WHO Child Growth Standards Research Articles

Development, Social-Emotional Behavior and Resilience of Orphaned Children in a Family-Oriented Setting

SOS children’s villages take care of orphaned or abandoned children who are likely to suffer from multiple psychosocial problems. Nevertheless, much is not known about the developmental, social-emotional, nutritional and resilience status of young SOS children (SOSc) living in poor settings of developing countries such as Ethiopia. The present study examined the developmental, social-emotional, nutritional and resilience status of SOSc in Jimma town of Ethiopia. In total, we selected 62 children (3.5–71.8 months of age; 32 boys and 30 girls) and tested for their personal-social, language, fine and gross motor development with the culturally adapted and standardized developmental screening tool, Denver II-Jimma; and their social-emotional behavior with the ages and stages questionnaire: social-emotional (ASQ:SE). We compared their outcomes to 62 age- and sex- matched family-reared children. To estimate the nutritional status of all children, we followed the WHO child growth standards. We used an interview guide to investigate resilience of the children. SOSc performed significantly poorer on language (p < 0.001, effect size (es) = 0.957), gross motor (p < 0.001, es = 0.879) and social-emotional (p < 0.001, es = 1.220) outcomes. Twenty-two (35.5%) of SOSc were undernourished and 17 (77.30%) of them were stunted. SOSc demonstrated resilient behavior, and child, SOS family and community characteristics were the major protective factors which enabled them to thrive in spite of the loss of their parents. Early intervention focusing on language, gross motor and social-emotional skills may be particularly beneficial to support children in SOS villages.

Improving the quality of child anthropometry: Manual anthropometry in the Body Imaging for Nutritional Assessment Study (BINA).

Anthropometric data collected in clinics and surveys are often inaccurate and unreliable due to measurement error. The Body Imaging for Nutritional Assessment Study (BINA) evaluated the ability of 3D imaging to correctly measure stature, head circumference (HC) and arm circumference (MUAC) for children under five years of age. This paper describes the protocol for and the quality of manual anthropometric measurements in BINA, a study conducted in 2016–17 in Atlanta, USA. Quality was evaluated by examining digit preference, biological plausibility of z-scores, z-score standard deviations, and reliability. We calculated z-scores and analyzed plausibility based on the 2006 WHO Child Growth Standards (CGS). For reliability, we calculated intra- and inter-observer Technical Error of Measurement (TEM) and Intraclass Correlation Coefficient (ICC). We found low digit preference; 99.6% of z-scores were biologically plausible, with z-score standard deviations ranging from 0.92 to 1.07. Total TEM was 0.40 for stature, 0.28 for HC, and 0.25 for MUAC in centimeters. ICC ranged from 0.99 to 1.00. The quality of manual measurements in BINA was high and similar to that of the anthropometric data used to develop the WHO CGS. We attributed high quality to vigorous training, motivated and competent field staff, reduction of non-measurement error through the use of technology, and reduction of measurement error through adequate monitoring and supervision. Our anthropometry measurement protocol, which builds on and improves upon the protocol used for the WHO CGS, can be used to improve anthropometric data quality. The discussion illustrates the need to standardize anthropometric data quality assessment, and we conclude that BINA can provide a valuable evaluation of 3D imaging for child anthropometry because there is comparison to gold-standard, manual measurements.

Enteric Infections in Young Children are Associated with Environmental Enteropathy and Impaired Growth.

To investigate the relationship between faecal contamination in child play spaces, enteric infections, environmental enteropathy (EE) and impaired growth among young children. A prospective cohort study was conducted of 203 children 6-30months of age in rural Bangladesh. Stool samples were analysed by quantitative PCR for Shigella, Enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Giardia intestinalis and Cryptosporidium spp. Four faecal markers of intestinal inflammation were also measured: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. Child growth was measured at baseline and 9months after enrolment. E.coli was measured in soil in child play spaces. Forty-seven percent of study children had three or more enteric pathogens in their stool. Thirty five percent (71/203) of children had Shigella, 30% (61/203) had ETEC, 73% (148/203) had C.jejuni, 79% (160/203) had Giardia intestinalis and none had Cryptosporidium. Children with ETEC had significantly higher calprotectin concentrations (Coefficient: 1.35, 95% Confidence Interval [CI]: 1.005, 1.82). Children with Shigella had a significantly higher odds of being stunted at our 9-month follow-up (OR: 2.01, 95% CI: 1.02, 3.93). Children with Giardia intestinalis had significantly higher E.coli counts in the soil collected from their play spaces (OR: 1.23, 95% CI: 1.02, 1.48). Enteric infections were significantly associated with EE and impaired growth in rural Bangladesh. These findings provide further evidence to support the hypothesis that contaminated soil in child play spaces can lead to enteric infections, many of which are likely subclinical, resulting in EE and impaired growth in young children.

Hair concentration of trace elements and growth in homeless children aged < 6 years: Results from the ENFAMS study

BackgroundGrowth is an important indicator of health in early childhood. This is a critical developmental period, during which a number of factors, including exposure to metals, might play a role in later physical and metabolic functions. ObjectiveTo study the association between exposure to arsenic (As), cadmium (Cd), mercury (Hg), lead (Pb) and selenium (Se), and physical growth of children from homeless families aged <6years. MethodsThis study was based on data of the cross-sectional survey (ENFAMS), which was conducted by the Observatoire du Samu Social on a random sample of homeless sheltered families in the Paris region during winter 2013. Families with children under 6years (N=324) were interviewed in 17 languages using face-to-face questionnaires. A nurse took anthropometric measures and collected hair samples where As, Cd, Hg, Pb and Se levels were measured. We calculated weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) and BMI-for-age Z-score (BMIZ) of children, using the 2006 WHO Child Growth Standards as a reference. Associations between ln-transformed metal exposures and growth outcomes were tested by multivariable linear regression models with adjustment for potential confounders (including maternal anthropometrical and socio-demographical characteristics, gestational age, child birthweight, breastfeeding, food insecurity of the child). Due to missing data (1.6% to 14.2% depending on the variables), we used multiple imputation by chained equations. ResultsA strong positive correlation was found between Pb and Cd levels (r=0.65; p<0.001). Positive associations between Se level and HAZ (β=0.61; p=0.05) and between Cd and BMIZ (β=0.21; p=0.03) and negative associations between As and HAZ (β=−0.18; p=0.05) were no more significant after multiple imputation. A weak negative trend was observed between Cd and HAZ (β=−0.14; p=0.14), while positive trends were found between Se and both WAZ (β=0.55; p=0.10) and HAZ (β=0.51; p=0.06) after multiple imputation. ConclusionOverall, our results found no strong association between exposure to metals and physical growth of homeless children but we observed some trends that were consistent with previous studies. More research is required studying these associations longitudinally, along with higher sample sizes, for better understanding the sources of exposure in homeless population and the potential effects on growth.

Study of cardiac changes in children with malnutrition

Background: Children with malnutrition usually exhibit several alterations in the body composition, one of them being a loss of cardiac muscle and its consequences. Aim: The aim of this study is to detect the incidence of cardiac involvement among malnourished schoolchildren as shown by clinical examination and corresponding investigations. Methodology: This is a prospective case-control study conducted on 15 children between 5 and 15 years of age with malnutrition. Inclusion criteria were children who fall under the definition of moderate malnutrition as per the World Health Organization (WHO) Z-score based on the WHO Child Growth Standards. Children with known congenital/acquired heart diseases were excluded from the study. Thesechildren were assessed by echocardiography and estimation of cardiac troponin T (cTn T) levels for cardiac involvement that was compared with 12 healthy controls. Results: The mean left ventricular mass (LVM) was 16.74 units higher in children with normal nutritional status compared with malnourished children (p=0.092, 95% confidence interval=2.91-36.40).The mean LVM index was 4.76 units higher in children with normal nutritional status compared with kids with malnutrition indicating the reduction of cardiac muscle mass. Conclusion: As cardiac muscle mass is reduced in children with malnutrition leading to various complications, they need early detection, monitoring, and appropriate management.

Prevalence and predictors of double burden of malnutrition in Palestinian children younger than 5 years: analysis of data from the Multiple Indicator Cluster Surveys round four

BackgroundIn the context of the global nutrition transition, large inequalities in the burden of child undernutrition persist across populations and are often concomitantly reported with increases in rates of overweight in these same communities. We aimed to compare the prevalence of stunting and overweight in Palestinian children younger than 5 years living in Lebanon and the occupied Palestinian territories and to investigate the predictors of undernutrition and overnutrition in these populations. MethodsWe used maternal and child health data, sociodemographic variables, and anthropometric measurements from the 2010 Multiple Indicator Cluster Surveys (MICS) undertaken among Palestinian refugees living in Lebanon (1922 children) and the occupied Palestinian territories (11 273 children). Z-scores for height-for-age and body-mass index-for-age for children younger than 5 years were based on WHO's child growth standards. Prevalence of stunting, overweight, and double burden (ie, children with stunted growth and overweight) was estimated. Logistic regression adjusted for survey design was used to model predictors of stunting, overweight, and double burden (STATA version 13). FindingsPrevalence of stunting, overweight, and double burden were all higher in Lebanon than in the occupied Palestinian territories (for stunting, 10·9% vs 10·1%, p<0·0001; for overweight, 11·3% vs 5·8%, p<0·0001; and for double burden, 3·2% vs 1·9%, p=0·0007). After adjusting for covariates, predictors of stunting were age 6–24 months (p=0·05) and region of residence in Lebanon, with Tyre having the highest probability of stunting (p=0·001). Boys (p=0·02), low level of maternal education (p=0·01), and region of residence predicted stunting in the occupied Palestinian territory, with the highest odds of stunting in central West Bank (p<0·0001). Predictors of being overweight were stunting (in Lebanon, odds ratio [OR] 4·30, 95% CI 2·98–6·20; in the occupied Palestinian territories, OR 4·48, 3·63–5·54), male sex (in Lebanon, OR 0·72, 95% CI 0·53–0·98; in the occupied Palestinian territories, OR 0·79, 0·66–0·96), region (highest odds in Bekaa and Tyre [p=0·003], and Central West Bank [p<0·0001]), and higher wealth index in the occupied Palestinian territories (OR 1·3, 95% CI 1·1–1·5). Double burden varied only by region, with highest odds in Lebanon in Tyre (p=0·006) and in the occupied Palestinian territory in the central West Bank (p<0·0001). InterpretationStunting of growth was a predictor for being overweight in Palestinian children younger than 5 years, with boys at a higher risk than girls. Susceptibility to child malnutrition varied most by region of residence, highlighting the role of structural factors. Nutritional interventions aimed at addressing the common structural determinants of stunting and overweight should be targeted to these subpopulations. FundingFaculty of Health Sciences, American University of Beirut.

Weight-for-length, early weight-gain velocity and atopic dermatitis in infancy and at two years of age: a cohort study

BackgroundOverweight and atopic dermatitis (AD) are major health problems in most industrialised countries, but the relationship between overweight and AD in infants and young children is unclear. We investigated if weight-for-length at birth, in infancy and at two years, as well as early weight-gain velocity, are associated with the development of AD in early life.MethodsCohort study of infants (n = 642), all living in south-east Norway, hospitalized with acute bronchiolitis (n = 404) or recruited from the general population (n = 238), examined at mean age 5.1 months (enrolment) and at a two-year follow-up visit (n = 499; 78%) at mean age 24.6 months. Exposures were weight-for-length (g/cm) at birth, enrolment and two-year follow-up, and early weight-gain velocity (gram/month from birth to enrolment). Excessive weight-for-length was defined as weight-for-length >95th percentile of WHO child-growth standards. Data on weight-for-length at the three time points were obtained for 435, 428 and 473 children. AD was diagnosed according to the Hanifin & Rajka criteria or from a history of physician-diagnosed AD. We performed multivariate analyses with weight-for-length at birth, at enrolment and at the two-year follow-up visit and with early weight gain velocity for the endpoint AD at each visit.ResultsIn adjusted analyses, excessive weight-for-length at enrolment was associated with concurrent AD (OR 3.03; 95% CI 1.23–7.50) and with AD at two years (OR 2.40; 1.11–5.17). In infants without AD, weight-for-length at enrolment increased the risk of AD at two years, with OR being 1.02 (95% CI 1.00–1.04) per increased gram/cm. AD at two years was not associated with concurrent excessive weight-for-length, nor was AD at any time associated with weight-for-length at birth or with early weight-gain velocity.ConclusionsThe results suggest that overweight in infancy may contribute to the development of AD in early life, highlighting the need for child health-care professionals to address potential overweight and atopic disease when advising infants’ caregivers.Trial registrationClinicalTrials.gov number, NCT00817466, EudraCT number, 2009–012667-34.

Wymiary ciała noworodków urodzonych na Mazowszu w jednym ośrodku w latach 2011–2015

We present the assessment of birth body measurements of neonates born during the years 2011–2015 in one hospital maternity unit in the administrative region of Masovia. The measurements were compared against the WHO Child Growth Standards and the locally published reference standards. AimTo determine mean body measurements in a cohort of neonates and compare them against the WHO standards and local standard reference values used in Poland. Material, methodsData were collected on the gender, birth weight (BW) [g; measured on electronic neonatal scales], birth length (BL) [cm; measured using a measuring tape], birth head circumference (BHC) [cm; measured using a measuring tape], gestational age (GA) [weeks; as estimated by an obstetrician] and mother's parity among 22 315 neonates born during the period of five consecutive years at one centre. ResultsBW, BL and BHC measurements were assessed in a cohort of 22 247 live births, including 11 519 males (M) and 10 0728 females (F; 48.2% of all neonates); most infants (92.8% of males and 93.9% of females) were born at term. Conclusions(1) The mean BW value in the study cohort was similar to that observed in Poland over the past several decades. (2) The mean birth length of a Masovian cohort cannot be compared against the standards set by the WHO because of the differences in the measurement methods. Birth length measurements should be based on the principles of anthropology and the use of a measuring tape should be discontinued.(3) The BHC value in the Masovian cohort did not differ from the standards set by the WHO or the standards published in Poland. A tendency for the BHC to increase with a simultaneous decrease in the BL has been observed however, it requires further studies.

Factors Associated with Stunting among Children Aged 0 to 59 Months from the Central Region of Mozambique.

The objective of this study was to identify the major socio-demographic, health, and environmental determinants of stunting among children aged 0–59 months from the Tete province (Mozambique) and offering useful information for future healthcare strategies and interventions. A case-control study was conducted among 282 (162 boys; 120 girls) children under five years of age from the central region of Mozambique between 1 May and 3 June 2014. Children with stunting (HAZ < −2 SD according to the WHO Child Growth Standards in 2006) were considered as cases and those who had a Z-score < −2 SD were considered as controls. We collected data related to mothers and children and their environment, and they were assessed in two groups to find a possible association. The software used for data analysis was the SPSS® (version, 21.0) using descriptive statistics, t-test, ANOVA, chi-square analyses, bivariate comparisons, and stepwise multiple logistic regression analysis. The results showed that birth weight, mother’s educational status, maternal occupation, living in a rural area, family size, number of children under five years of age in the household, cooking with charcoal, inhabiting wooden or straw housing or housing without proper floors, overall duration of breastfeeding as well as duration of exclusive breastfeeding, and time of initiation of complementary feeding were significantly related to stunting. Thus, appropriate nutritional intervention programmes considering these determinants and the dissemination of knowledge at the population level related to undernutrition are necessary to ameliorate the children´s nutritional status.

Investigating the relationship between precocious puberty and obesity: a cross-sectional study in Shanghai, China

ObjectivesObesity is reported to be closely relevant to early sexual development but the relationship between sexual precocity and obesity or central obesity is still inconsistent, especially in boys. We aimed...

Program Impact on Nutritional Status among Children Aged 6 to 24 Months in Rural Malawi: Findings from a Longitudinal Cohort Study

ObjectiveTo evaluate the 18‐month impact of a program providing a daily lipid‐based nutrient supplement (LNS) and social and behavior change communication (SBCC) to promote infant and young child feeding practices from 6–23 months, on undernutrition (stunting, wasting, and underweight) and linear‐ and ponderal growth [length‐for‐age z‐score (LAZ), weight‐for‐length (WLZ), weight‐for‐age (WAZ) z‐score] in rural Malawi.MethodsTwo cohorts of infants (n=348), aged 6–7 months, were enrolled in the program (n=176) and comparison (n=172) districts, respectively, and followed‐up at 12, 18, and 24 months of age. Child weight and length were taken at each visit and converted to z‐scores using the WHO child growth standards. Multilevel mixed‐effects linear regression models estimated the program impact on growth, accounting for within individual and village correlations, and adjusted for age, sex, and baseline nutritional status.ResultsPercentages of children stunted and wasted were comparable at enrollment in both districts: 42.4% and 1.5% (districts combined), but underweight was higher in the program district (15.4% vs. 6.5%;p&lt;0.01). A trend toward a higher LAZ emerged in the program district at 12 (+0.13 z;p=0.15) and 18 (+0.14 z; p=0.19) months of age, that was significant at 24 (+0.34 z; p=0.003) months. Similarly, significant program impact on WAZ was noted at 12 (+0.20 Z; p=0.03), continued at 18 months (+016 Z; p=0.08), and became larger at 24 months of age (+0.32 Z; p=0.003) in program over comparison district. No statistically significant differences between groups were notable for WLZ at any visit. Further, at 18 and 24 months of age, the percent of children underweight was lower by 8.3% (p=0.04) and 9.8% (p=0.02), respectively, in the program vs. comparison district. No significant reduction in the percent of children stunted or wasted between groups were found at any visit.ConclusionsFindings suggest that a daily provision of LNS and SBCC messaging from 6–23 months of age in rural Malawi may improve linear growth and underweight.Support or Funding InformationThis study was funded by the Children's Investment Fund Foundation, UK.

Body‐Segment Profile in Mid‐Life Women Residents in Quetzaltenango, Guatemala: A Perspective on Stunting in Adulthood

BackgroundStunting is highly prevalent in the Guatemalan population and presents many health issues. In regards to growing children, stunting is defined by the WHO Child Growth Standards (2006) as a length or height below 2 SD of the median of the reference growth curve. Guatemala has highest prevalence of stunting in the Americas, with under‐5yo children having rates of 49.8% in a 2009 survey and falling to 46.5% in the 2015 follow‐up, with an even higher proportion in the indigenous children (63.7%). It is associated with poverty, food insecurity, neglect and infection, with effects extending to health, social, and gender disparities. Stunting during childhood is the most common correlate of adult stunting, the latter defined as less than 145 cm in women and 150 cm in men. Humans develop in a cephalocaudal fashion – as extension of the lower part of the anatomy is delayed, body proportions are representative of childhood environment. A high torso‐to‐stature ratio is indicative of higher risk of cardiac arterial disease, liver disorders, and certain cancers. Segmental analysis, as in the NHANES, is conventionally assessed using sitting‐height to indicate the torso, which is confounded by gluteal thickness. Body posture photographs have been shown to be a promising tool with high inter‐rater reliability in calculating torso‐to‐height ratio in children.ObjectiveThis study aims to assess photography as an anthropometric tool to measure body proportions in Guatemalan women between the ages of 35–59 years, living in the city of Quetzaltenango, and to analyze the contribution of the torso‐to‐height ratio as a function of height (i.e. the effect that stunting has on segmental ratios).MethodsPhotographs and anthropometric measurements in a total of 105 women within the age criteria were collected. Their iliac crest was palpated and marked, representing their iliac height. Photographs were taken – with their right side facing the lens on a digital camera Samsung WB150F propped vertically on a tripod and positioned at about 5 feet from the objective. On the developed photo print, the distances on the page‐printed paper from the bottom of the feet to the iliac‐crest mark (leg), from the mark to the crown of the head (torso), and then the sole‐to‐crown (height) were registered. Segmental ratios were calculated from the measurements taken in millimeters. Total height (cm) was measured on a wall stadiometer.ResultsThe median age of study participants was 47yo and standing height was 148 cm. 31 (29.5%) women were stunted and 74 (71.5%) were non‐stunted. Their respective torso‐to‐height ratios were 0.57 and 0.51 (p=0.011). In a continuous‐variable context, the ratio vs height Spearman correlation coefficient was −0.240 (p=0.014).ConclusionThe photo‐image method appears to be an effective tool for assessing body proportions in adults. The significantly different body proportions in the stunted versus non‐stunted individuals may be indicative of growth disparities during the participants' childhood.

Association of Novel Complementary Feeding Indicators with Length‐for‐Age Z‐Scores in Rural Malawi

BackgroundInadequate complementary feeding (CF) from 6–24 months contributes to growth failure in many low income settings. However, recommended indicators of CF are inconsistently associated with length‐for‐age z‐scores (LAZ).ObjectiveTo assess the relationship between novel indicators of CF, including consistency and meal volume, with LAZ in rural Malawi.Methods1,331 households with a child aged 6 to 17 months were sampled from 53 communities in Mchinji district, Malawi using a single stage cluster sampling approach based on caregivers' participation in community women's groups. Data were collected on household sociodemographics, CF practices, and child anthropometry using WHO recommended methods. To assess food consistency, caregivers selected from a series of photographs that which most closely resembled their child's food. Caregivers estimated meal volume using uncooked rice which was then measured; meal volume was then classified as either below or above the age‐specific median for the following age categories: 6–8 months, 9–11 months, and 12–17 months. A summary feeding index (range 0–8 points) was created based on partially or fully meeting WHO recommended CF practices in addition to meal volume and consistency. Length‐for‐age z‐scores, derived from WHO Child Growth Standards, were regressed onto individual CF indicators and the summary feeding index, controlling for covariates. Logistic regression was used to assess the relationship between stunting and scoring in the second or third range of index scores (3–5 and 6–8 points, respectively).ResultsMean child age was 10.8 ± 3.2 months and 51% were female. There was no association between LAZ and minimum dietary diversity (P=0.4), minimum meal frequency (P=0.6), or minimum acceptable diet (P =0.8). There was evidence of interaction between child's age and both food consistency and meal volume. Among 6–8 month old infants, thicker food consistency was positively associated with LAZ (β = 0.14, 95% CI 0.02, 0.27); there was no relationship in older age categories. Meal volume was positively associated with LAZ in children 9–11 months (β = 0.29, 95% CI = 0.04, 0.54) and 12–17 months (β = 0.33, 95% CI = 0.10, 0.56), but not those aged 6–8 months. Each one point increase in the summary feeding index (median=5, IQR=3), was positively associated with LAZ (β = 0.05, 95% CI 0.00, 0.10) and reduced odds of stunting (OR = 0.93, 95% CI 0.87, 1.00). Compared to scoring in the lowest index category, scoring in the middle (3–5 points; OR=0.69, 95% CI 0.46, 1.05) or highest range (6–8 points; OR=0.58, 95% CI 0.38, 0.88) was associated with reduced odds of stunting.ConclusionNovel indicators of CF, such as consistency and meal volume, may be useful to understand the totality of CF and its relation to child growth in low income settings.Support or Funding InformationFunding and support for this research was provided by Concern Worldwide; Malawi Department of Nutrition, HIV and AIDS; World Bank; Emory Global Health Institute; Laney Graduate School, Emory University; and the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health under award number T32DK007734.

Analysis of Malnutrition and Associated Factors among Under Five Years in Kaura Local Government, Kaduna State, Nigeria

This study was intended to apply statistical analysis to determine malnutrition and associated factors among under- five years in Kaura Local Government Area of southern Kaduna State, Nigeria. Malnutrition remains a public health problem in developing countries like Nigeria. The study involved 150 children drawn using multi-stage sampling was adopted. Observation for edema, emaciation, sunken eyes, dehydrated skin, tin grey hair and protruding abdomen was done. Stunting, Underweight and wasting were determined using the WHO child growth standards. The classification of Protein Energy Malnutrition (PEM) was done using weight-for-age with or without edema. Children between 80-60% without edema were considered underweight, 80-60% with edema is Kwashiorkor and less than 60% with edema is Marasmic-Kwashiorkor while less than 60% without edema is Marasmus. Questionnaire, Weighing scale and a length board was used in the collection of data. Data was analyzed using Chi-squared and descriptive statistics. Findings indicate that prevalence of stunting, wasting and underweight was 47.33%, 8.67% and 25.33% respectively. About 18.67% were diagnosed with various forms of protein energy malnutrition and is most common among male children (27.4%), younger children (31%) between (0-11 months) and children having mothers with no formal education (20%). Marasmus was the most common form of protein energy malnutrition (65.38%). Age of Child, Gender and maternal Educational status have influence on Malnutrition. At (p=0.05) the relationship between malnutrition and age of baby, gender with mothers education was statistically significant.

Effects of Nutrient-Fortified Milk-Based Formula on the Nutritional Status and Psychomotor Skills of Preschool Children

This randomized, single-masked, controlled trial examined the effects of nutrient-fortified milk-based formula supplementation on nutritional status, nutrient intake, and psychomotor skills of selected preschool children with mean age of 4.10 ± 0.14 years. The study participants were divided equally into three major groups, normal, underweight, and severely underweight based on WHO-Child Growth Standards, and were further divided into two groups: fortified milk group who was given two glasses of fortified milk (50 g of powdered milk/serving) a day for twelve weeks in addition to their usual diet and the nonintervention group who was not given fortified milk and thus maintained their usual intake. Anthropometric measurements, dietary intake, and psychomotor developmental score were analyzed. Results showed that consumption of two servings of fortified milk a day for twelve weeks significantly increased the height of preschool children by 1.40 cm, weight by 1.35 kg, body mass index by 0.96 kg/m2, mid-upper arm circumference by 0.66 cm, and psychomotor scores by 13.74% more than those children who did not consume fortified milk (p < 0.0001). Hence, fortified milk-based supplement in the diet of preschool children improved overall nutritional status, nutrient intake, and performance in psychomotor scale. This study is registered in Philippine Health Research Registry: PHRR140923-000234.

Stunting is associated with blood lead concentration among Bangladeshi children aged 2-3 years.

BackgroundLead toxicity is of particular public health concern given its near ubiquitous distribution in nature and established neurotoxicant properties. Similar in its ubiquity and ability to inhibit neurodevelopment, early childhood stunting affects an estimated 34 % of children under 5 in low- and middle-income countries. Both lead and stunting have been shown to be associated with decreased neurodevelopment, although the relationship between these childhood burdens is underexplored. The association between lead exposure and stunting has been previously established, yet limited data are available on susceptibility windows.MethodsWhole blood lead samples were collected from rural Bangladeshi children at delivery (umbilical cord blood) and at age 20–40 months (fingerstick blood). Stunting was determined using the Child Growth Standards developed from the World Health Organization Multicentre Growth Reference Study. Children with height for age < -2 z-scores below the median of the WHO Child Growth Standards were classified as stunted in all analyses.ResultsMedian (IQR) umbilical cord and fingerstick blood lead levels were 3.1 (1.6–6.3) μg/dl and 4.2 (1.7–7.6) μg/dl, respectively. In adjusted multivariable regression models, the odds of stunting at 20–40 months increased by 1.12 per μg/dl increase in blood lead level (OR = 1.12, 95 % CI: 1.02–1.22). No association was found between cord blood lead level and risk of stunting (OR = 0.97, 95 % CI: 0.94–1.00).ConclusionsThere is a significant association between stunting and concurrent lead exposure at age 20–40 months. This association is slightly attenuated after controlling for study clinic site. Additional research including more precise timing of lead exposure during these critical 20–40 months is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0190-4) contains supplementary material, which is available to authorized users.

Are stunted young Indonesian children more likely to be overweight, thin, or have high blood pressure in adolescence?

To determine whether stunted young children are at greater risk of (1) overweight/obesity or thinness, and (2) high blood pressure (HBP) in adolescence. A secondary data analysis using the Indonesian Family Life Survey waves 1 (1993) to 4 (2007). We generated a 14-year follow-up cohort (1993-2007) and two 7-year cohorts (1993-2000 and 2000-2007) of children aged 2.0-4.9years. Stunting (HAZ<-2), thinness (BMIZ<-2), and overweight/obesity (BMIZ>+1) were determined based upon the WHO Child Growth Standards. HBP (>90th percentile) was interpreted using the 4th Report on the Diagnosis of HBP in Children and Adolescents. 765, 1083, and 1589 children were included in the 14-year cohort, and the two 7-year cohort analyses, respectively. In the 7-year cohorts, early life stunting was inversely associated with overweight/obesity (prevalence ratio 0.32 and 0.38, respectively; P<0.05), but no significant association was found with the 14-year cohort. There was no significant association between childhood stunting and thinness at adolescence or in the odds/likelihood of having high systolic or diastolic blood pressure. We found no association between early life stunting and overweight/obesity, thinness and HBP in adolescence.

Predominantly nighttime feeding and weight outcomes in infants

Background: The influence of circadian feeding patterns on weight outcomes has been shown in animal and human studies but not in very young children.Objective: We aimed to examine the association of infant circadian feeding patterns at 12 mo of age with subsequent growth and weight status after 1 y.Design: Mothers from a Singapore birth cohort (n = 349) reported the food given to their infants and the feeding time at 12 mo of age. Predominantly daytime (pDT) (0700–1859; n = 282) and predominantly nighttime (pNT) (1900–0659; n = 67) feeding infants were defined by whether daytime energy intake was >50% or <50% of total energy intake as assessed with the use of a 24-h recall. Body mass index–for-age z scores (BAZs) were computed with the use of the WHO Child Growth Standards 2006 to determine changes in BAZs from 12 to 24 mo of age and weight status at 24 mo of age. Multivariable linear and logistic regression analyses were performed.Results: Compared with pDT feeding, pNT feeding was associated with a higher BAZ gain from 12 to 24 mo of age (adjusted β = 0.38; 95% CI: 0.11, 0.65; P = 0.006) and increased risk of becoming overweight at 24 mo of age (adjusted OR: 2.78; 95% CI: 1.11, 6.97; P = 0.029) with adjustments for maternal age, education, ethnicity, monthly household income, parity, infant BAZ at 12 mo of age, feeding mode in the first 6 mo of life, and total daily energy intake.Conclusions: Our study suggests that the role of the daily distribution of energy consumption in weight regulation begins in infancy. The feeding of infants predominantly during nighttime hours was associated with adiposity gain and risk of overweight in early childhood. The inclusion of advice on the appropriate feeding time may be considered when implementing strategies to combat childhood obesity. This trial was registered at clinicaltrials.gov as NCT01174875.

Stunting, Underweight and Overweight in Children Aged 2.0-4.9 Years in Indonesia: Prevalence Trends and Associated Risk Factors.

ObjectiveThe double burden of malnutrition affects many low and middle-income countries. This study aimed to: a) determine temporal trends in the prevalence of underweight, stunting, and at risk of overweight/ overweight or obesity in Indonesian children aged 2.0–4.9 years; and b) examine associated risk factors.DesignA repeated cross-sectional survey. This is a secondary data analysis of waves 1, 2, 3, and 4 (1993, 1997, 2000, and 2007) of the Indonesian Family Life Survey, which includes 13 out of 27 provinces in Indonesia. Height, weight and BMI were expressed as z-scores (2006 WHO Child Growth Standards). Weight-for-age-z-score <-2 was categorised as underweight, height-for-age-z-score <-2 as stunted, and BMI-z-score >+1, >+2, >+3 as at-risk, overweight and obese, respectively.ResultsThere are 938, 913, 939, and 1311 separate children in the 4 waves, respectively. The prevalence of stunting decreased significantly from waves 1 to 4 (from 50.8% to 36.7%), as did the prevalence of underweight (from 34.5% to 21.4%). The prevalence of ‘at-risk’/overweight/obesity increased from 10.3% to 16.5% (all P<0.01). Stunting and underweight were related to lower birth weight, being breastfed for 6 months or more, having parents who were underweight or had short stature, and mothers who never attended formal education. Stunting was also higher in rural areas. Being at-risk, or overweight/obese were closely related to being in the youngest age group (2–2·9 years) or male, having parents who were overweight/obese or having fathers with university education.ConclusionsThe double burden of malnutrition occurs in Indonesian children. Development of policy to combine the management of chronic under-nutrition and over-nutrition is required.

Wasting and stunting are still prevalent in children with sickle cell anaemia in Lagos, Nigeria

BackgroundSickle cell anaemia (SCA) is associated with growth failure. However, recent reports indicate high rates of overweight or obesity among children with SCA in developed countries. It is unclear whether overweight or obesity is also common in children with SCA in developing countries. The objectives of the study were to determine the prevalence of overweight or obesity, wasting and stunting and identify predictors of wasting and stunting among children with SCA in Nigeria.MethodChildren with SCA attending a public-funded tertiary hospital clinic were studied. Weight, height, haemoglobin, haemoglobin fractions and white cell count were measured. Anthropometric values were converted to z scores and referenced to the WHO Child Growth Standards and WHO Reference 2007. The proportions with wasting, stunting and overweight or obesity were determined. Regression analysis was used to identify the predictors of wasting and stunting.ResultsTwo hundred and thirty-three children [mean (±SD) age of 9.0 (±4.0) years, 60.9 % males] participated in the study. Wasting, stunting and overweight or obesity rates were 22.7 %, 11.6 % and 1.7 %, respectively. Boys and children from low socioeconomic class were 3.25 (1.45-7.29) and 2.42 (1.14-5.18) times more likely to be wasted respectively, while both wasting and stunting were more common with increasing age [adjusted OR of 1.33 (1.18-1.51) and 1.15 (1.01-1.32) respectively]. Sickle cell-related complications and intake of oral penicillin and hydroxyurea were not associated with wasting and stunting.ConclusionOverweight or obesity is uncommon while wasting and stunting are still prevalent in children with SCA in Lagos. The strongest predictors of wasting and stunting were older age, male gender and low socioeconomic status.