WHO Child Growth Research Articles

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.

Stunting coexisting with overweight in 2·0-4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys.

The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height. A secondary data analysis of children aged 2·0-4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children's height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined 'concurrent stunting and overweight' as height-for-age Z-score +1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors. Thirteen out of twenty-seven provinces in Indonesia. Children (n 4101) from four waves of the Indonesian Family Life Survey (1993-2007). There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0-2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34-2·01). Concurrent stunting and overweight occurs in Indonesian children aged 2·0-4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.

Nutrient and food group intakes of the Korean preschoolers according to growth status

Dietary habits such as nutrient and food intake are one of the most important factors for growth status, especially in early childhood population. This study was conducted to compare the intakes of nutrients and food groups in according to the growth status using data from national survey. The study included 1,665 subjects aged 2–5 years with 24h diet recall and anthropometric data who participated in the 2009–2013 Korea National Health and Nutrition Examination Survey. Growth status of children was assessed by weight for height (WFH) and height for age (HFA). Children were classified into three groups based on the percentiles of children's WFH and HFA compared to 15th and 85th percentiles of the WHO Child Growth Standard 2 to 5 years. The nutrient and food group intake were compared according to growth status adjusted for potentially confounding variables. In total, 4.2% children were classified as the low WFH group (<15th percentile) and 25.2% children were classified as the high WFH group (≥85th percentile). The low WFH group consumed significantly lower intake of several micronutrients such as sodium, thiamin, riboflavin, and vitamin C, compared with the high WFH group. When compared the food group intake according to the WFH status, cereals and fruits intake were lower and nuts & seeds and fishes & shellfishes were higher in the low WFH group than in the high WFH group. In total, 14.0% children were classified as the low HFA group (<15th percentile) and 10.7% children were classified as the high HFA group (≥85th percentile). The low HFA group had a significantly lower intake of energy and iron, compared with the high HFA group. No significant differences in food group intake according to the HFA status. Further studies are needed to assess the effects of eating habits on the growth and health in Korean early childhood population.Support or Funding InformationThis research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science, ICT & Future Planning(grant no. 2013R1A1A2057600)

Ultrasound measurements during the third trimester predict height and stunting at 1 y of age among Vietnamese children

Early childhood growth faltering is a major public health problem associated with negative short‐and long‐term health and development outcomes. The use of ultrasound technology (US) represents an opportunity for early detection and intervention. The objective of this analysis was to assess if US measurements performed during the second and third trimester of pregnancy predicted child height and stunting at 1 y of age.We used prospective data from women participating in a randomized controlled trial of preconception micronutrient supplementation (PRECONCEPT) in Vietnam (n=1137). Inclusion criteria were having at least one US measurement during the second (n=712) or third trimester (n=798) of pregnancy, singleton birth, and child anthropometric information available at 1 y. Fetal measurements were performed during routine prenatal visits using a portable US machine. US measurements included head circumference, biparietal diameter, abdominal circumference, and femur length which were converted into Z‐scores relative to the INTERGROWTH 21st reference (Zac, Zbp, Zfl, and Zhc respectively). Small for gestational age (SGA) was defined as birth weight below the 10th percentile. Recumbent length was measured at the 1 y postnatal visit and converted into Height for Age Z‐scores (HAZ) relative to the WHO Child Growth Standards and stunting was defined as HAZ < 2 SD. We used multivariate regression models to examine associations between US measurements and stunting/HAZ at 1 y. All models were controlled for socioeconomic status, maternal height, child sex and child age. Results were also stratified by SGA to test if US predictive value was independent of SGA.Mean HAZ at 1 y was −0.85 ± 1.05, and the prevalence of stunting was 13.4%; there were no significant differences by sex. US measurements obtained during the second trimester of pregnancy did not predict HAZ or stunting at 1 y. However, all US measurements obtained during the third trimester were positively associated with HAZ at 1 y. A 1 standard deviation (SD) increase in US z‐scores was associated with 0.12–0.14 SD increase in HAZ (Zac=0.12±0.02; Zbp=0.12±0.03; Zfl=0.14±0.02; Zhc=0.14±0.03, p<0.001). Moreover, all third trimester measurements were also inversely associated with stunting (odds ratios (95% confidence intervals): Zac= 0.76 (0.64–0.91); Zbp =0.81 (0.67–0.97); Zfl= 0.75(0.64–0.88); Zhc=0.82, (0.69–0.98), p<0.05). The prevalence of SGA in this sample was of 15.9%. The association of third trimester US measurements remained unchanged when the sample was restricted to non‐SGA children, indicating the information provided by prenatal measurements was independent of SGA status.In conclusion, US measures could be useful predictors of child growth through 1 y. Prenatal detection of children at risk of growth faltering can contribute to timely implementation of interventions to promote child growth.Support or Funding InformationFunded by the Mathile Institute for the Advancement of Human Nutrition, the Micronutrient Initiative, and Nestle Foundation.

Using growth velocity to predict child mortality

AbstractBackground: Growth assessment based on the WHO child growth velocity standards can potentially be used to predict adverse health outcomes. Nevertheless, there are very few studies on growth velocity to predict mortality.Objectives: We aimed to determine the ability of various growth velocity measures to predict child death within 3 mo and to compare it with those of attained growth measures.Design: Data from 5657 children <5 y old who were enrolled in a cohort study in the Democratic Republic of Congo were used. Children were measured up to 6 times in 3-mo intervals, and 246 (4.3%) children died during the study period. Generalized estimating equation (GEE) models informed the mortality risk within 3 mo for weight and length velocity z scores and 3-mo changes in midupper arm circumference (MUAC). We used receiver operating characteristic (ROC) curves to present balance in sensitivity and specificity to predict child death.Results: GEE models showed that children had an exponential increase in the risk of dying with decreasing growth velocity in all 4 indexes (1.2- to 2.4-fold for every unit decrease). A length and weight velocity z score of <−3 was associated with an 11.8- and a 7.9-fold increase, respectively, in the RR of death in the subsequent 3-mo period (95% CIs: 3.9, 35.5, and 3.9, 16.2, respectively). Weight and length velocity z scores had better predictive abilities [area under the ROC curves (AUCs) of 0.67 and 0.69] than did weight-for-age (AUC: 0.57) and length-for-age (AUC: 0.52) z scores. Among wasted children (weight-for-height z score <−2), the AUC of weight velocity z scores was 0.87. Absolute MUAC performed best among the attained indexes (AUC: 0.63), but longitudinal assessment of MUAC-based indexes did not increase the predictive value.Conclusion: Although repeated growth measures are slightly more complex to implement, their superiority in mortality-predictive abilities suggests that these could be used more for identifying children at increased risk of death.

The Prevalence of Overweight and Obesity in Children Under 5 Years in Tehran, Iran, in 2012: A Population-Based Study.

Background:Overweight and obesity in children are a serious problem. They are increasingly prevalent and associated with a wide range of health problems in adulthood. Monitoring their status is essential for effective planning in the health system.Objectives:This study aimed to assess the prevalence of overweight and obesity in children below 5 years in Tehran in 2012.Patients and Methods:This cross-sectional study employed data provided by the urban health equity assessment in Tehran. The sample comprised a total of 4656 children under 5 years, recruited via multistage sampling. Data were collected through questionnaires and anthropometric measures of height and weight. The WHO child growth standards were used to determine overweight and obesity. Data were analyzed using chi-square tests, with SPSS version 11.5.Results:The prevalence of overweight and obesity in children were 12% and 23.7% respectively. The prevalence of overweight was significantly higher in girls than boys and the prevalence of obesity was significantly higher in boys than girls (P = 0.001). Obesity was more prevalent in children from high economic percentiles, but this finding was not statistically significant.Conclusions:The prevalence of overweight and obesity in children under 5 years is high. Overweight and obesity should be considered an epidemic and serious health problem in Tehran. They certainly require more attention and intervention.

Chronic undernutrition amongst under-five in an urban slum of Central India

Background: Malnutrition is a major public health problem in India. Chronic undernutrition - stunting is one of the major causes of morbidity and mortality among under-five children. It continues to be a growing problem in most developing countries. Present study was planned to estimate prevalence of stunting (chronic undernutrition) and its determinants amongst under-five children in an urban slum of central India. Methods: This community based cross-sectional study was conducted in an urban slum area of Nagpur, India. Study subjects were under five children residing in the slum. Data collection was done by conducting house to house survey and information was recorded in pre-designed pre-tested survey tool. Height was measured with standard techniques and classified as stunting according to WHO child growth standards 2006. Results: The overall prevalence of stunting amongst under five children in urban slum area was found to be 34.77%. Determinants found to be significantly (P<0.05) associated with stunting were lower socio-economic status, illiteracy of mother, working status of mother, separated marital status of mother, not exclusively breastfed for 6 months, duration of breastfeeding <2 years, immunization not appropriate for age. Conclusions: Stunting still continues to exists as problem among under five children of urban slum. Efforts need to be directed towards maternal education, promotion of optimal infant & young child feeding practices and immunisation as these factors are significantly associated with stunting.

Tolerability Study of a Free Amino Acid-based Formula in Children with Cow's Milk Allergy

Background: The prevalence of food allergy has increased worldwide. Cow’s milk allergy is a very common type of allergy in childhood. In non-breast-fed infants, with extremely severe or life-threatening symptoms, an amino acidbased formula may be considered the first choice for the dietary treatment. This study aimed to assess the tolerance to a new Brazilian amino acid-based formula and the nutritional status in children affected by cow’s milk allergy fed with this formula. Objective: To assess the tolerance to an amino acid-based formula and its nutritional status impact on children affected by cow’s milk allergy. Method: This is a clinical study conducted with a sample of 15 children, less than 5 years old with a clinical cow’s milk allergy diagnosis. The children were followed-up, in a Pediatric Outpatient Clinic. Anthropometric, clinical, epidemiological data were collected at the baseline and it was also prescribed the amino acid-based formula. Throughout the treatment, which lasted five months, the clinical response was assessed based on the remission of symptoms initially presented and the evolution of nutritional status, using the WHO child growth standards charts. Results: The sample included predominantly boys with a mean age of 28.1 months and 66.7% IgE-mediated. The average age of onset of the allergic symptoms was 2.15 ± 2.33 months. Symptoms were reported in different systems (cutaneous, gastrointestinal and respiratory). In every child, there was complete remission of allergy symptoms initially presented and proper evolution of nutritional status. Conclusion: This new free amino acid-based formula can safely be used for the dietary treatment for children with cow’s milk allergy. The subjects studied showed adequate children’s nutritional status evolution.

Correlation between Obesity, Diet, Physical Activity and Sedentary Behaviour among School-aged Children and Young Adolescents in Macedonia

Diet and physical activity education in school-aged children and young adolescents are in the focus of the modern healthcare and education system. The aims of our cross-section study were to estimate the prevalence of obesity in youth, and the significant correlation between nutrition status, health behavioural and biological markers. The sample size was 400 randomly selected school-aged children and adolescent from 14 to 18 years old. They were divided into two population groups of school-aged children (12-13 years old) and young adolescent (17-18 years). Standardized, non-quantitative Food Frequency Questionnaire (FFQ) and the International Questionnaire for assessment of Physical Activity (IPAQ-short version) were used as well as the anthropometric measurements: body weight and height, body mass index (BMI kg/m2) presented in percentile using the WHO Child Growth Standards. Statistical analysis was included descriptive statistics, Pearson Chi-square test and Logistic regression analysis using SPSS Statistics 17.0. In accordance with the distribution of Pearson Chi-square=16.94 (p<0.001), there was statistical significance between nutritional status of study participants in both, first and second study groups. Also, there was significant difference in high intensity sports activity between two groups (Pearson Chi-square=26.59; p<0.001). Sedentary behaviour had the highest influence on development of childhood obesity (Wald=2.81; p=0.09). Significant correlation was estimated between obesity and sweetness food (pasta, rise and potatoes), soft drinks, but drinking water had a protective effect. Prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, sports coaches as well as consistent and integrated messages and environmental support across all sectors of society, especially educational sector. The next step is to develop an innovative “Skills for health” model including nutrition and physical activity education program in Macedonia.

An Epidemiological Study of Nutritional Status of Rural Children in Jaipur District (Raj.)

Background: Uncontrolled fertility in rural areas without the requisite economic and social infrastructure has resulted in a great problem of malnutrition among the under five children of rural population. Their nutritional status is far from being satisfactory. Objectives: To determine the nature and extent of the health and nutritional problems of under-five rural children, to highlight the various factors contributing to the health and nutritional problems, and to develop a project for solving the nutritional and health problems. Method and Material: A cross sectional epidemiological study was conducted in field practice area of Rural Health Training Center, Achrol village, district Jaipur (Rajasthan). The mothers or care givers of under-fives were interviewed and the children were examined clinically with the help of a pre-designed, pre-tested pro-forma after taking informed consent. WHO Child Growth Standards were used to assess the nutritional status of children. Results were subjected to statistical analysis. Results: In present study of rural children, out of 334 children 137 (41.01%) were found to suffer from various grades of malnutrition. Among malnourished 45.98% were male and 54.01% were female under-fives. 42.33% children belonged to nuclear family, 29.92% to joint family and 27.73% children belonged to three generation type of family among the malnourished children. 35.03% of malnourished children were delivered at hospital and remaining 64.96% were delivered at home. Among the malnourished only 5.10% mothers were studied up to secondary and above, a majority i.e. 46.71% were illiterate. 41.60% malnourished children were having three and more siblings. Third and above birth order children suffered more from malnutrition (44.52%). Among malnourished only 12.81% were weaned by 4-6 months.SC (48.17%)/ST/OBC (33.57%) children suffered more from malnutrition than general caste. Malnourished children were from grade I (3.64%), grade II (6.56%), grade III (25.54%), grade IV (29.19%) and grade V (35.03%). Most of the malnourished belonged to the age group 2-3yrs (48.90%) and 3-5yrs (35.03%). 56.93% female and 43.06% male were among the malnourished children. 40.87% malnourished were from grade I, 29.19% were from grade II, 18.24% were from grade III, and 11.67% were from IV grade of malnutrition. Vit. A deficiency was observed in 7.29% malnourished, Vit. D deficiency in 11.67% malnourished, Vit. B. deficiency in 18.97% malnourished, and Protein deficiency was observed in 17.5% of malnourished children in present study. Most of the deficiency signs were seen in 2-3 years and 3-5 yrs age groups. Conclusion: Malnutrition is the most widespread condition affecting the health of children. Scarcity of suitable foods, lack of purchasing power of the family as well as traditional beliefs and taboos about what the baby should eat, often lead to an insufficient balanced diet, resulting in malnutrition. Keywords: Deficiency, Illiteracy, Malnutrition, Under-fives

The prevalence of overweight and obesity in children under 5 years in Tehran, Iran, in 2012: A population-based study

Background: Overweight and obesity in children are a serious problem. They are increasingly prevalent and associated with a wide range of health problems in adulthood. Monitoring their status is essential for effective planning in the health system. Objectives: This study aimed to assess the prevalence of overweight and obesity in children below 5 years in Tehran in 2012. Patients and Methods: This cross-sectional study employed data provided by the urban health equity assessment in Tehran. The sample comprised a total of 4656 children under 5 years, recruited via multistage sampling. Data were collected through questionnaires and anthropometric measures of height and weight. The WHO child growth standards were used to determine overweight and obesity. Data were analyzed using chi-square tests, with SPSS version 11.5. Results: The prevalence of overweight and obesity in children were 12% and 23.7% respectively. The prevalence of overweight was significantly higher in girls than boys and the prevalence of obesity was significantly higher in boys than girls (P = 0.001). Obesity was more prevalent in children from high economic percentiles, but this finding was not statistically significant. Conclusions: The prevalence of overweight and obesity in children under 5 years is high. Overweight and obesity should be considered an epidemic and serious health problem in Tehran. They certainly require more attention and intervention.

Maternal depression and malnutrition in children in southwest Uganda: a case control study.

BackgroundMalnutrition remains one of the most significant child health problems in developing countries with an estimated 53 % of child deaths per year attributed to being underweight. The 2011 Uganda Demographic and Health Survey (UDHS) showed that 38 % of the children were stunted and 16 % were underweight. While dietary and environmental factors are known major contributors to children's nutritional status, maternal depression may also contribute since it disrupts the mothers’ ability to cope with demands of childcare. This study aimed to determine the association between maternal depression and malnutrition in children aged one to 5 years in southwest Uganda.MethodsThe study was undertaken between October and December 2014 on children aged one to 5 admitted to the Mbarara regional referral hospital. Cases were malnourished children and controls were children with other chronic conditions but normal nutritional status admitted to the same hospital. Children’s ages were recorded, weight and height taken and converted into height for age, weight for height and weight for age and malnutrition was determined based on WHO child growth standards. Mothers of both groups of children were assessed for depression using the depression module of the Mini International Neuropsychiatric Interview (MINI). Participants provided informed consent prior to enrollment. The study was approved by Mbarara University of Science and Technology Research Ethics Committee and funded by MicroResearch.ResultsAll 166 mothers who were approached agreed to participate in the study. The prevalence of depression among mothers of malnourished children (86 cases) was 42 % compared to 12 % among mothers of controls (86 controls). The mean age was 25 years (SD 4.43, range 18–40 years). The majority (75 %) were married and most were peasant farmers (62 %). Maternal depression was significantly associated with malnutrition in children with a crude odds ratio of 2.23 (1.08–1.89) and an adjusted odds ratio of 2.4 (1.11–5.18).ConclusionMaternal depression impacts negatively on child nutrition and development as shown by a higher prevalence of depression among mothers of malnourished children compared to the control group. Routine screening and treatment for depression should be included in all maternal and child health clinics.

Do different parenting patterns impact the health and physical growth of 'left-behind' preschool-aged children? A cross-sectional study in rural China.

Many migrants from rural China seek work in urban areas and leave their children in their home villages to be raised by relatives. These children are often referred to as 'left-behind children'. Parental migration tends to have a profound impact on a child's growth. This study sought to assess the prevalence of illness and malnutrition among children in rural areas raised with different parenting patterns and to explore factors affecting their health and development. A cross-sectional survey was conducted to examine the physical health of children raised with different parenting patterns and to explore associated risk factors. In total, this study examined 735 children ages 3-6 years in eight rural villages in two counties of Shandong Province. Their primary caregivers were interviewed with a semi-structured questionnaire. Anthropometric measurements of the children were taken and their nutritional status was determined according to WHO Child Growth Standards. This study found a relatively high prevalence of wasting, overweight and obesity among left-behind children. After potential confounders were controlled for, the parenting pattern, annual household income and health literacy of the primary caregiver significantly influenced the health and developmental indicators of children. This study highlighted the impact of the characteristics of the primary caregiver on a child's health and development and the importance of practical interventions for preschool-aged children who are left behind and raised with different parenting patterns.

Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project.

Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus. The INTERGROWTH-21(st) Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks' gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on breastfeeding, and data on morbidity, treatments, and development. To construct the preterm postnatal growth standards, we selected all live singletons born between 26 and before 37 weeks' gestation without congenital malformations, fetal growth restriction, or severe postnatal morbidity. We did analyses with second-degree fractional polynomial regression models in a multilevel framework accounting for repeated measures. Fetal and neonatal data were pooled from study sites and stratified by postmenstrual age. For neonates, boys and girls were assessed separately. From 4607 women enrolled in the study, there were 224 preterm singleton births, of which 201 (90%) were enrolled in the Preterm Postnatal Follow-up Study. Variance component analysis showed that only 0·2% and 4·0% of the total variability in postnatal length and head circumference, respectively, could be attributed to between-site differences, justifying pooling the data from all study sites. Preterm growth patterns differed from those for babies in the INTERGROWTH-21(st) Newborn Size Standards. They overlapped with the WHO Child Growth Standards for term babies by 64 weeks' postmenstrual age. Our data have yielded standards for postnatal growth in preterm infants. These standards should be used for the assessment of preterm infants until 64 weeks' postmenstrual age, after which the WHO Child Growth Standards are appropriate. Size-at-birth charts should not be used to measure postnatal growth of preterm infants. Bill & Melinda Gates Foundation.

Child Malnutrition at Different World Regions in (1990-2013)

Adequate nutrition is essential in early childhood to ensure healthy growth, proper organ formation and function, a strong immune system, and neurological and cognitive development. Child malnutrition – as measured by poor child growth – is an important indicator for monitoring population nutritional status and health. In 2013, about 17%, or 98 million children under five years of age in developing countries were underweight (low weight-for-age according to the WHO child growth standards). Underweight prevalence is highest in the United Nation (UN) region of Southern Asia (30%), followed by Western Africa (21%), Oceania and Eastern Africa (both 19%) and South-Eastern Asia and Middle Africa (both 16%), and Southern Africa 12%. Prevalence below 10% for 2013 is estimated for the UN regions of Eastern, Central and Western Asia, Northern Africa and Latin America and the Caribbean. Childhood malnutrition, including fetal growth restriction, suboptimum breastfeeding, stunting, wasting and Vitamin A and zinc deficiencies, is an underlying cause of death in an estimated 45% of all deaths among children under five years of age.

Food insecurity and malnutrition in Chinese elementary school students.

It has been shown that food insecurity is associated with poor diet quality and unfavourable health outcomes. However, little is known about the potential effects of food insecurity on the overall malnutrition status among children. In this study, we investigated the prevalence of food insecurity among 1583 elementary school students, aged 6-14 years, living in Chinese rural areas and examined its association with four malnutrition signs, including rickets sequelae, anaemia, stunting and wasting. Information on food security was collected via questionnaires. Rickets sequelae were assessed by an experienced paediatrician during the interview. Anaemia was determined by the WHO Hb thresholds adjusted by the local altitude. Weight and height were measured during the interview. Stunting and wasting were then evaluated according to WHO child growth standards (2007). We examined the association between food insecurity and the number of malnutrition signs (total number = 4), and the likelihood of having severe malnutrition (presence of 3+ signs), after adjusting for potential confounders, such as age, social-economic status and dietary intakes. During the previous 12 months, the overall prevalence of food insecurity was 6.1% in the entire studied population and 16.3% in participants with severe malnutrition. Participants with food insecurity had a slightly higher number of malnutrition signs (1.14 v. 0.96; P=0.043) relative to those who were food secure, after adjusting for potential confounders. Food insecurity was also associated with increased likelihood of having severe malnutrition (adjusted OR 3.08; 95% CI 1.47, 6.46; P=0.003). In conclusion, food insecurity is significantly associated with malnutrition among Chinese children in this community.

Exclusively breastfed overweight infants are at the same risk of childhood overweight as formula fed overweight infants

Background and objectiveSeveral early life determinants play a role in childhood obesity. Rapid weight gain and overweight in infancy increases the risk while breast feeding seems to protect against childhood...

Longitudinal growth and health outcomes in nutritionally at-risk children who received long-term nutritional intervention.

BackgroundThe benefits of short‐term oral nutritional supplementation (ONS) in undernourished children are well‐established. The benefits of long‐term ONS in promoting longitudinal growth and health in children who are at risk of undernutrition have not been reported previously.MethodsIn this 48‐week prospective, single‐arm, multicentre trial, 200 Filipino children aged 3–4 years with weight‐for‐height percentiles from 5th to 25th (WHO Child Growth Standards) were enrolled. Parents received dietary counselling at baseline, and at weeks 4 and 8. Two servings of ONS (450 mL) were consumed daily, providing 450 kcal, 13.5 g protein and micronutrients. Weight, height, dietary intake using 24‐h dietary recalls, and physical activity and appetite using the visual analogue scales were assessed at baseline and weeks 4, 8, 16, 24, 32, 40 and 48. The number of sick days for acute illnesses was collected over the study period.ResultsAt baseline, mean age was 41.2 months with 50% being male. Weight‐for‐height percentiles showed the greatest increase in the first 4 weeks (12.1 and 12.8 percentiles, respectively, P < 0.0001) and remained significantly higher than baseline (P < 0.0001) but were relatively stable from week 4 onwards. Height‐for‐age percentiles increased steadily over time and became significantly higher than baseline from week 24 onwards (P < 0.0001). Appetite and physical activity scores at all post‐baseline visits improved from baseline (P < 0.0001), and a reduction in the number of sick days from week 16 onwards was also observed (P < 0.0001). Higher parental education level, being male and higher baseline weight‐for‐height percentiles were significantly associated with higher ponderal and linear growth over time in repeated measures analysis of covariance.ConclusionsIntervention consisting of initial dietary counselling and continued ONS helped sustain normal growth after a catch‐up growth in nutritionally at‐risk children.

Association between dietary habits and asthma severity in children.

To investigate association between dietary habits and asthma severity in children. Cross-sectional study. Two teaching hospitals in Brazil. Cases (n=268) were children (3-12yr) with persistent asthma and age-matched controls (n=126) were those with intermittent asthma. Dietary habits were determined based on food consumption in the past 12 months classified as frequent (≥3 times per week) or infrequent (never or <3 times per week).Nutritional status was classified into two categories according to WHO Child Growth Standards: obese: >2Z-score of BMI-for-age; non-obese: ≤2Z-score of BMI-for-age. After adjusting for confounding factors, maternal smoking during pregnancy, preterm birth and obesity were significantly associated with persistent asthma, with adjusted ORs (95% CI) of 2.11 (1.08- 4.13), 2.61(1.07-6.35) and 2.89 (1.49-5.61), respectively. No significant association was observed between frequency of consumption of specific foods, food groups, or dietary pattern (pro- or contra-Mediterranean diet) and the severity of asthma. This study did not find a significant association between dietary habits and asthma severity in children. Maternal smoking during pregnancy, preterm birth and obesity were independent factors associated with persistent asthma.

Linear Growth Faltering Should Be Assessed in Absolute and Relative Terms

Dear Editor:The concept of standard deviations was first proposed by KarlPearson 120 y ago (1) to account for the fact that an absolutemeasure (e.g., in centimeters or kilograms) may have differentinterpretations depending on how much variability there iswithin a population. Had Pearson still been among us, he wouldnot be surprised by the findings of Leroy et al. (2)—namely,that conflicting results are produced when growth faltering isassessed in absolute (centimeters) or relative (z scores) scales.Leroy et al. reanalyzed data from 51 national surveys in low-and middle-income countries included in our 2010 publication onthe timing of growth faltering (3). Consistent with our findings,they concluded that there was substantial faltering during the first2 y of life. Thereafter, mean height-for-age, expressed as z scoresor SDs of the WHO Child Growth Standards (HAZ), remainedstable at a z score of approximately 21.8upto5yofage.Inthesame age range, however, they found that the mean absoluteheight-for-age deficit (HAD) increasedby ;2cm(Figure1intheirarticle). Their extensive reanalyses were not quite necessary.Simple arithmetic applying our 2010 results to the WHO ChildGrowth Standards will reveal that the mean deficit of a 21.8zscoreat24mocorrespondsto 25.5cm,whereasthesame zscorevalue corresponds to 28.2 cm at 60 mo (averaging boys and girls),adifferenceof2.7cm.In general, their article is well balanced. Their main conclusionsdonotdetractfromthoseinouroriginalpublications(3,4),namelythatthefirst1000dconstitute aunique windowof opportunityfornutritionalinterventions.However,wemusttakeexceptiontotheirsweepingconclusionthat“HAD, ratherthanHAZ,shouldbeusedtodescribeandcomparechangesinheight.”Takingtheirargumentto its extreme, a 2-cm deficit for 24-mo-old boys ( 20.65 z score)would be equivalent to a 2-cm deficit in 19-y-old men (2 0.27z score) (5), and such a population would have remained stableovertimeintermsofheightdeficit.Onemightjustaswellarguethatthere was definite catch-up in relative (SD) terms, and that being2cmshortofthemedianasanadultispreferabletobeing2cmshortat the age of 2 y.There are many instances in biology and in public health inwhich absolute and relative scales provide apparently contra-dictory results. For example, if stunting prevalence in group Adecreases from 40% to 20% and prevalence in group Bdecreases from 10% to 5%, the absolute gap is reduced from30 to 15 percentage points, but the relative measure (prevalenceratio)remains4-fold.Choosing1measureovertheotherimpliesa value judgment (6), and there is no single correct answer.We argue that expressing growth faltering in absolute termsprovides an alternative, complementary approach to the relativemeasures used in our earlier publications. Each approach hasa different interpretation, and both are worth presenting (7).It is not only a matter of when growth falters. It is alsoa matter of which tissues and organs grow more rapidly duringdifferent age ranges, such as the well-documented rapid braingrowth in the first 2 y (8). Emphasis on the first 1000 d is basednot only on the magnitude of faltering but also on its long-termimpact on adult human capital, as well as on the fact thatpromoting rapid weight gain after this critical window has beenstrongly associated with the risk of noncommunicable diseasesin adulthood (9,10). Although rapid linear growth after the ageof 2 y does not appear to lead to increased noncommunicabledisease risk (11), at the present state of knowledge one cannotbe sure that promotion of linear growth will not also lead toexcessive weight gain. Therefore, although from an academicstandpoint both absolute and relative faltering are noteworthy,from a programmatic standpoint focusing on the correction ofabsolute deficits after 2 y of age may be detrimental.Cesar G Victora*Postgraduate Program in EpidemiologyFederal University of PelotasPelotas RS, BrazilMercedes de OnisDepartment of NutritionWHOGeneva, SwitzerlandRoger ShrimptonDepartment of Global Community Health andBehavioral SciencesSchool of Public Health and Tropical MedicineTulane UniversityNew Orleans, LA