WHO Child Growth Standards Research Articles

Trends in socioeconomic inequalities in stunting prevalence in Latin America and the Caribbean countries: differences between quintiles and deciles

BackgroundWith the adoption of the Sustainable Development Goals (SDGs), there is a renewed commitment of tackling the varied challenges of undernutrition, particularly stunting (SDG 2.2). Health equity is also a priority in the SDG agenda and there is an urgent need for disaggregated analyses to identify disadvantaged subgroups. We compared time trends in socioeconomic inequalities obtained through stratification by wealth quintiles and deciles for stunting prevalence.MethodsWe used 37 representative Demographic and Health Surveys and Multiple Indicator Cluster surveys from nine Latin American and Caribbean (LAC) countries conducted between 1996 and 2016. Stunting in children under-5 years was assessed according to the 2006 WHO Child Growth Standards and stratified by wealth quintiles and deciles. Within-country socioeconomic inequalities were measured through concentration index (CIX) and slope index of inequality (SII). We used variance-weighted least squares regression to estimate annual changes.ResultsEight out of nine countries showed a statistical evidence of reduction in stunting prevalence over time. Differences between extreme deciles were larger than between quintiles in most of countries and at every point in time. However, when using summary measures of inequality, there were no differences in the estimates of SII with the use of deciles and quintiles. In absolute terms, there was a reduction in socioeconomic inequalities in Peru, Honduras, Dominican Republic, Belize, Suriname and Colombia. In relative terms, there was an increase in socioeconomic inequalities in Peru, Bolivia, Haiti, Honduras and Guatemala.ConclusionsLAC countries have made substantial progress in terms of reducing stunting,. Nevertheless, renewed actions are needed to improve equity. Particularly in those countries were absolute and relative inequalities did not change over time such Bolivia and Guatemala. Finer breakdowns in wealth distribution are expected to elucidate more differences between subgroups; however, this approach is relevant to cast light on those subgroups that are still lagging behind within populations and inform equity-oriented health programs and practices.

Anthropometric indicators of physical development and nutritional status employed in hygiene practice in Russia

In the current review, we consider the main working methods of Russian hygienists to assess anthropometric indices using a) regional data on (populational) variability of the concerning measurements and b) unified reference data applicable in most regions. An analysis showed that in most cases, the regional standards are based on average values and variabilities derived from a local sample, which can not serve as a working normative. As a result, these so called "standards" do not provide information on how healthy children should develop, and the assessments inferred are difficult to integrate to draw a picture for the whole country. In 2017, the Ministry of Health of the Russian Federation recommended the use of the WHO Child Growth Standards and the WHO Growth Reference for the purpose of medical screenings in children and adolescents. These data sets reflect the conditions, that healthy children should attain growing in supportive environment, with adequate nutrition and care. The single set of criteria will allow unifying the data collected in different regions, which is a necessity in communal hygiene and medical statistics. However, additional research is needed to check the validity of the WHO standards and reference to assess physical development and nutritional status in highly anthropologically specific populations, in particular in those indigenous and long-ago adapted to the sharply continental or Arctic climate.

Nutrisi untuk Stunting

Stunting / stunted growth / nutritional stunting is a decrease in height growth rate as measured by the value of height by age under minus 2 standard deviations of the WHO child growth standards graph. In 2016 as many as 22.9% (154.8 million) of children under 5 years of age suffered from stunting and Indonesia is on the 5th place of country that suffers most from stunting.The main cause of stunting is unbalanced nutritional factors in quantity and quantity during growth period. Other causes are human factors (infant and child feeding practices, severe infections that cause wasting, subclinical infections, low birth weight babies and premature infants and social factors (household poverty, neglect of caregiving, unresponsive eating practices, inadequate child stimulation, food insecurity, limited health services, access to clean water and sanitation) Children can be predicted to be stunting by measuring height periodically since birth and most effective intervention to prevent stunting is to increase children‟s diet quality.The government role as program and policy makers is to create a Kerangka Intervensi Stunting (Stunting Intervention Framework), namely Specific Nutrition Interventions and Sensitive Nutrition Interventions.In conclusion, stunting can be predicted and can be prevented. Provision of MPASI in accordance with WHO recommendations that are timely, adequate, safe and are given in right manner is a specific nutrition intervention that can prevent stuntingKeywords:

Physical growth: is it a good indicator of development in early childhood in low- and middle-income countries?

BackgroundGrowth and early development (ECD) are vital outcomes for children. This study aimed to examine the association between child growth and overall development in children aged 3 to 5 years in low- and middle-income countries.MethodsA secondary analysis of nationally representative data collected in UNICEF’s Multiple Indicator Cluster Surveys (MICS) and national Demographic and Health Surveys (DHS). The early development of children aged 3 to 5 years from the randomly selected households was ascertained using a 10-item scale which assessed four developmental domains: language-cognitive, physical, socio-emotional, and approaches to learning with a total development score ranging from 0 (the least optimal) to 10 (the most optimal). Children’s growth, the height-for-age Z score (HAZ), was calculated using the WHO Child Growth Standards. Unadjusted (Pearson’s correlation coefficient, r) and adjusted estimations (standardised mean difference (SMD) adjusted for child sex, child age, and household wealth index) of the magnitude of the association between HAZ and ECD scores were calculated for each country.ResultsData contributed by 178,393 children aged 36 to 59 months from 55 countries were included in the analyses. The pooled r between HAZ and standardised ECD scores was 0.12 and the pooled adjusted SMD was 0.06. The r ranged from ~ 0 in Barbados, Lebanon, and Moldova to 0.32 in Pakistan and 0.36 in Nigeria. Overall, 47/55 countries had correlation coefficients less than the cut-off for a small association. The adjusted SMDs were ~ 0 in 20 countries. All SMDs were lower than the cut-off for a small effect size. The magnitudes of the association were highest in South Asia and lowest in Middle East and North Africa, and lowest in the highest HDI group.ConclusionsThe association between growth and development in early childhood appears to be primarily a co-occurrence because the magnitude of the association varies among settings from no association in higher-income countries to a moderate level in low-income countries. In low-income countries, interventions targeting child growth and ECD should be integrated given their common risks frequency in these settings. Overall, growth is not a sensitive and therefore suitable indicator of child development.

Comparing The Anthropometric Measurements of Intra-Extra Uterine Period between Stunting and Non-stunting Children Aged 6-24 Months Old in Bogor Tengah Subdistrict, Bogor City, West Java

Introduction: The prevalence of stunting in children under two years old is high in developing country. Stunting in the early of life has many negative health consequences in later life, while the positive view is stunting could be prevent earlier by detecting a predisposing factors in intrauterine and extrauterine periode. Anthropometry of intrauterine predisposing factors (IntraPF) and Extrauterine predisposing factors (ExtraPF) could detect growth retardation. These study aim was to prove that there were significant different of IntraPF and ExtraPF between stunting and non stunting children aged 6-24 months.Methods: This comparative cross sectional study was nested to (Bogor longitudinal study on child growth and development (BLSCGD) held by National Health Research and Development (NHRD), Health Ministry of Indonesia. Subjects who defined as stunting if their height for age was more than two standard deviations below the WHO Child Growth standards median. There were 38 stunting and 46 non-stunting aged 6-24 months who met the study criteria. Independent variable was (1)IntraPF follow as maternal height, weight and length of neonatal, (2)ExtraPF: weight gain and body length gain at first six months of neonatal. Primary and secondary data collection was carried out from July 2017 to Februari 2018, held at the BLSCGD. All of body measurement using WHO standard. Appropriate statistical analysis was used to compare the stunting and non-stunting groups with a significance limit of p <0.05.Results: Statistical analysis tests showed that: significantly different and lower IntraPF in the stunting group was maternal height, birth weight and length of the subjects compare to non-stunting and there were significant different and lower of ExtraPF follow as weight gain in the first six months, average weight gain per month in the first six months, increase in body length in the first six months, average increase in body length every month in the first six monthssignificantly lower in stunting children compare to non stunting children.Conclusion: The antropometric of intrauterine, extrauterine predisposing factors have been showed to have an impact on the child's height. It is important to monitor the anthropometry of the mother before pregnancy and provide nutritional interventions in the first 1000 days

Partially Hydrolysed Whey-Based Formulae with Reduced Protein Content Support Adequate Infant Growth and Are Well Tolerated: Results of a Randomised Controlled Trial in Healthy Term Infants.

The current study aimed to investigate growth, safety and tolerance of partially hydrolysed infant formulae in healthy full-term infants. Fully formula-fed infants were randomised ≤14 days of age to receive a partially hydrolysed whey formula with 2.27 g protein/100 kcal (pHF2.27) or the same formula with 1.8 g or 2.0 g protein/100 kcal (pHF1.8 and pHF2.0) until 4 months of age. The primary outcome was equivalence in daily weight gain within margins of ± 3 g/day; comparison with WHO Child Growth Standards; gastrointestinal tolerance parameters and number of (serious) adverse events were secondary outcomes. A total of 207 infants were randomised, and 61 (pHF1.8), 46 (pHF2.0) and 48 (pHF2.27) infants completed the study per protocol. Equivalence in daily weight gain was demonstrated for the comparison of pHF1.8 and pHF2.27, i.e., the estimated difference was −1.12 g/day (90% CI: [−2.72; 0.47]) but was inconclusive for the comparisons of pHF2.0 and pHF2.27 with a difference of −2.52 g/day (90% CI: [−4.23; −0.81]). All groups showed adequate infant growth in comparison with the World Health Organization (WHO) Child Growth Standards. To conclude, the evaluated partially hydrolysed formulae varying in protein content support adequate growth and are safe and well tolerated in healthy infants.

Clinical, Paraclinical Characteristics in Children with Renal Tubular Acidosis

This descriptive study describes the clinical, paraclinical characteristics in children with renal tubular acidosis. In this study, 36 children with renal tubular acidosis were hospitalized in the National Hospital of Pediatrics from June, 2012 to July, 2017. Among the patients, 64.0% were male; the male/female ratio was 1.8/1. The average age of the patients was 7.7 ± 4.6 years. There were 29 type 1 renal tubular acidosis patients (80.6%) and 7 type 2 renal tubular acidosis (19.6%). The most common clinical signs were slow weight gain (100%), polyuria and vomiting were 25.7%, excessive water drinking (16.7%), diarrhea (13.9%), weak lower limb (11.1%), and apnea (8.3%). The laboratory values on admission were: blood pH 7.23 ± 0.11; HCO3- 12.5 ± 5.07; serum sodium 136 ± 7mmol/l; potassium 2.9 ± 0.5 mmol/l; chloride 112 ± 9 mmol/l. The study concludes that 53.8% of the clinical, paraclinical characteristics in children with Renal Tubular Acidosis were inconspicuousness, which effected the children’s growth. The study recommends a long-term strategy for diagnosis and follow–up treatment of renal tubular acidosis.
 Keywords
 Renal tubular acidosis, Fanconi syndrome.
 References
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Exploring the association of anthropometric indicators for under-five children in Ethiopia

BackgroundChild undernutrition is a global health concern. Many studies have focused on the association of childhood undernutrition indicators with their predictors. A few studies have looked at relationship between the undernutrition indicators. This study aimed at investigating the possible association structures of childhood undernutrition indicators.MethodsA log-linear model of cell counts of a three way table of stunting, wasting, and underweight was fitted based on the 2016 Ethiopia demographic health survey data. The variables of interest were generated based on the 2006 WHO Child Growth Standards as: stunted, wasted and underweight if z-scores of height-for-age, weight-for-height and weight-for age are below-2, respectively; otherwise not stunted, wasted and underweight.ResultsThis study showed that 36.34, 12.09 and 24.87% were stunted, wasted and underweight out of sampled children respectively and the prevalence of total undernutrition in children was about 45.96%.The fitted log-linear model showed that underweight was associated with both stunting (P-value< 0.001), and wasting (P-value< 0.001). There was no association between stunting and wasting (P-value = 0.999). Furthermore, the model showed that there is no a three way interaction among stunting, wasting, and underweight (P-value = 1.000).ConclusionThe authors conclude that there is lack of three way association of stunting, wasting, and underweight. This confirms that the three anthropometric indicators of children have multi-dimensional nature. Thus, the concerned body should consider the three undernutrition indicators simultaneously to estimate the actual burden of childhood undernourishment as they are not redundant of each other.

Nocturnal enuresis in obese children: a nation-wide epidemiological study from China

Childhood obesity increases the risk of obstructive sleep apnea syndrome, type 2 diabetes mellitus, cardiovascular abnormalities, and psychological and behavioral disorders. But it is unclear whether obesity is associated with childhood nocturnal enuresis (NE). This study aimed to assess the relationship between childhood obesity and NE in a nationally representative large sample in China. Subjects were enrolled from Urumqi, Chengdu, Xi’an, Hohhot, Wuhan, Canton, Shanghai, and Harbin cities in China in November and December 2005. The survey included 20,987 children aged 5–12 years and they and their caregivers completed questionnaires. Height and weight were measured by school teachers trained in healthcare. According to the WHO child growth standards, obesity was defined as a body mass index >95th percentile of peers with the same age and gender. NE was defined as bed wetting for more than twice a week for 3 consecutive months. Demographic variables were compared among different groups. The prevalence of obesity, asthma, attention-deficit/hyperactivity disorder (ADHD), depressive moods, and snoring were different between the NE and without-NE groups (P < 0.05). The raw odds ratio (OR) for NE and obesity was 1.36 (95%CI = 1.07–1.74; P = 0.013) and the adjusted OR was 1.42 (95%CI = 1.11–1.82; P = 0.005) in the multivariable analysis. When adjusting for co-occurring conditions, the results showed that asthma did not affect the risk of NE (OR = 1.42, 95%CI = 1.11–1.82; P = 0.005), but ADHD (OR = 1.41; 95%CI = 1.10–1.81; P = 0.006) and depressive moods (OR = 1.34; 95%CI = 1.07–1.76; P = 0.012) slightly weakens the association between NE in children and obesity, while snoring weakens the association between obesity and NE and the risk became non-significant (OR = 1.21; 95%CI = 0.94–1.56; P = 0.138). In conclusion, obese children were at a higher risk of incurring NE compared to non-obese children. This association was weaker in children who either snored, had ADHD, or had depressive mood.

Change of Stunting, Wasting and Overweight Among Children Under 5 in China During 2000–2010 (P11-099-19)

ObjectivesTo describe the change of children under 5 years old that are stunted, wasted or overweight without overlapping status in China during 2000–2010. MethodsData from 2000, 2005, and 2010 were sourced from the National Food and Nutrition Surveillance System. About 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites. Anthropometric measurements for children under 5 were conducted. Nutritional status was determined according to WHO child growth standards (2006). Stunting, wasting and overweight is defined as HAZ < -2 SD, WHZ < -2 SD and WHZ > + 2SD respectively. ResultsThe prevalence of wasting only remained less than 3%(2.05%, 2.55%, and 2.03%); the prevalence of stunting only declined from 18.70% in 2000 to 8.77% in 2010; the prevalence of overweight only increased from 2.56% in 2000 to 5.62% in 2010; the prevalence of stunting, wasting or overweight declined from 24.55% in 2000 to 17.60% in 2010; the same trends were found in urban and rural areas during 2000–2010. ConclusionsThe prevalence of stunting is decreasing, and childhood overweight has increased dramatically in China that need for effective interventions. Funding SourcesUnicef China Office; Ministry of Science and Technology, Special survey of basic science and technology resources 2017FY101107.

Differences in Birth Size Associated with Preconception Maternal Nutrition Intervention Persist in Postnatal Growth Through 6 Months (OR10-05-19)

ObjectivesNewborn size, including length, has been associated with later growth. Preconception nutrition supplementation in Women First (WF) trial (clinicaltrials.gov NCT01883193) was associated with higher newborn length and lower rates of stunting. The objective was to examine postnatal growth outcomes through 6 mo in the WF offspring. MethodsSubjects were 2450 infants from the WF sites in Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan with the 3 WF arms maintained: Arm 1 started a lipid-based nutrition supplement ≥ 3 mo prior to conception; Arm 2 started same supplement at ∼11 wk gestation; and Arm 3 received no trial supplements. Maternal supplementation was discontinued at delivery. Anthropometric measurements were obtained at birth, 0.5, 1, 3, and 6 mo; Z-scores were calculated from WHO Child Growth Standards. Primary and secondary outcomes were analyzed using longitudinal generalized estimating equations accounting for the correlation of repeated measures over time and study cluster. Intervention effects were evaluated within each site as well as overall, adjusting for site and baseline maternal covariates that differed by arm. Statistical interaction between arm and infant sex was evaluated and included if significant. ResultsLongitudinal growth (length and weight) curves from 0–6 mo demonstrated differences by intervention arm, with Arms 1 and 2 more favorable compared to Arm 3 (Table + LAZ in Figure). Relative risks (RR) for stunting were significantly lower for Arms 1 and 2 (vs. Arm 3) (Table). Site-specific analyses revealed some site differences warranting further exploration. ConclusionsWithout any postnatal intervention, differences in fetal growth evident at birth persisted at 6 months. Funding SourcesBill & Melinda Gates Foundation; NIH, NICHD & ODS. Supporting Tables, Images and/or Graphs▪▪

RISK FACTORS FOR STUNTING AMONG ELEMENTARY SCHOOL STUDENTS

Stunting is a situation where the child's height measured by the height by age TB / U is below minus two standard deviations (&lt;-2SD) on nutritional status table WHO child growth standards. The prevalence of stunting in children of school age (5-12 years) in Indonesia reached 30.7% prevalence in Magelang reached 30%.The results of monitoring of nutritional status of children in 2015 in the District Ngablak show as much as 32.7% of children are stunted. The research is purposes of analysis of risk factors for stunting in children of primary school age in the District of Magelang Ngablak. The study was observational research with. cross sectional approach. Subject were students of public primary schools of the Ngablak District ware taken as 72 samples. Collecting data by questionnaires, examination of urine iodine. The results of chi-square test showed risk factors for stunting among at elementary school students of Ngablak District Magelang Regency is nutritional status (p=0.007), history of exposure to pesticides (p=0.006), and iodine urine (EIU) with (p=0.033).

The bidirectional relationship between weight, height and dental caries among preschool children in China.

There is evidence of a bidirectional association between dental caries and anthropometric measures among children. This dual relationship has not been examined in the same population. The objectives of this study are (1) to examine the relationship between baseline caries and changes in weight and height; and (2) to assess whether baseline weight and height are associated with changes in dental caries in a sample of preschool Chinese children. Children were recruited from 15 kindergarten in Liaoning Province at baseline (8 in rural area and 7 in urban area), a total of 1,111 of children were included at baseline. The mean age of children at baseline was 50.82 months. Data were collected through clinical oral examination, assessment of anthropometric measures and structured questionnaire. Dental caries was assessed according World Health Organization (WHO) methods by one dentist. Sociodemographic and behaviour data were also collected. At follow-up, 772 children were included (attrition rate: 30%), dental caries and anthropometric measures were assessed again. Z-score for weight-for-age and height-for-age were calculated using the 2006 and 2007 WHO Child Growth Standards. The sum of decayed, missing and filled primary teeth (dmft) were used in the analysis. Multilevel analysis for longitudinal data was conducted to explore the relationship between z-score for weight-for-age and height-for-age, and dental caries among children. The median follow-up time was 10.12 months. There was a significant negative association between dmft at baseline and change in height-for-age. On the other hand, weight-for-age at baseline was negatively associated with change in dmft at follow-up. The findings suggest that dental caries impedes children’s growth indicated by height for age. Low weight children appear to be more susceptible to dental caries in the same population.

Growth in the first 5years after antiretroviral therapy initiation among HIV-infected children in the IeDEA West African Pediatric Cohort.

To describe growth evolution and its correlates in the first 5years of antiretroviral therapy (ART) initiation among HIV-infected children followed up in West Africa. All HIV-infected children younger than 10years followed in the IeDEA pWADA cohort while initiating ART, with at least one anthropometric measurement within the first 5years of treatment were included in the study. Growth was described according to the WHO child growth standards, using Weight-for-age Z-score (WAZ), Height-for-age Z-score (HAZ) and Weight-for-Height/BMI-for-age Z-score (WHZ/BAZ). Growth evolution and its correlates, measured at ART initiation, were modelled in individual linear mixed models for each anthropometric indicator, with a spline term added at the 12-, 24- and 9-month time point for WAZ, HAZ and WHZ/BAZ, respectively. Among the 4156 children selected (45% girls, median age at ART initiation 3.9years [IQR interquartile range 1.9-6.6], and overall 68% malnourished at ART initiation), important gains were observed in the first 12, 24 and 9months on ART for WAZ, HAZ and WHZ/BAZ, respectively. Correlates at ART initiation of a better growth evolution overtime were early age (<2years of age), severe immunodeficiency for age, and severity of malnutrition. Growth evolution is particularly strong within the first 2years on ART but slows down after this period. Weight and height gains help to recover from pre-ART growth deficiency but are insufficient for the most severely malnourished. The first year on ART could be the best period for nutritional interventions to optimize growth among HIV-infected children in the long-term.

How can mindful parenting be related to emotional eating and overeating in childhood and adolescence? The mediating role of parenting stress and parental child-feeding practices

To explore whether the association between mindful parenting and children/adolescents’ disordered eating behaviors (i.e., emotional eating and overeating) may be mediated by parenting stress and parental child-feeding practices.The sample comprised 726 family dyads composed of a mother (79.8%) or a father (20.2%) and their child (7–18 years old), of which 362 children/adolescents had normal weight (BMI = 5–85th percentile) and 364 had overweight or obesity (BMI ≥ 85th percentile) according to the WHO Child Growth Standards. Parents completed self-report measures of mindful parenting, parenting stress, and child-feeding practices, and children/adolescents completed measures of emotional eating and overeating. The path model was estimated in AMOS.Mindful parenting was negatively associated with children's emotional eating through lower levels of parenting stress followed by less frequent use of food as a reward and through less frequent use of food as a reward only. Mindful parenting was linked to children's overeating through lower levels of parenting stress. Moreover, mindful parenting was associated with less frequent use of food as a reward, pressuring to eat and monitoring through lower levels of parenting stress, among parents of girls, mostly from the early stage of adolescence. Additionally, higher levels of parenting stress were associated with using food as a reward and, consequently, with higher levels of emotional eating among girls, and with more restriction and, consequently, with more overeating among early-stage adolescents.A comprehensive model suggesting that mindful parenting can help children/adolescents engage less in disordered eating behaviors through lower levels of parenting stress and the adoption of more adaptive child-feeding practices is proposed. Parental practices, particularly mindful parenting, may have an important role in promoting healthier eating behaviors among children/adolescents.

Overweight trajectory and cardio metabolic risk factors in young adults

BackgroundObesity is one of the conditions that increases the risk of cardiovascular disease. Studies about obesity trajectory and cardio metabolic outcomes at adulthood are still scarce. Therefore, we aimed to assess the association between patterns of overweight over the life-course and cardio metabolic risk factors in young adults.MethodsIn 1982, the maternity hospitals in Pelotas were visited daily and those newborns whose family lived in the urban area of the city were identified (n = 5914), and have prospectively followed for several occasions. Weight and height were measured at every visit. BMI-for-age z-score was calculated using the WHO Child Growth Standards. Overweight and obesity were defined as a BMI greater than or equal to 25 kg/m2 and 30 kg/m2 respectively. This was the definition adopted for evaluations overweight and obesity at 30 years. The participants were divided into eight groups according to the presence of overweight or obesity in childhood, adolescence and adulthood. Blood pressure, random blood glucose, HDL cholesterol, LDL cholesterol triglycerides and fat mass were measured.ResultsFrom 2219 participants with anthropometric data in childhood, adolescence and adulthood, 25% never had been overweight, whereas 11.6% were overweight in the three periods. Random blood glucose, SBP and DBP were higher among those subjects who were always overweight/ obese or only overweight/obese during adolescence and adulthood. The participants who were never overweight/obese or only in childhood or adolescence had a lower cardiovascular risk profile (higher HDL cholesterol, lower blood pressure, lower random glucose, lower LDL cholesterol) at 30 years. Fat mass captured from 25 to 100% of the association of overweight and obesity trajectory with cardiometabolic risk factors.ConclusionsThe tracking of overweight/obesity is associated with an adverse cardio metabolic profile and this association is largely mediated by fat mass in adulthood.

Socio-demographic and economic determinants of overweight and obesity in preschool children in Palestine: analysis of data from the Palestinian Multiple Indicator Cluster Survey

BackgroundObesity is a global public health issue and worldwide rates of childhood obesity are ten times higher than 40 years ago. A limited number of studies have been conducted to determine the prevalence of preschool obesity and overweight and associated factors in Palestinian children. The aim of this study was to examine sociodemographic and economic factors associated with preschool overweight and obesity in Palestinian children younger than 5 years of age. MethodsWe used data from the fifth Palestinian Multiple Indicator Cluster Survey (MICS5), a cross-sectional survey of a representative sample of Palestinian households in 2014. The analysis was based on 6853 children (after excluding children whose z-score was out of range or not measured) below 5 years of age (46% [3152 out of 6853] in the Gaza Strip and 54% [3701 out of 6853] in the West Bank), drawn from 7816 completed surveys of a multi-stage cluster sample (99% response rate). The z-scores for BMI-for-age of children were used to evaluate weight status. Underweight, overweight, and obesity were defined as the proportion of preschool children with z-score values of 2 SDs or less, greater than 2 SDs, and greater than 3 SDs, respectively, from the WHO Child Growth Standards. Covariates included gender, age, area and region, number of children per household, mother's level of education, marital status of the mother, mother's age at birth, and wealth quantile (which we used as a composite indicator of wealth, with the first quintile representing the poorest households, and the fifth quintile representing the wealthiest households). We used multiple logistic regression analysis to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). FindingsThe overall prevalence of overweight and obesity in Palestinian children (birth to 5 years) was 8·8% (95% CI 8·1–9·4); 7·3% were overweight and 1·5% were obese. The prevalence of underweight was 1·4%. The odds of overweight and obesity were lower among children in the Gaza Strip than in the West Bank (AOR=0·74; 95% CI 0·61–0·90). Girls were less likely to be obese and overweight than boys (AOR=0·75; 95% CI 0·63–0·89). Children under 4 years of age had a higher risk of being obese and overweight than children aged 4–5 years. Children who lived in the wealthiest households (fifth quintile) were more likely to be overweight and obese than children in the poorest (first) quintile (AOR=1·36; 95% CI 1·09–1·71). InterpretationThe prevalence of obesity and overweight among preschool children in Palestine (8·8%) is higher than the global prevalence (6·7%; derived using the same standardised method as in this study, and using the WHO Child Growth Standards to assess the nutritional status of children). Obesity and overweight were more likely to affect children from wealthier households, children from the West Bank, boys, and younger children. Excessive weight gain in early childhood is a strong predictor of adulthood obesity. Routine assessment of all children needs to become standard clinical practice from very early childhood. Effective management and preventive interventions are needed to tackle the increasing obesity problem in preschool children. FundingNone.

Identification of infants at risk of child undernutrition in India: building a predictive algorithm with data from a nationally representative survey

Abstract Background India is at the centre of global child undernutrition, with a burden of malnourished children nearly twice that of all sub-Saharan African countries. The Indian government has established many national-level initiatives to address this public health crisis. However, there is substantial variation between and within states in the prevalence of child undernutrition, and strategies to identify at-risk populations are needed in the context of limited resources. Here, we describe the development of an algorithm that can be deployed at the time of delivery to characterise newborns' risk of undernutrition in the first 5 years of life. Methods We extracted data on 232 440 children younger than 5 years from the 2015–16 National Family Health Survey. A child was considered undernourished if either height-for-age, weight-for-height, or weight-for-age was more than 2 SD below median WHO child growth standards. We used predictor variables identified in published studies if they could be measured at the time of delivery and used multilevel logistic regression to model the outcome. Model calibration was assessed using the Hosmer-Lemeshow test. We tested internal validity of the model using 200 bootstrapped samples to derive an optimism-adjusted c-statistic. All analyses were done with svy command in STATA to account for complex clustered sampling. Findings In 2016, 54·7% of Indian children younger than 5 years were either stunted (38·4%), underweight (35·8%), or wasted (21·0%). The predictive model for overall undernutrition included maternal factors (height, education, reproductive history, number of antenatal visits), child factors (sex and birthweight), and household characteristics (district of residence, caste, rural residence, toilet availability, presence of a separate kitchen). The model demonstrated good discrimination ability (c-statistic: 0·688, optimism-adjusted c: 0·686). The prevalence of child undernutrition in the lowest decile risk group was 24·0%, and in the highest decile risk group it was 77·9%. Interpretation We are developing a mobile-based app to collect the information and categorise children into a risk decile at the time of delivery. Since more than 80% of births in India are registered by community health workers, who are also responsible for implementing child nutrition programmes, this tool could help workers identify infants at risk of malnutrition and prioritise their interventions. Funding AS: NIH-NCATS (TL1-TR001454) and NIH-NICHD (1F30HD091975-01A1) [AS] and NIH-NIMH (P60-MD006912-05) [JA].

Prevalence of anemia in under five-year-old children: a hospital-based study

Background: Anemia affects individuals of both gender and all ages, there is a need for localized and age- and context-specific studies to improve our knowledge of prevalence patterns and associated risk factors of Indian population. The present study was done to determine the prevalence of and associated risk factors for anemia in under five-year-old children in a tertiary care teaching hospital.Methods: A prospective observational study was carried out among under five-year-old children suffering from anemia. For the diagnosis of anemia, WHO criteria for haemoglobin (Hb) threshold in different age group were used. The growth and development statuses of children were evaluated by WHO's Child Growth Standards 2006.Results: Total 240 anaemic children were enrolled into the study. Children of age group of between 2-5 years was more affected. A majority of the mother of anaemic children had primary level of school education. More than half of the children belong to lower socioeconomic classes (Class IV + Class V). Nutritional deficiency was the single most important causative factor in the development of anemia. Infectious diseases found to be more prevalent.Conclusions: Nutritional deficiency, particularly, iron deficiency is the leading cause of anemia in the present study. In addition to nutritional deficiency, socioeconomic factors like, gender, maternal education and SE class also play an important role in development of anemia.

Associations of grandparental diabetes mellitus with grandchild BMI status

BackgroundMaternal family history of diabetes was significantly and positively associated with birth weight in grandchildren, we aim to assess the effect of grandparental diabetes on the grandchild’ body mass index (BMI) at infancy peak (IP) and obesity status at age 2.MethodsIn our study, family diabetes mellitus (DM) information from Ma’anshan Birth Cohort Study (MABC) were gathered. For children, height and weight were retrieved from medical records. BMI at 6 observations (0, 3, 6, 9, 12, 18 months) was plotted for every child. Onset of IP was determined by visual inspection. BMI at age 2 was categorized according to WHO Child Growth Standards as normal, overweight or obesity. The association between maternal grandfather’ diabetes and the grandchild’ BMI at IP and BMI at age 2 were tested using linear regression models and logistic regression models, respectively.ResultsIn our sample, about 6% of the maternal grandfather had DM, mean of infancy BMI peak was 18.37 kg/m2, and 6.6% of the children were obesity at age 2. Maternal grandfather with DM could significantly increase the IP BMI values (β = 0.30, 95 CI = 0.02~0.57), and was associated with obesity status at age 2 (OR = 1.92, 95 CI = 1.08~3.39), but maternal grandmother and paternal grandparents were unrelated.ConclusionThese results suggest that DM in maternal grandfather may be a risk factor for the grandchild high BMI at peak and obesity at age 2.