WHO Charts Research Articles

Field Testing of IAP2015 Charts.

To field test the IAP2015 (Indian Academy of Pediatrics) charts in different socioeconomic classes; to compare standard deviation scores (Z-scores) of children's height, weight and body mass index (BMI) for age as computed based on IAP2007 or WHO charts against the IAP2015 references. A cross-sectional observational study was conducted in the district of Pune on apparently healthy 5-18 y old children from urban affluent, urban underprivileged and rural areas. Anthropometric measurements were performed and parameters were converted into Z-scores. Urban affluent children were tallest and heaviest whereas urban underprivileged children were shortest. Z-score comparison showed that all children were shortest on WHO references and taller as per IAP2007 references. BMI Z-score was higher on IAP2007 charts and lower on WHO references. Highest number of children were within the reference range on IAP2015 charts among urban affluent. More children were classified stunted on WHO references and least on IAP2007 references. WHO references overestimated wasting and as per IAP2007 charts, less number were wasted. Less number of children were classified as being obese/overweight by WHO and IAP2007 references. IAP2015 charts are better representative of healthy children of current generation and may be used to prevent inappropriate classification in present scenario.

Neck circumference as a marker of malnutrition among children attending the under five clinic of a tertiary care hospital in Nagpur, Maharashtra

Introduction: India is facing a dual burden of overweight/obesity and under nutrition among children less than 5 years of age. Neck circumference is recently studied marker for malnutrition among adults and older children. Objective: To correlate neck circumference with body mass index and to associate it with wasting and underweight status. Material & Methods: A cross sectional study was conducted among children less than 5 years of age attending the outpatient setup of a tertiary care setup in Nagpur, Maharashtra. Demographic details and anthropometric measurements were done for the children with necessary permission before the start of the study. Anthropometry was done using standard guidelines and WHO charts were used for classification of wasting and underweight Results: We included 260 study subjects in our study. The mean age of the children was 21.55 ± 17.31 months and majority of them were females, belonged to Hindu religion (58.07%), belonged to Class 4 (33.08%) and the mothers were educated up to senior secondary (34.62%). Neck circumference had significant positive correlation with birth weight (r=0.138) and body mass index (r=0.211). The average neck circumference was significantly lower in case of wasted (p

Severe and moderate acute malnutrition detection in a rural hospital pediatric outpatient clinic and their comparison with the IAP charts: a two-year study

Background: Children with moderate acute malnutrition (MAM) have an increased list of mortality, infections and impaired physical and cognitive development compared to well-nourished children. The Objectives of this study were to diagnose Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) using WHO growth charts as a criterion and to compare the WHO classification with the IAP classification in the diagnosis of SAM and MAM.Methods: A two-year duration cross-sectional study conducted in Pediatric outpatient clinic of a rural hospital from January 2013 to December 2014. In case of moderate acute malnutrition (MAM) was diagnosed as weight-for-height >-3 but <-2 Z scores of the median according to WHO growth standards. We defined MAM as mid-upper am circumference (MUAC) of >11.0 cm and <12.5 cm with no bilateral pitting edema and SAM as MUAC less than 11.5 cm. We compared the values with the IAP charts for diagnosis of malnutrition. Our set up is not a nutrition rehabilitation centre, feeding programmes were not implemented.Results: The distribution of prevalence of SAM and MAM differs significantly across three age groups studied (P-value <0.001). However, it did not differ significantly between boys and girls aged between 6 months to 6 years (P-value >0.05). Of 90 SAM cases, 55 cases (61.1%) had Grade 1 IAP grade of malnutrition, 28 cases (31.1%) had Grade 2 IAP grade of malnutrition, 7 cases (7.8%) had Grade 3 IAP grade of malnutrition. None of the SAM cases fell in Grade 4 IAP. The distribution of prevalence of SAM and MAM differs significantly across various IAP grades of malnutrition (P-value <0.001).Conclusions: The IAP charts used for diagnosing malnutrition did not have any comparative value with the WHO charts used for the SAM MAM detection. WHO grading of SAM and MAM is more sensitive than IAP grading in early diagnosis of under nutrition and facilitate early treatment. Not having a targeted nutrition-specific intervention to address MAM in this set up places these children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered.

Relationship between dietary habits and nutritional status among adolescents in Abuja municipal area council of Nigeria

Background : Dietary intake assessment is essential to understanding the nutritional status. Healthy eating pattern promotes optimal health, growth and intellectual development and prevents diseases, while poor dietary eating choices may cause malnutrition. Aims : To determine the dietary eating patterns and nutritional status among adolescents in secondary schools within Abuja Municipal area council (AMAC). Subjects and Methods : crosssectional among adolescents, 10 – 19years in secondary schools within AMAC, Nigeria. Using a multistage stratified sampling technique, four urban and four rural schools, 1550 students, were enrolled. Subject’s bio data, dietary habits and knowledge of nutrition and general physical examination were obtained. Dietary assessment included intake of main meals (breakfast, lunch and dinner), skipping meals; methods used to control weight in the previous 30days; knowledge and preference of a balanced diet and food choices. Subject’s height and weight and Body Mass Index (BMI) were determined using the 2007 WHO charts. Data was analyzed using SPSS version 17 statistical package and p value less than 0.05 was significant. Results : 1550 students were recruited, males 688 (44.4%) and females 862 (55.6%); mean age 14.43±1.94 years. Of the 780 urban adolescents, 502 (64.4%) were of upper class and 68 (8.7%) lower class; and of the 770 (49.7%) rural, 206 (26.8%) and 232 (30.1%) belong to upper and lower class respectively, p=.000. Stunting 174(11.2%) and overweight 195(12.6%) were the major forms of malnutrition recorded. Food preferences was based mainly on good taste in 546 (35.2%), balanced diet 530 (34.2%); and 539 (34.8%) had good nutritional knowledge of a balanced diet. Five hundred and forty six (35.2%) admitted to taking carbonated drinks within the previous 7days and 147 (9.5%) missed breakfast, lunch and supper as single meal. Breakfast only was skipped by 71(4.6%) while 160 (10.3%) took lunch outside the home. The methods used to control weight were eating less food or fats, fasting, use of diet pills, inducing vomiting/use of laxatives. Skipping meals and taking meals outside the home was significant for the sex, (p value <0.05), school setting (p value .000) and the infrequent intake of fruits/ vegetables (p value .025). Those that skipped meals showed significant stunting (p value .009), while those who took fruits and vegetables infrequently had significant wasting (p value .049). Conclusion : poor dietary habits were identified among the adolescent. Malnutrition especially stunting and wasting was identified among those that skipped meals and took little fruits and vegetables. Key words : dietary habits, adolescent, urban, rural, prevalence, nutritional status, carbonated drinks.

The associations between VDR BsmI polymorphisms and risk of vitamin D deficiency, obesity and insulin resistance in adolescents residing in a tropical country.

BackgroundThe vitamin D receptor (VDR) gene is expressed abundantly in different tissues; including adipocytes and pancreatic beta cells. The rs1544410 or BsmI single nucleotide polymorphism (SNP) in the intronic region of the VDR gene has been previously associated with vitamin D levels, obesity and insulin resistance.AimsThis study was aimed to examine the association between BsmI polymorphism and risk of vitamin D deficiency, obesity and insulin resistance in adolescents living in a tropical country.MethodsThirteen-year-old adolescents were recruited via multistage sampling from twenty-three randomly selected schools across the city of Kuala Lumpur, Malaysia (n = 941). Anthropometric measurements were obtained. Obesity was defined as body mass index higher than the 95th percentile of the WHO chart. Levels of fasting serum vitamin D (25-hydroxyvitamin D (25(OH)D)), glucose and insulin were measured. HOMA-IR was calculated as an indicator for insulin resistance. Genotyping was performed using the Sequenom MassARRAY platform (n = 807). The associations between BsmI and vitamin D, anthropometric parameters and HOMA-IR were examined using analysis of covariance and logistic regression.ResultThose with AA genotype of BsmI had significantly lower levels of 25(OH)D (p = 0.001) compared to other genotypes. No significant differences was found across genotypes for obesity parameters. The AA genotype was associated with higher risk of vitamin D deficiency (p = 0.03) and insulin resistance (p = 0.03) compared to GG. The A allele was significantly associated with increased risk of vitamin D deficiency compared to G allele (adjusted odds ratio (OR) = 1.63 (95% Confidence Interval (CI) 1.03–2.59, p = 0.04). In those with concurrent vitamin D deficiency, having an A allele significantly increased their risk of having insulin resistance compared to G allele (adjusted OR = 2.66 (95% CI 1.36–5.19, p = 0.004).ConclusionVDR BsmI polymorphism was significantly associated with vitamin D deficiency and insulin resistance, but not with obesity in this population.

Anthropometric charts and congenital anomalies in newborns with Down syndrome.

The objectives of this study were to obtain updated neonatal measurements in French newborns with Down Syndrome (DS) according to their gestational age, and to assess the frequency and distribution of congenital anomalies. Data on congenital malformations, birth weight, birth length and birth occipito-frontal circumference (OFC) according to the gestational age was gathered from 1,030 babies, born between 1980 and 2010. The mean gestational age was 38 weeks from the date of the last menstrual period (LMP) (range: 29-42 weeks). Repartition of complications was found to be similar to previous studies, with no difference according to the date of birth. For girls born after 37 weeks, the mean birth weight was 3,012 ± 430 g, the mean birth length was 47.7 ± 2 cm, and the mean birth OFC was 33 ± 1.4 cm. For boys born after 37 weeks, the mean birth weight was 3,103 ± 459, the mean birth length was 48.4 ± 2.2 cm, and the mean birth OFC was 33.2 ± 1.4 cm. We did not find any difference in these measurements when we compared children born before 1997 and after 2007. When compared to the general population (French data and WHO charts), newborns with DS have a more pronounced difference in their birth length and their birth OFC (15-25th) than in their birth weight (25-50th). The shape of the growth curves shows that growth velocity decreases during the last weeks of gestation in all measurements, which suggests that the modal age for delivery could be earlier in DS newborns than in the general population.

Effectiveness of supplementary suckling technique in underweight infants

Background: The period from birth to 6 months is part of a larger critical ‘window of opportunity’ within which the impact of undernutrition has both immediate and long term adverse consequences. Protocols for older children are often extended to this age group owing to the absence of evidence-based treatment protocols. The following study was carried out to assess the effectiveness of supplementary suckling technique and lactation counselling over counselling alone in management of malnourished infants in the age group of 1- 6 months.Methods: After IRB clearance, all underweight infants with weight for age &lt;-2SD by WHO charts were enrolled in the study. Once identified as lactation failure, the infants were randomly allocated into two groups using SAS 9.2 package. Both, cases and controls were counselled regarding breast feeding practices as per WHO module. Cases were additionally started on supplementary feeds by Supplementary Suckling Technique (SST) for the 1st week. Weight gain was monitored at enrolment, on day 7 and day 14. Weight gain &gt;20gm/day in the 2nd week was considered successful re-lactation. Data was analysed using student unpaired t test and chi square test.Results: Mean weight gain per day in 1st and 2nd week in the cases was significantly higher than that in the controls (p= &lt;0.001). In 2nd week, maximum weight gain i.e. 20-30 g/day was found in 93.3% cases as against 13.3% controls (p=0.01) depicting successful re-lactation.Conclusions: Lactation counselling along with supplementary suckling technique should be the standard of care in management of malnourished infants.

Does measurement technique explain the mismatch between European head size and WHO charts?

ObjectiveTo test whether different measuring techniques produce systematic differences in head size that could explain the large head circumferences found in Northern European children compared with the WHO standard.DesignCross-sectional observational...

Is Constipation More Common in Overweight Children?

Introduction: Obesity rates have doubled in children and quadrupled in adolescents in the past 30 years. The most important causes of obesity are sedentary life style and low fiber, high calorie diet which are also putative causes of constipation. Some studies have found a correlation between constipation and obesity while others have been inconclusive. In an effort to understand this relationship we undertook a study to assess if overweight children have a higher risk of constipation as compared to normal weight children. Methods: A retrospective review of charts of new patients seen at Pediatric GI Clinic between 1/1/11 and 12/31/12 was performed. All charts were reviewed with an emphasis on growth curves and final diagnoses. Growth status of each patient was assessed by using standard WHO charts for weight, height, and body mass index (BMI) for age and sex. Obesity was defined as a BMI above 95th percentile, overweight between 85-95th percentile, normal between 3rd-85th percentile and failure to thrive (FTT) below 3rd percentile. For statistical analysis, overweight and obese patients were combined into one single group (overweight). The final diagnosis of constipation was made by the attending Pediatric Gastroenterologist. The incidences of constipation in the overweight and FTT were compared to that in normal children using chi-squared analysis. Results: Out of 1876 (M:F, 941:935) new patients seen during study period, 295 patients were overweight (M:F 146:149, 225 obese), 211 FTT and 1370 normal weight (other GI complaints/diagnoses). Observed and expected incidence of constipation in these groups is reported in Table 1. The data was analyzed by chi-squared analysis for significance of incidence of constipation in three individual categories: obese, normal, and failure to thrive (FTT). There was a higher incidence of constipation in overweight patients than expected (a chi-square value of 25. 137 and a p-value < 0.05, CI 95%). Furthermore, the data showed that the incidence of constipation was lower than expected in FTT (a chi-square value of 15.2 and a p-value < 0.05, CI 95%).Table 1: The Observed vs Expected Total Number of Constipated and Non-Constipated PatientsConclusion: There is a higher incidence of constipation in overweight children. Children with FTT have lower incidence of constipation. An analysis of nutrition and exercise habits amongst patients with constipation, obesity, overweight, and failure to thrive could further reveal associations between constipation and BMI.

Clinical And Etiological Profile of Children Aged 1 Month To 60 Months Admitted with Microcephaly in Bal Chikitsalaya, Maharana Bhupal Goverment Hospital, RNT Medical College , Udaipur (Rajasthan)

Objective: To study the clinical and etiological profile with the change in brain by neuroimaging (MRI brain) in children with microcephaly aged 1 month to 60 months. Materials and Methods: Study Design – Hospital based prospective study. Children attending Bal Chikitsalaya, Maharana Bhupal Goverment Hospital, RNT Medical College, Udaipur (Rajasthan) were evaluated as per protocol. Z scores of head circumference were calculated using WHO charts and clinical and etiological profile with the change in brain by neuroimaging (MRI brain) of those with microcephaly. Results: 103 children with microcephaly were enrolled in the study. 58 (56.31%) were male and 45 (43.68%) were female. Male to female ratio was 1.29:1. Mean age of children with microcephaly was 19.71±14.79 months. Most children with microcephaly presented with developmental delay 93(90.29%), abnormal tone 75(72.82%), convulsion 29(28.15%), regression of mile stone 13(12.62%), tremor 11(10.68%), visual abnormalities 12(11.65%), hearing abnormalities 10(9.71%) and dysmorphic facies 9(8.74%). The patients were classified according to the final diagnosis into 3 groups; group I: primary microcephaly – 12(11.65%) cases, group II: secondary microcephaly – 88(85.44%) cases and group III: undiagnosed – 3(2.91%). The most frequent MRI findings were cerebral atrophy in 50(48.54%) cases followed by changes suggestive of hypoxic ischemic encephalopathy (HIE) 19(18.94%) cases. Conclusion: Among the microcephaly children admitted in hospital, severe acute malnutrition was the commonest cause followed by cerebral palsy. Cerebral atrophy was most frequent finding on neuroimaging (MRI) followed by changes suggestive of hypoxic ischemic encephalopathy.

Impact of malnutrition on pediatric risk of mortality score and outcome in Pediatric Intensive Care Unit.

Objectives:This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU) and on the pediatric risk of mortality (PRISM) scoring.Subjects and Methods:This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years), who were divided into cases with weight for age <3rd centile and controls with ≥3rd centile of WHO charts. Cases were subdivided into mild/moderate (61–80% of expected weight for age) and severe malnutrition (<60%).Results:Out of total, 38.5% patients were underweight, and malnutrition was more in infancy, 61/104, i.e. 58.5% (P - 0.003). There was no significant difference in vitals at admission. Cases needed prolonged mechanical ventilation (P - 0.0063) and hospital stay (P - 0.0332) compared to controls. Mean and median PRISM scores were comparable in both the groups, but mortality was significantly higher in severely malnourished (P value 0.027).Conclusion:Severe malnutrition is independently associated with higher mortality even with similar PRISM score. There is need to give an additional score to children with weight for age <60% of expected.

The Atherogenic Dyslipidemia Ratio Log (Tg)/Hdl-C Was Not Associated with Urinary Albumin Excretion Rate (Uaer) and Increased Cardiovascular Risk in Black Patients with Type 2 Diabetes

Objective: The objective is to assess the relationship of Log (TG)/HDL-c as surrogate estimate of atherogenic dyslipidemia with urinary albumin excretion rate and cardiovascular risk among black patients with type 2 diabetes. Patients and methods: A post-hoc analysis of data from 181 type 2 diabetes patients enrolled in a cross-sectional study of urinary albumin excretion rate seen at a tertiary healthcare. Microalbuminuria and macroalbuminuria were defined as ACR 30 - 299.9 mg/g and ACR ≥ 300 mg/g, respectively. Quartiles of Log (TG)/HDL-c were used as surrogate estimates of atherogenic dyslipidemia. Cardiovascular risk was assessed using WHO chart for estimation of CV risk in low and middle income countries. Comparisons across Log (TG)/HDL-c quartiles were performed using one way ANOVA and Chi square for trend as appropriate. P < 0.05 defined the level of statistical significance. Results: A high prevalence (69%) of atherogenic dyslipidemia (AD) was observed in the present case series of Black Africans with type 2 diabetes. Average total cholesterol levels showed significant (p = 0.010) trends towards lower values across quartiles of Log (TG)/ HDL-c. No significant trends were observed for average UAER and cardiovascular risk across quartiles of Log (TG)/HDL-c. Conclusion: Log (TG)/HDL-c as a surrogate estimate of atherogenic failed to predict cardiovascular risk in the present case series of black patients with type 2 diabetes.

Accuracy of body mass index for age to diagnose obesity in Mexican schoolchildren.

To compare the accuracy of three BMI-forage references (World Health Organization reference, WHO; the updated International Obesity Task Force reference, IOTF; and Centers for Disease Control and Prevention (CDC) growth charts) to diagnose obesity in Mexican children. A convenience sample of Mexican schoolchildren (n = 218) was assessed. The gold standard was the percentage of body fat estimated by deuterium dilution technique. Sensitivity and specificity of the classical cutoff point of BMI-for-age to identify obesity (i.e. > 2.00 standard deviation, SD) were estimated. The accuracy (i.e. area under the curve, AUC) of three BMI-for-age references for the diagnosis of obesity was estimated with the receiver operating characteristic (ROC) curves method. The optimal cutoff point (OCP) was determined. The cutoff points to identify obesity had low (WHO reference: 57.6%, CDC: 53.5%) to very low (IOTF reference: 40.4%) sensitivities, but adequate specificities (91.6%, 95.0%, and, 97.5%, respectively). The AUC of the three references were adequate (0.89). For the IOTF reference, the AUC was lower among the older children. The OCP for the CDC reference (1.24 SD) was lower than the OCP for WHO (1.53 SD) and IOTF charts (1.47 SD). The classical cutoff point for obesity has low sensitivity--especially for the IOTF reference. The accuracy of the three references was similar. However, to obtain comparable diagnosis of obesity different cutoff points should be used depending of the reference.

Use of growth charts in Canada: A National Canadian Paediatric Surveillance Program survey.

In 2010, the WHO Growth Charts for Canada were recommended for use in Canada, while the US Centers for Disease Control and Prevention (Georgia, USA) charts remained in active use. To assess the availability, utilization of and satisfaction with growth charts in clinical practice in Canada. In October 2012, a one-time survey was sent through the Canadian Paediatric Surveillance Program (CPSP) to 2544 paediatricians and 280 family physicians with a stated interest in paediatrics. The response rate was 24% (63% general paediatricians, 36% subspecialists, 1% family physicians). Of these respondents, 68% preferred the WHO charts for infants and 49% for children and youth. Regarding the WHO charts, 49.7% of respondents reported concerns with their inability to assess weight for children >10 years of age, and many believed that there were too few percentile lines between the third and 97th percentiles for infant (24%) and for child and youth measures (19%). The addition of extreme percentiles (0.1 and 99.9), shading on charts and lack of availability with electronic medical record providers were other concerns mentioned by 10% to 13% of respondents. There is support for the use of the WHO data for monitoring the growth of Canadian children. Concerns regarding the design of the charts were raised. These survey results lend support to the redesign of the WHO Growth Charts for Canada, as was recently completed in 2014.

A Study to Assess and Compare the Daily Nutrient Intake and Nutritional Status of the Children Utilizing and Not Utilizing Aanganwadi Services of District Ambala, Haryana.

The children <6yrs are the best resource for human development and constitute 17% of total population of India, IMR in our country is 46.07/1000 live births and under five mortality is 62/1000 live births, Govt. of India is expanding ICDS programme. The present study compared the Daily nutrient intake against Recommendatory Dietary Allowance and Nutritional status, and to determine relationship between daily nutrients intake and Nutritional status of the children utilizing and not utilizing Anganwadi services. Utilizing General system model and non experimental approach, data was collected using 24 hour dietary recall for Daily nutrient intake (carbohydrate, proteins, fats and calories) and anthropometric assessment for nutritional status (Height, Weight and BMI on WHO charts) of 60 randomly selected children utilizing and not utilizing Anganwadi services of Ambala, Haryana. Finding revealed that under nutrient intake, daily carbohydrate intake of children utilizing (132.95±62.28) and not utilizing (86.65±39.78), calories intake of children utilizing (820.89±257.64) and not utilizing (632.62±283.92) Anganwadi services was significantly different at with t value 3.42 and 2.69 respectively, at 0.05 level of significance. Under nutritional status of children utilizing and not utilizing Anganwadi services was not significantly different .There was significant relationship of carbohydrate intake with height in both groups and significant relationship of carbohydrate with weight in children availing Anganwadi services . There was significant relationship of protein intake with height & weight and Fat intake with height with(r =0.618,P value<0.05) and(r= 0.605 , P < 0.05) respectively in children not availing Anganwadi services. Study concluded that the children utilizing and not utilizing Anganwadi services have the similar nutritional status.

The growing controversy about growth charts: WHO or regional?

Since production of WHO Multicenter Growth Reference Study (MGRS) growth standards in 2006, many countries have adopted the WHO charts for under five children [1]. In UK, WHO growth charts are used until 4 years [2] and in US only up to 2 years of age. Over-diagnosis of stunting and underweight in Asian children is likely with the use of these standards as Asian children are still thinner and lighter.

Clinical profile of children with developmental delay and microcephaly

Aim:To study the profile of children with developmental delay and microcephaly.Materials and Methods:Children attending child development clinic with developmental delay were evaluated as per protocol. Z scores of head circumference were calculated using WHO charts. Clinical, radiological and etiological profile of those with microcephaly and those without was compared.Results:Of the 414 children with developmental delay 231 had microcephaly (z score ≤ -3). Mean age of children with microcephaly was 35.1 ± 27.9 months (range 4-184), males (72.7%). Comorbidities were epilepsy (42.9%), visual abnormality (26.4%), hearing abnormality (16.9%). Mean DQ was 29.75 + 17.8 in those with microcephaly was significantly lower compared to the rest (P = 0.002). Secondary microcephaly was associated with cerebral palsy in 69.7%. Other causes were congenital infections (4), inborn error of metabolism (3), post-meningoencephalitis (5), malformations (12), and syndromic (13). Neuroimaging was done in 118 (51.1%) cases of which 104 (88.1%) were abnormal. On comparison children with microcephaly had more epilepsy, lower developmental quotient, vision abnormalities findings as compared to normocephalic children with developmental delay (P > 0.05).Conclusion:Microcephaly was associated with lower, DQ, higher comorbidities in children with developmental delay. Spastic CP is commonly associated with microcephaly.

CPC-098 Osteoporosis After Lung Transplant

BackgroundOsteoporosis after a lung transplant is common, with reported vertebral fracture rates of up to 30% [1]. Bisphosphonates, and calcium and vitamin D supplements may be less effective in patients...

Longitudinal growth of very low birth weight neonates during first year of life and risk factors for malnutrition in a developing country

To study growth of very low birth weight neonates (VLBW) during first year and identify risk factors for malnutrition. Neonates ≤34weeks and ≤1500g enrolled in a human milk fortification trial were prospectively followed till 1year corrected age (CA). Anthropometry was plotted on WHO charts. Risk factors were compared between well nourished and underweight infants. One hundred and thirty-two, 127, 110, 99 and 101 neonates were followed at CA of 40weeks, 3, 6, 9 and 12months. Weight (Mean Z score -2.3±1.2 to -1.7±1.4; p=0.005) and length (-2.1±1.5 to -1.5±1.3; p=0.004) improved significantly, from 40 weeks to one year while head circumference declined (-0.92±1.1 to -1.2±1.1; p<0.001). Incidence of underweight, stunting, microcephaly and wasting changed from 63%, 53%, 13% and 52% neonates at 40weeks to 41%, 32%, 21% and 27% at one year. Growth between fortified and unfortified or small for gestational age (SGA) and appropriate for gestational age (AGA) groups were similar, while extremely low birth weight (ELBW) neonates showed poorer growth. Z score of weight at 3months emerged as an independent predictor of malnutrition at one year. VLBW neonates, especially the ELBW group remained growth retarded at CA of one year. Z score of weight at 3months was a significant risk factor for malnutrition at one year.

Effects of trimming weight-for-height data on growth-chart percentiles

Before estimating smoothed percentiles of weight-for-height and BMI-for-age to construct the WHO growth charts, WHO excluded observations that were considered to represent unhealthy weights for height. The objective was to estimate the effects of similar data trimming on empirical percentiles from the CDC growth-chart data set relative to the smoothed WHO percentiles for ages 24-59 mo. We used the nationally representative US weight and height data from 1971 to 1994, which was the source data for the 2000 CDC growth charts. Trimming cutoffs were calculated on the basis of weight-for-height for 9722 children aged 24-71 mo. Empirical percentiles for 7315 children aged 24-59 mo were compared with the corresponding smoothed WHO percentiles. Before trimming, the mean empirical percentiles for weight-for-height in the CDC data set were higher than the corresponding smoothed WHO percentiles. After trimming, the mean empirical 95th and 97th percentiles of weight-for-height were lower than the WHO percentiles, and the proportion of children in the CDC data set above the WHO 95th percentile decreased from 7% to 5%. The findings were similar for BMI-for-age. However, for weight-for-age, which had not been trimmed by the WHO, the empirical percentiles before trimming agreed closely with the upper percentiles from the WHO charts. WHO data-trimming procedures may account for some of the differences between the WHO growth charts and the 2000 CDC growth charts.