impact of the interventions on weight-for-height z-scores (WHZ) (p for interaction = 0.074). Among children in the lowest quintile of CAL concentrations, there was a trend towards a higher WHZ at endline in the MNP [−0.57 (−0.73, −0.42)] and TZ [−0.68 (−0.86, −0.51)] groups compared to the control [−0.79 (−0.97, −0.61)] and the PZ [−0.88 (−1.05, −0.72)] groups. ConclusionsIn this population of young Laotian children PZ, MNP and TZ had no overall impact on EED or growth, but intestinal function modified the growth response to supplementation suggesting its potential role in the pathways of growth impairment. Funding SourcesFunded by the Bill & Melinda Gates Foundation, Nutrition International and the Mathile Institute for the Advancement of Human Nutrition.

Promoting Children Growth and Development: A community-based cluster randomized controlled trial in rural areas of Indonesia.

This study examined the influence of the Promote Children's Growth and Development (PCGD) intervention on children's growth and development in rural areas in Indonesia. A community-based nonblinded cluster randomized controlled trial was conducted. Twelve clusters of villages were matched based on population and randomly assigned to intervention group (six clusters and 72 caregivers dyads) or control group (six clusters and 72 caregivers dyads) with inclusion criteria age 0-72months and attending integrated health centers (Posyandu). The intervention was conducted for 14weeks with caregivers. The weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), weight-for-height Z-score (WHZ), and body mass index-for-age Z-score (BAZ) were calculated using World Health Organization Anthro-Plus version 1.0.3. A prescreening developmental questionnaire (PSDQ) measured the development of children before and after the intervention. The proportion of stunting of HAZ, wasting of WHZ, and deviation development of PSDQ were higher in the control group compared to the intervention group, respectively (22.2% vs. 37.5%), (9.7% vs. 4.2%), and (12.5% vs. 2.8%). Caregivers were more confident promoting children's growth and development after attending 12 sessions of the PCGD intervention. The 12 session PCGD intervention is effective for promoting the growth and development of children of 0-72months. The PCGD could be considered for implementation in community health centers.