WHO Child Growth Standards Research Articles

Overnutrition in Indian Children: Challenges and Opportunities.

Global and Indian data indicate that children from all the segments of population face dual nutrition burden and related health consequences. Long-term cohort studies have shown that both the under- and overnutrition are risk factors for overnutrition and non-communicable diseases in adult life. Halting the rise in overnutrition is one of the Sustainable Development Goal (SDG) targets to be achieved by 2030. With the development and inclusion of body mass index (BMI)-for-age in the WHO child growth standards, it has become possible to assess over- and undernutrition in short-statured children. In India, the Annual Health Survey (AHS) (2014) and the District Level Household Survey 4 (DLHS4) (2013) undertook measurement of height/length and weight (AHS 557016 and DLHS4 295663) in the 0–18-year of school-age children from selected households. Prevalence of overnutrition in 0–18-year children was calculated from these two surveys by using the WHO standards for BMI-for-age (BMI-for-age z scores (BAZ) > +2 in 0–5 and BAZ > +1 in 5–18-year children) as well as uniform norms of either > +1 or > +2 BAZ across 0–18-year children. An attempt was made to explore the policy and program implications of using different norms for assessing overnutrition in preschool and school age children in the Indian context. Body mass index-for-age curve for the 0–18-year Indian children was calculated and compared with the WHO BMI-for-age curve. Across 0–18-year children, the mean BMI-for-age of Indian boys and girls was lower than the mean of the WHO standards, but the trajectory followed was similar. Therefore, Indian high-risk under- and overnourished children can be monitored by using the WHO BMI-for-age curve. Irrespective of the cutoff used for BMI-for-age, prevalence of overnutrition was higher in preschool as compared to school-age children. Overnourished school-age children outnumbered preschool children, especially if the WHO cutoffs were used. The school health system may find it difficult to implement programs that aimed at detection and management of large number of overnourished children. If uniform norm of BAZ > +1 was used, prevalence of overnutrition in preschool children was high and almost similar to undernutrition. Currently, nutrition programs for preschool children are focused on undernutrition and they may find it difficult to manage program focused on overnutrition in large number of children. If the uniform norm of BAZ > +2 was used, both the prevalence of overnutrition and number of children requiring intervention were relatively low in all the age groups. The existing preschool and school nutrition programs can take up an integrated program aimed at early detection and effective management of both the under- (BAZ < −2) and overnutrition (BAZ > +2) in 0–18-year children and strive to achieve the SDG targets.

The Influence of Treatment with Ledipasvir/Sofosbuvir on Growth Parameters in Children and Adolescents with Chronic Hepatitis C.

Background: There are limited data available on the influence of direct-acting antivirals used to treat chronic hepatitis C (CHC) on growth in children. In this study, we aimed to analyze the growth parameters in children treated with ledipasvir/sofosbuvir (LDV/SOF). Methods: We included 38 patients (16 girls and 22 boys) aged 10–17 years treated with LDV/SOF for CHC (33 infected with genotype 1 and 5 with genotype 4; 36 were treated for 12 weeks, and 2 for 24 weeks according to the current guidelines). Patient weight and height were measured at baseline, after 4 weeks of treatment, at the end of the treatment (EOT), and 12 weeks and one year after the EOT. Body mass index (BMI), BMI z and height-for-age (HA) z scores were calculated according to the WHO Child Growth Standards and Growth reference data using the WHO anthropometric calculator AnthroPlus v. 1.0.4. In addition, correlations between BMI z scores and liver fibrosis (liver stiffness measurement, LSM), the aspartate transaminase (AST)-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4) and liver steatosis (controlled attenuation parameter, CAP) were analyzed. Results: At baseline, 5/38 (13%) patients were obese (BMI z score > 2 SD), 4/38 (11%) were overweight, and 29 (76%) were normal. A significant increase was observed in mean weight, height and BMI both 12 weeks and one year after the treatment compared to the baseline, whereas no differences were observed for BMI z scores and HA z scores. Baseline BMI z scores correlated with alanine aminotransferase levels (r = 0.33, 95% CI 0.01–0.58, p = 0.04), LSM (r = 0.40, 95% CI 0.09–0.65, p = 0.01), the APRI (r = 0.33, 95% CI 0.02–0.59, p = 0.03), and the CAP (r = 0.40, 95% CI 0.08–0.64, p = 0.01). No similar correlations were reported at 12 weeks posttreatment. Conclusions: Treatment with LDV/SOF in children with CHC (genotypes 1 and 4) did not negatively influence the patients’ growth. However, higher baseline BMI z scores correlated with more advanced liver fibrosis and steatosis in children with CHC.

Nutritional status of children with heart disease at the Komfo Anokye Teaching Hospital, Ghana

Background Undernutrition is associated with forty-five percent of all deaths in children under-five years. Irrespective of the type of heart disease (HD), malnutrition remains a constant phenomenon in children with both congenital and acquired HD. To minimize the long-term effect of malnutrition in a cohort of patient who have very limited chance of surgical treatment even when indicated, their nutritional statuses must be assessed periodically, and rehabilitation instituted early. The objective of this study was to assess the nutritional status of children attending the Pediatric Heart Disease clinic of the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.&#x0D; MethodsA retrospective review of children up to fourteen years, enrolled into the Pediatric Heart Disease clinic with confirmed HD from November 2020 to June 2021 were systematically recruited. Their ages, weights, heights and mid-upper arm circumferences (MUAC) were measured by standardized methods to assess their nutritional status. Subsequently, their Weight-for-Height (WfH), Height-for-Age (HfA), Weight-for-Age (WfA), Body Mass Index-for-Age (BfA) and MUAC-for-Age (MfA) z-scores were determined based on the WHO Child Growth Standards (2006). Z-scores less than -2 standard deviations (SDs) or greater than +2SDs were considered abnormal. Data was collected and analyzed using Epidata and R statistical software respectively.&#x0D; ResultsA hundred and sixty-seven patient were recruited with 86 (51.5%) being females. The median age was 56 months (Range: 1 to 172). The mean z-score for the WfH was -1.21 (95%CI: -1.48 to -0.94), HfA -1.18 (95%CI: -1.44 to -0.93), WfA -1.81 (95%CI: -2.06 to -1.56), BfA -1.41 (95%CI: -1.61 to -1.21) and MfA -1.66 (95%CI: -1.87 to -1.46). None of the patients had a z-score greater than +2SD for all anthropometric methods determined. The percentage of children with z-scores less than -2SD for WfH was 20.5% (95%CI: 12.0 to 31.6), HfA 21.3% (95%CI: 14.4 to 29.6), WfA 41.5% (95%CI: 33.1 to 50.3), BfA 31.1% (95%CI: 23.1 to 40.2) and MfA 36.0% (95%CI: 28.6 to 44.0).&#x0D; ConclusionThere is a high prevalence of malnutrition, wasting and stunting among children attending the Pediatric Heart Disease clinic at KATH. Strategies should be put in place to improve their nutritional status, which in turn could improve surgical and long-term developmental outcome.

НУТРИТИВНЫЙ СТАТУС И КОМПОНЕНТНЫЙ СОСТАВ ТЕЛА ШКОЛЬНИКОВ 6-7 КЛАССОВ Г. ХАНТЫ-МАНСИЙСКА

The purpose of ̶assessment of the health and healthy lifestyle of schoolchildren of grades 6-7 of secondary schools in Khanty-Mansiysk based on the results of the analysis of physical development and nutritional status. In 411 children aged 11-14 years, body mass index and standard deviation from the reference median of WHO Child Growth Standards and body component composition were determined using the ABC-01 Medass bioimpedance analyzer in 59 children. It was revealed with a normal level of nutrition - 53.3% of the subjects, with overweight - 17.7%, with obesity - 14.4%, with reduced nutrition ̶12.4% and with malnutrition ̶2.2%. Obesity was more common among boys (64.4%). In children with excessive nutrition and obesity, significantly high indicators of fat mass, a decrease in the proportion of musculoskeletal mass, and impaired distribution of subcutaneous fat were revealed. In 16% of children with elevated BMI, the results of the fat content were within normal limits. Findings. The method of bioimpedansometry is indicated for children and adolescents with high BMI for the assessment of body fat mass and the diagnosis of obesity.

Comparison of Indonesian Growth Reference Chart and World Health Organization Child Growth Standard in Detecting Stunting: A Systematic Review and Meta-analysis of 15,874 Children

Recognition of an overestimation of stunted children in Indonesia when using the World Health Organization Child Growth Standards (WHOCGS) led to the creation of the Indonesian Growth Reference Chart (IGRC) in 2005, with further improvement in 2018. This systematic review aimed to determine whether there is a difference in the diagnosis of stunting when using these two charts. This systematic review is registered in the PROSPERO database (CRD42021259934). Literature research was performed on PubMed, Science Direct, Medline, Scielo, Medrxiv, Research Square, SSRN, and Biorxiv to identify studies published from 2018 onwards that examined the comparison of IGRC and WHOCGS in detecting stunting. Three studies were included in this review. Pooled analysis showed that IGRC resulted in a lower prevalence of stunted and severely stunted children [risk ratio (RR): 0.28 (95% confidence intervals (CI): 0.15-0.51), p<0.0001, I2=97%]. Comparison between IGRC and WHOGCS for prevalence of normal height children showed that there was no difference, and this finding was not significant [RR: 1.56 (95% CI: 0.92-2.66), p=0.1, I2=100%], and the comparison for prevalence of tall children also showed that there was no difference when using IGRC or WHOGCS, and this finding was also insignificant [RR: 2.02 (95% CI: 0.78-5.20), p=0.14, I2=98%]. This meta-analysis showed that stunted and severely stunted Indonesian children are over-represented using WHOCGS. The difference between IGRC and WHOCGS has occurred because of the sample population, as IGRC includes children from all 33 provinces in Indonesia, better reflecting the growth of all children in Indonesia.

Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

BackgroundNutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa.MethodsIn 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d’Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention.ResultsOverall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d’Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767).ConclusionsThis intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV.Trial registrationPACTR202001816232398, June 01, 2020, retrospectively registered.

Penyuluhan Kesehatan Cegah Stunting dengan Perbaikan Pola Makan, Pola Asuh Dan Sanitasi pada Ibu Hamil di UPT Puskesmas Antang

: Stunting is a chronic malnutrition problem caused by lack of nutritional intake for a long time, resulting in growth disorders in children, namely the child's height is lower or shorter (short) than the standard age. The condition of a child's short body is often said to be a hereditary factor (genetic) from both parents, so that many people just accept it without doing anything to prevent it. In fact, as we all know, genetics is a determinant of health that has the least effect when compared to behavioral, environmental (social, economic, cultural, political) factors and health services. In other words, stunting is a preventable problem. Stunting is a growth failure problem experienced by infants under 5 years of age who are malnourished since in the womb until the baby is born. Assessment of stunting nutritional status can be done through anthropometric measurements of TB/U classified through nutritional classification status. Stunting is a condition where the child's height is shorter than the height of children his age. According to UNICEF, stunting occurs in children aged 0 to 59 months with a height below minus (moderate and severe stunting) and minus three (chronic stunting) measured from the WHO child growth standards. In Indonesia, stunting is still a health problem in quite a large number. Based on the 2013 Basic Health Research, around 37.2 percent of Indonesian children under the age of 5 are stunted.

The “Great Wave”: Childhood Obesity and Overweight

IntroductionObesity was declared a real epidemic by the World Health Organization (WHO); and is still on the rise; especially in childhood.We report the results of an anthropometric survey in primary schools and decipher the specific rates of Algerian childhood overweight and obesity. Material and methodWe performed a cross-sectional descriptive study through a representative sample of primary school pupils in the city of Sétif, north-east of Algeria.Consents were obtained from the parents, the establishments’ directors and the Inspector of the Academy.All children had a full anthropometric evaluation and clinical examination.The WHO Child Growth Standards (WHO, 2006) were used to assess the weight-for-age for boys and girls. ResultsAmong 2,493 children screened, 387 (=15.52%) were overweight or obese (with a body mass index (BMI) > 1 standard deviation on the WHO pediatric weight curves)After stratification, 272 pupils (10.91%) were overweight (i.e. BMI = [+1, +2] SD) and 115 pupils =4.61% were obese (BMI = >+2 SD).No patient exhibited somatic signs of insulin resistance (i.e. acanthosis nigricans). ConclusionChildhood overweight and obesity are an increasing reality worldwide, including in Algeria.Prompt, proactive actions are needed to refrain the onset of post-puberty obesity, real prelude of adulthood cardiovascular and metabolic diseases.

A case-control study on body composition of teenagers with adolescent idiopathic scoliosis

Abstract Background Adolescent idiopathic scoliosis (AIS) is the most common form of spinal abnormality. It affects about 2-3% of all teenagers. Its etiology remains unknown but studies suggest that multiple factors may play a role. A growing body of evidence supports the role of body composition abnormalities including low body mass index (BMI) and low body fat percentage (BF%) as risk factors for AIS development. This study aimed to evaluate these indicators in a group of teenagers with AIS and compare them to age and gender-matched controls. Methods The study included 98 adolescents with AIS and 73 controls aged 11-18 years from Varna, Bulgaria. Data was collected after receiving informed consent from the parents. Data on AIS diagnosis and severity was collected from the available medical documentation. Anthropometrics were measured using calibrated Tanita BC-420MA (ISSO 9001) and following ESPEN guidelines. BMI for age and BF% for age were estimated using WHO Child Growth Standards and BF% reference curves for children. Results In the AIS group, 15% were underweight with BMI for age under -2SD. 11% were above +1SD indicating a risk of overweight or obesity. In comparison, 7% of the control group were underweight while 32% were at risk of being overweight or obese. There is a statistically significant difference between the BMI for age in the two groups (χ2=19.564 Đ¿рĐ, p &amp;lt; 0.005). In the AIS group, 47% had BF% for age under the 2nd percentile indicating underfat, while 7% of AIS cases had BF% for age above the 85th percentile indicating they are overfat or obese. In comparison, 15% of the control group were underfat while 19% were overfat or obese. There is a statistically significant difference between the BF% for age in the two groups (χ2=21,504 Đ¿рĐ, p &amp;lt; 0.001). Conclusions Children with AIS are more likely to be underweight and underfat compared to their healthy peers. Cases of having a high BF% and being overweight or obese are scarce amongst AIS patients. Key messages The majority of children with AIS have abnormal body composition compared to healthy age and gender-matched controls. Aspects of the nutritional status may play a role in the etiology of AIS. Children with low body fat might be at a higher risk of developing AIS. AIS screening programs should be directed towards underweight children.

Marasmus and stunting in 2-month-old boy with pneumatocele

BackgroundNutrition is essential for humans and if inadequate may lead to undernutrition. Undernourished children are very susceptible to infections, such as pneumonia, one of its complications being pneumatocele, which is a more severe condition. Pulmonary pneumatoceles are thin-walled, air-filled cysts that develop within the lung parenchyma and have been found in 2.4 percent of 493 infants and children with pneumonia. However, in staphylococcal pneumonias, the frequency of pneumatocele can reach as high as 85 percent. Infants and young children are more likely to have pneumatoceles. It is critical to distinguish marasmus with pneumatocele from many other similar diagnoses. Failure to recognize can lead to incorrect diagnosis and treatment, causing more harm than good to patient care. This case highlights the importance of maintaining a high suspicion of pneumonia in neonates even with normal radiological findings and of searching for pneumatoceles. Case DescriptionWe report a case of marasmus and stunting accompanied by pneumatocele in a 2-month-old boy. The diagnosis was made based on history, physical examination, anthropometric examination using the WHO child growth standards, laboratory tests, and radiological imaging. Management of the patient was according to a multidisciplinary system including antibiotics administration and wasting management. ConclusionPneumatoceles are serious complications after pneumonia. Pneumonia is common in children with marasmus. Children with marasmus are caused by various underlying factors. The progression begins in the womb and continues through the first 1000 days of life.

The Mothers, Infants, and Lactation Quality (MILQ) Study: A Multi-Center Collaboration.

ABSTRACTLittle valid information is available on human milk nutrient concentrations, especially for micronutrients (MNs), and there are no valid reference values (RVs) across lactation. In this multi-center collaborative study, RVs will be established for human milk nutrients across the first 8.5 mo postpartum. Well-nourished, unsupplemented women in Bangladesh, Brazil, Denmark, and The Gambia (n = 250/site) were recruited during the third trimester of pregnancy. Milk, blood, saliva, urine, and stool samples from mothers and their infants are collected identically at 3 visits (1–3.49, 3.5–5.99, 6.0–8.49 mo postpartum). Milk analyses include macronutrients, selected vitamins, trace elements and minerals, iodine, metabolomics, amino acids, human milk oligosaccharides, and bioactive peptides. We measure milk volume; maternal and infant diets, anthropometry, and morbidity; infant development, maternal genome, and the infant and maternal microbiome. RVs will be constructed based on methods for the WHO Child Growth Standards and the Intergrowth-21st Project. This trial was registered at clinical trials.gov as NCT03254329.

Nutritional status and concomitant factors of stunting among pre-school children in Malda, India: A micro-level study using a multilevel approach

BackgroundMalnutrition was the main cause of death among children below 5 years in every state of India in 2017. Despite several flagship programmes and schemes implemented by the Government of India, the latest edition of the Global Nutrition Report 2018 addressed that India tops in the number of stunted children, which is a matter of concern. Thus, a micro-level study was designed to know the level of nutritional status and to study this by various disaggregate levels, as well as to examine the risk factors of stunting among pre-school children aged 36–59 months in Malda.MethodA primary cross-sectional quantitative survey was conducted using structured questionnaires following a multi-stage, stratified simple random sampling procedure in 2018. A sum of 731 mothers with at least one eligible child aged 36–59 months were the study participants. Anthropometric measures of children were collected following the WHO child growth standard. Children were classified as stunted, wasted, and underweight if their HAZ, WHZ, and WAZ scores, respectively, were less than −2SD. The random intercept multilevel logistic regression model has been employed to estimate the effects of possible risk factors on childhood stunting.ResultsThe prevalence of stunting in the study area is 40% among children aged 36–59 months, which is a very high prevalence as per the WHO’s cut-off values (≥40%) for public health significance. Results of the multilevel analysis revealed that preceding birth interval, low birth weight, duration of breastfeeding, mother’s age at birth, mother’s education, and occupation are the associated risk factors of stunting. Among them, low birth weight (OR 2.22, 95% CI: 1.44–3.41) and bidi worker as mothers’ occupation (OR 1.92, 95% CI: 1.18–3.12) are the most influencing factors of stunting. Further, about 14 and 86% variation in stunting lie at community and child/household level, respectively.ConclusionSpecial attention needs to be placed on the modifiable risk factors of childhood stunting. Policy interventions should direct community health workers to encourage women as well as their male partners to increase birth interval using various family planning practices, provide extra care for low birth weight baby, that can help to reduce childhood stunting.

Safety and Tolerance of a Novel Anti-Regurgitation Formula: A Double-Blind, Randomized, Controlled Trial.

ABSTRACTObjectives:A novel anti-regurgitation (AR) formula has been designed to support gut health and improve gastrointestinal (GI) symptoms beyond regurgitation. This study assessed the tolerance and safety of this new AR formula.Methods:This was a 4-week double-blind, randomized, controlled trial with a 4-week extension in formula-fed infants with regurgitation. The new AR (Test) formula contained 0.4 g/100 mL locust bean gum (LBG) as thickener, partly fermented formula with postbiotics, and short-chain galacto-oligosaccharides (scGOS) and long-chain fructo-oligosaccharides (lcFOS) (0.4 g/100 mL, ratio 9:1). The Control AR formula contained LBG (0.4 g/100 mL) with postbiotics and has a history of safe use. The primary outcome was the Infant Gastrointestinal Symptom Questionnaire (IGSQ) sum score including stooling, spitting-up/vomiting, crying, fussiness and flatulence.Results:All 182 infants screened were enrolled in the study. The primary analysis showed the equivalence of the IGSQ sum scores at Week 4 between groups. IGSQ sum scores improved significantly within 1 week (Mixed Model Repeated Measurement [MMRM], P < 0.001). Post-hoc analyses showed a bigger improvement of the IGSQ score in the Test (n = 38) versus Control (n = 44) group (MMRM, P = 0.008) in infants with more severe gastrointestinal (GI) symptoms (IGSQ score ≥35). Stool characteristics were comparable between groups. Growth related z scores were in line with the WHO child growth standards and both groups showed improvement of regurgitation. Adverse events did not show any safety concerns.Conclusions:The novel AR formula combining LBG, scGOS/lcFOS and postbiotics is well-tolerated, safe and supports adequate growth during the intervention. Post-hoc analyses suggest that the formula results in more improvement of GI symptom burden in infants with more severe symptoms.

Growth and development of children under 5\xa0years of age with tetralogy of Fallot in a Chinese population

Congenital Heart Defects (CHDs) are associated with different patterns of malnutrition and growth retardation, which may vary worldwide and need to be evaluated according to local conditions. Although tetralogy of Fallot (TOF) is one of the first described CHDs, the etiology outcomes in growth and development of TOF in early age child is still unclear in most cases. This study was designed to investigate the growth retardation status of Chinese pediatric TOF patients under 5 years old. The body height, body weight and body mass index (BMI) of 262 pediatric patients (138 boys and 124 girls) who underwent corrective surgery for TOF between 2014 and 2018 were measured using conventional methods. The average body height, body weight and BMI of the patients were significantly lower than WHO Child Growth Standards, while the most affected was body height. Meanwhile, higher stunting frequency and greater deterioration of both the body height and weight happened in elder age (aged 13–60 months) rather than in infant stage (aged 0–12 months) among these patients. Our results confirmed that intervention should be given at early age to prevent the growth retardation of TOF patients getting severer.

Multilevel analysis of risk factors associated with severe underweight among children under 5 years: evidence from the 2014 Ghana Demographic and Health Survey

Background: Undernutrition among children &lt;5yr. is a global public health problem, especially in developing countries like Ghana. Undernutrition increases the risk of child morbidity and mortality. There is paucity of data on household-level effects on severe underweight and associated factors. Objective: The study investigated the risk factors associated with severe underweight among children &lt; 5yr.in Ghana and examined unobserved differences across households based on the 2014 Ghana Demographic and Health surveys (GDHS) data. Methods: Data from a population-based cross-sectional study was obtained from the 2014 Ghana Demographic and Health Survey. Data on 2720 children nested within 1972 households was extracted for analysis. Our regression analysis used data on 2716 children with complete data on the outcome and risk factors. Children with weight-for-age Z-score below -3 standard deviations were classified as severely underweight based on the 2006 WHO child growth standards. We applied random intercept multilevel logistic regression to examine whether severe underweight status in children differ across households while simultaneously identifying potential risk factors. Results: A total of 2720 children had valid weight-for-age z-score and 53 (1.95%) of them were identified as severely underweight. In the univariate model, child level variables such as multiple birth [odds ratio (OR), 4.03;95%confidence interval (CI): 1.85-8.76]and child born average (OR, 2.17;95%CI: 1.09-4.32) or small (OR, 4.08; 95%CI: 2.01-8.28) in size at birth are associated with increased odds of severe underweight. Maternal/household level variables such as increase in number of children below 5 yr. (OR, 1.61; 95%CI: 1.28-2.04), poorest households (OR, 4.85; 95%CI: 1.14-20.59) and increase in number of births in last 5 yr. (OR, 1.80, 95%CI: 1.24-2.60) were associated with increased odds of severe underweight. Increase in maternal years of education (OR, 0.89; 95%CI: 0.83-0.95) was associated with reduced odds of severe underweight. In the multilevel logistic model, only type of birth (OR, 1.61;95%CI: 1.28-2.04), size of child (average: OR, 2.12;95%CI: 1.04-4.33; small: OR, 3.87;95%CI: 1.80-8.33) at birth, and maternal education (OR, 0.92;95%CI: 0.84-1.00) were independently associated with severe underweight. There were no significant residual household-level variations in severe underweight status. Conclusion: Our findings suggest that improving maternal education, socioeconomic conditions of families, and family planning are critical in addressing severe underweight

Prevalence of Stunting According to WHO Growth Standards and Indonesian Growth Reference Charts: A Descriptive Study from Blega Sub-District

Stunting is one of the remaining health issues in Indonesia and its prevalence was still high in the last decades. There are two types of growth charts that can be used in recording the child's growth: growth standards and growth references. In recent times, the selection of the suitable growth charts has become a subject of discussion in many countries. The objective of this study is to describe the prevalence of stunting according to World Health Organization Child Growth Standards (WHOCGS) and Indonesian National Growth Reference Charts (INGRC) of children under five from the Blega sub-district. The secondary data from 2884 children were collected recapitulation of the 'Bulan Timbang' program in February 2020. Z-score of length/height-for-age was plotted according to WHOCGS and INGRC. The result showed that the prevalence of stunting were lower for the INGRC than WHOCGS (5.83% and 11.17%, with p-value &lt;0.001). There was an advantage and disadvantage when using both two growth charts. Further research is still needed to support the result of this study.&#x0D; Keywords: Stunting, World Health Organization Child Growth Standards, Indonesian National Growth Reference Charts

HUBUNGAN TINGKAT PENDIDIKAN IBU DAN PEMBERIAN ASI EKSKLUSIF DENGAN KEJADIAN STUNTING PADA BALITA DI PUSKESMAS SUNGAI LEKOP KOTA BATAM

Stunting is impaired growth and development that children experience from a number of impacting factors with poor nutrition being one of them. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median. According to the report of the Health Office of Batam in 2018, out of 20 puskesmas (community clinics) in the region, five of them recorded the highest prevalence of stunting among toddlers with Puskesmas Sei Lekop being the highest hitting 110 reported cases (0.89%). This research aims to discover the correlations between mother’s educational background and exclusive breastfeeding practice on the toddlerhood stunting prevalence in Puskesmas Sei Lekop, Batam, in 2019.The research design employs analytic method with cross-sectional approach. Conducted from April to August 2019, the research involves 97 respondents in total. The data analyzing technique employs chi-square. The findings reveal the correlations between mother’s educational background and the stunting prevalence among toddlers with ρ-value 0.01 < 0.05; and between exclusive breastfeeding practice and the stunting prevalence among toddlers with ρ-value 0.00 < 0.05. In conclusion, the findings confirm the correlations between mother’s educational background and exclusive breastfeeding practice on the stunting prevalence among toddlers. In suggestion, the following researchers who are interested in studying similar subject are expected to develop more detailed parametric variables and investigate other possible factors that may contribute or are related to stunting issues .

WHO Child Growth Standards in context: The Baby–bod Project - Observational study in Tasmania

ObjectiveThis research evaluated (1) differences in body size and composition of Tasmanian infants at birth and 3 and 6 months postpartum compared with WHO child growth standards and (2) body...

160-OR: Increased Adiposity and Low Height-for-Age in Early Childhood Is Associated with Later Metabolic Risk in American Indian Children and Adolescents

Background: Growth abnormalities in early childhood have been related to later metabolic risk, but little is known about these associations in populations at high risk of diabetes. Methods: We linked anthropometric data collected at ages 0-&amp;lt;5 y from 2928 routine clinical examinations conducted 1990-2000 to metabolic data from a longitudinal study in a southwestern American Indian population at high risk of diabetes. A total of 701 participants with ≥1 follow-up examination at ages 5-16 y were included. We derived age and sex-specific z-scores (from WHO Child Growth Standards) of weight-for-height (WHZ) and height-for-age (HAZ) at ages 0-&amp;lt;5 y. We selected the highest observed WHZ and the lowest HAZ and analyzed associations of categories of WHZ and HAZ with metabolic data at ages 5-9 y and 10-16 y. Linear mixed effects models were used to account for repeated measures. Results: In age and sex-adjusted models, overweight and obesity (WHZ &amp;gt; 2) at ages 0-&amp;lt;5 y was significantly associated with higher BMI and with greater height at ages 5-16 y relative to normal weight (WHZ ≤ 1). It was also associated with increased fasting glucose, 2-h glucose, fasting insulin, 2-hr insulin, total cholesterol, triglycerides, SBP, DPB and decreased HDL. For example, at ages 5-9 y 2-h glucose was 10.4 mg/dl higher (95% CI: 5.6, 15.3) and fasting insulin was 1.88 times higher (95% CI: 1.58, 2.24). Associations were attenuated and no longer significant when adjusted for BMI. Low height-for-age (HAZ&amp;lt; -2) at ages 0-&amp;lt;5 y was associated with lower BMI and lower height at ages 5-16 y relative to normal height (HAZ ≥ 0). With adjustment for BMI, low height-for-age was associated with 1.40 times higher 2-h insulin (95% CI: 1.05, 1.87) and 5.47 mg/dL lower HDL (95% CI: 2.68, 8.62) at ages 10-16 y. Conclusion: These analyses suggest that both overweight/obesity and low height-for-age in early childhood can influence subsequent metabolic risk in American Indian children and adolescents. Disclosure M. J. Ramirez-luzuriaga: None. S. Kobes: None. M. Sinha: None. W. C. Knowler: None. R. L. Hanson: None.

Micronutrient Status and Child Growth in Mexico: Results From the 2018 National Health and Nutrition Survey (ENSANUT)

ObjectivesTo examine the associations between micronutrient status and child growth, as part of the National Health and Nutrition Survey in Mexico. MethodsData from the National Health and Nutrition Survey (ENSANUT 2018) were analyzed to examine the association between micronutrient status and child growth in 1,656 children 36 to 59 months of age. Micronutrient biomarkers (serum ferritin (SF), vitamin B12, vitamin D, serum zinc) were measured in venous blood samples via immunoassays. Child weight and height were measured using standardized procedures, and indicators weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and body mass index (BMI) Z-scores were calculated using the WHO Anthro V3.1 and categorized as per WHO Child Growth Standards. Micronutrient biomarkers were natural logarithmically transformed prior to analyses. Iron deficiency was defined as SF < 12.0 μg/L and iron insufficiency was defined as SF < 20.0 μg/L. Vitamin B12 deficiency and insufficiency were defined as < 148 and < 221 pmol/L, respectively. Vitamin D deficiency was defined as < 50 nmol/L, and zinc deficiency was defined as < 65μg/dL. Survey linear regression models were used to examine associations of micronutrient status with WHO Z-scores. ResultsSerum ferritin concentrations (β [SE]: 0.096 [0.001], p < 0.0001) and vitamin B12 (0.092 [0.003], p < 0.0001) concentrations were associated with higher WHZ. Vitamin B12 (0.171 [0.004], p < 0.0001), vitamin D (0.358 [0.007], p < 0.0001), and zinc (0.122 [0.006], p < 0.0001) concentrations were associated with higher HAZ. Iron deficiency (β [SE]: -0.469 [0.004], p < 0.0001) and zinc deficiency (-0.203 [0.01], p < 0.0001) were associated with lower WHZ, and vitamin B12 (-0.449 [0.002], p < 0.0001), vitamin D (-0.215 [0.001], p < 0.0001) and zinc (-0.216 [0.01], p < 0.0001) deficiencies were associated with lower HAZ. ConclusionsMicronutrient deficiencies of vitamin B12, vitamin D, and zinc were associated with lower linear growth in young children in Mexico. Funding SourcesENSANUT was funded by The Ministry of Health of Mexico.