World Health Organization Growth Research Articles

Growth and gut comfort of healthy term infants exclusively fed with a partially hydrolysed protein-based infant formula: a randomized controlled double-blind trial

ObjectiveThis study aimed to investigate growth and gut comfort of healthy infants fed with a partially hydrolysed cow's milk protein-based infant formula (pHF) compared to a standard intact cow's milk protein-based formula (IPF).MethodsA double-blind, multi-center, randomized, controlled trial was performed. Healthy full-term, exclusively formula-fed infants (n = 345), aged ≤28 days were allocated to consume either a pHF (n = 173) or an IPF (n = 172) until the age of 17 weeks. The primary outcome was equivalence of weight gain (g/d) until the age of 17 weeks. The secondary outcomes were equivalence of other growth parameters, i.e., infants’ weight, length, head circumference, body mass index (BMI) and anthropometric Z-scores, while tertiary outcomes were gut comfort, formula intake, and adverse events (AEs).ResultsOverall, 288 infants completed the study (pHF group: 138, IPF group: 150). No differences were observed between the two groups in weight gain (g/d) during the three-months intervention [p = 0.915 for the Per Protocol (PP) population]. The 90% CI was [−1.252 to 1.100] being within the pre-defined equivalence margin of ±3.0 g/d. Similar findings were observed in the Full Analysis Set (FAS) and the sensitivity analysis. Regarding the secondary outcomes, no differences over the intervention period were shown between the two groups in both the PP and FAS analysis sets. Average Z-scores were in the normal range based on World Health Organization (WHO) growth standards for both groups at all time points in both analysis sets. Stool consistency, amount, and colour were different in the two groups. No differences were observed in gut comfort, stool frequency, and formula intake, between the two groups. In total 14 AEs and 22 serious adverse events (SAEs) were reported of which 15 (12%) and 1 (5%) were considered as (possibly) related to the study product, respectively.ConclusionsThe study demonstrates that the consumption of pHF results in adequate infant growth, equivalent to that of infants consuming IPF. Furthermore, the overall gut comfort was comparable between the two groups. Therefore, it can be concluded that the pHF is safe for and well tolerated by healthy infants.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT05757323?id=NCT05757323&rank=1, identifier (NCT05757323).

Growth patterns by birth size of preterm children born at 24-29 gestational weeks for the first 3 years.

Concerns are prevalent about preterm infant long-term growth regarding plotting low on growth charts at discharge, stunting, underweight, high body fat and subsequent cardiometabolic morbidities. To examine (a) longitudinal growth patterns of extremely and very preterm infants to 3 years corrected age (CA) (outcome), categorised by their birthweight for gestational age: small, appropriate and large for gestational age (SGA, AGA and LGA, respectively) (exposure); and (b) the ability of growth faltering (<-2 z-scores) to predict suboptimal cognitive scores at 3 years CA. Post-discharge head, length, weight and weight-4-length growth patterns of the PreM Growth cohort study infants born <30 weeks and < 1500 g, who had dietitian and multi-disciplinary support before and after discharge, were plotted against the World Health Organization growth standard. Infants with brain injuries, necrotising enterocolitis and bronchopulmonary dysplasia were excluded. Of the included 405 infants, the proportions of infants with anthropometric measures > - 2 z-scores improved with age. The highest proportions <-2 z-scores for length (24.2%) and weight (24.0%) were at 36 gestational weeks. The proportion with small heads waslow by 0 months CA (1.8%). By 3 years CA, only a few children plotted lower than -2 z-scores for length, weight-4-length and weight (<6%). After zero months CA, high weight-4-length and body mass index > + 2 z-scores were rare (2.1% at 3 years CA). Those born SGA had higher proportions with shorter heights (16.7% vs. 5.2%) and lower weights (27.8% vs. 3.5%) at 3 years CA compared to those born AGA. The ability of growth faltering to predict cognitive scores was limited (AUROC 0.42, 95% CI 0.39, 0.45 to 0.52, 95% CI 0.41, 0.63). Although children born <30 weeks gestation without major neonatal morbidities plot low on growth charts at 36 weeks CA most catch up to growth chart curves by 3 years CA.

Health-Related Physical Fitness Evaluation in HIV-Diagnosed Children and Adolescents: A Scoping Review.

Health-related physical fitness has been widely used to investigate the adverse effects of HIV infection/ART in children and adolescents. However, methods/protocols and cut-points applied for investigating health-related physical fitness are not clear. The aim of this scoping review was to map the literature to identify gaps in knowledge regarding the methods/protocols and cut-points. A scoping review, following the Joana Briggs Institute (JBI) guidelines, was conducted through ten major databases. Search followed the PCC strategy to construct block of terms related to population (children and adolescents), concept (health-related physical fitness components) and context (HIV infection). The search resulted in 7545 studies. After duplicate removal, titles and abstracts reading and full text assessment, 246 studies were included in the scoping review. Body composition was the most investigated component (n = 244), followed by muscular strength/endurance (n = 23), cardiorespiratory fitness (n = 15) and flexibility (n = 4). The World Health Organization growth curves, and nationals' surveys were the most reference values applied to classify body composition (n = 149), followed by internal cut-points (n = 30) and cut-points developed through small populations (n = 16). Cardiorespiratory fitness was classified through cut-points from three different assessment batteries, as well as cut-points developed through studies with small populations, muscular strength/endurance and flexibility were classified through the same cut-points from five different assessment batteries. The research on muscular strength/endurance, cardiorespiratory fitness and flexibility has been scarcely explored. The lack of studies that investigated method usability as well as reference values was evidenced.

Analysis and prediction of nutritional outcome of patients with pediatric inflammatory bowel disease from Bahrain

BackgroundInflammatory bowel disease (IBD) is a chronic gastrointestinal disease that causes anorexia, malabsorption, and increased energy requirements. Childhood IBD can significantly impact nutritional status and future health.ObjectiveThis study aimed to analyze the nutritional status of patients with pediatric IBD at presentation and during follow-up and to identify predictors of nutritional outcome.MethodsThis retrospective cohort study reviewed the medical records of children diagnosed with IBD in the Pediatric Department, Salmaniya Medical Complex, Bahrain, 1984 − 2023. Demographic data, clinical characteristics, and anthropometric data were collected. World Health Organization growth standards were used to interpret nutritional status.ResultsOf the 165 patients, 99 (60%) had anthropometric data at presentation, and 130 (78.8%) had follow-up data. Most patients were males (64.6%) and had Crohn’s disease (CD) (56.2%), while 43.8% had ulcerative colitis (UC). The median age at presentation was 10.9 years and the mean follow-up duration was 12.6 years. At presentation, 53.5% of the patients were malnourished, that decreased to 46.9% on follow-up. Thinness was reduced from 27.3% at presentation to 12.1% at follow-up (p = 0.003). There was an increased tendency to normal weight on follow-up (59.6%) compared to time of presentation (46.5%), p = 0.035. Overweightness showed a non-significant increase from 26.3% at presentation to 28.3% at follow-up (p = 0.791). Children with IBD were more likely to become obese when they grow up to adulthood (2.3% versus 20.5%, respectively, p < 0.001). Weight-for-age, and height-for-age at presentation were higher among CD compared to UC, but body mass index (BMI) at follow-up was higher among UC patients (p < 0.05). Thinness at follow up was associated with very early-onset disease (p = 0.02), lower weight and BMI at presentation (p < 0.001 each), younger age at follow-up (p = 0.002), pediatric age group (p = 0.023), lower hematocrit (p = 0.017), and higher C-reactive protein (p = 0.007). Overweight at follow up was associated with increased weight and BMI at presentation (p < 0.001 each), longer disease duration (p = 0.005), older age (p = 0.002), and azathioprine intake (p = 0.026). Considering follow-up duration, univariate analysis exhibited that Bahraini nationality, post-diagnosis disease duration, age at follow-up, occurrence of diarrhea, height, and BMI at presentation were factors that decreased liability to abnormal nutritional status, while CD, history of weight loss, perianal disease, and skin rash, and intake of prednisolone expressed increased liability of abnormal nutritional status (p < 0.05).ConclusionPediatric IBD is associated with a high incidence of malnutrition. Thinness is more prominent at presentation, while overweight is higher on follow-up. Multiple risk factors aggravating abnormal nutritional status were highlighted. Accordingly, nutritional counseling should be prioritized in a multidisciplinary approach.

Unsafe child feces disposal and childhood wasting among under five children in Myanmar

Background: Wasting is a major public health problem among under five children in developing countries, including Myanmar. The distribution of wasting and its associated factors are not well known in Myanmar. Objectives: This study aimed to examine the wasting prevalence and identify the association between child feces disposal and wasting among under-five children in Myanmar. Methods: A cross-sectional study was conducted on 1,207 under five children in Myanmar from September to December 2022. This study employed a multistage random sampling method with structured questionnaires and anthropometric measures. The World Health Organization's (WHO) definition and growth standards were used to determine the wasting. Multivariable logistic regression was performed to identify the association. An adjusted odds ratio with a 95% confidence interval and a p-value &lt;0.05 was used to define statistical significance. Results: The prevalence of childhood wasting among under five children in Myanmar was 11.10% (95% CI: 9.45 to 13.00). This study revealed that children from unsafe child feces disposing families were 94 % more likely to be wasted (AOR=1.94, 95% CI: 1.22 to 3.09; p-value 0.005). Other covariates to childhood wasting were water shortage (AOR=2.17, 95% CI: 1.13 to 4.16; p-value 0.02), less than four handwashing steps of mother (AOR=3.20, 95% CI: 1.93 to 5.32; p-value &lt;0.001), located in hilly region (AOR=2.27, 95% CI: 1.53 to 3.37; p-value &lt;0.001), boys (AOR=2.80, 95% CI: 1.86 to 4.23; p-value &lt;0.001), birth interval less than 3 years (AOR=1.84, 95% CI: 1.10 to 3.11; p-value 0.02), and eating more than 4 times per day (AOR=3.19, 95% CI: 1.93 to 5.27; p-value &lt;0.001). Conclusion: This study showed a high prevalence of wasting among under five children in Myanmar. Improving the safe child feces disposal practices of mothers would be a critical intervention to reduce under five children's wasting.

Significant differences in the length and weight measurements of Jordanian infants compared to the World Health Organization 2006 growth standards.

In 2006, the World Health Organization (WHO) introduced new growth standards based on data derived globally from optimally nourished breastfed infants. The aim of this study was to assess the effects of implementing WHO growth standards on the growth patterns of Jordanian infants. In addition, it was to ascertain the necessity of establishing country-specific growth standards and charts tailored to Jordanian infants. The data of 102,846 infants (50.1% boys, 49.9% girls) aged 0-24 months, from 115 primary healthcare centers across the country were retrieved from a National E-health Program. Weight and length measurements were analyzed, and age- and sex-specific z-scores were calculated relative to the WHO growth standards. Data was analyzed using SPSS version 26. Mann-Whitney U test was performed to determine significant differences between the measurements for boys and girls in terms of age, length, and weight. Jordanian infants exhibited significantly shorter length-for-age measurements than WHO standards with mean z-scores of -0.56 and -0.38, for boys and girls, respectively. Weight-for-age measurements showed a good fit and were comparable to the WHO growth standards for boys (mean z score = -0.05) and girls (mean z score = 0.04). Notably, Jordanian infants displayed higher weight-for-length measurements, with mean z-scores of 0.51 for boys and 0.47 for girls. The availability of Jordanian-specific growth standards will improve the accuracy of assessing infant growth and enhance the monitoring and evaluation of their health and development.

IJCM_39A: To compare the World Health Organization growth charts with Indian Academy of Pediatrics growth charts of under-five children attending urban health center of a Medical College

Background: The nutritional status of the child can be measured by using anthropometry which is the valuable tool and the gold standard method. The magnitude of different measures of nutritional status is affected by choice of reference charts used. Objective: To compare the world Health Organization growth charts with Indian academy of pediatrics growth charts to assess the malnutrition among under 5 children attending Urban health center of a medical College. Methodology: A cross sectional study was conducted among 220 children attended urban health centre of SS. Institute of Medical Sciences for a period of 4 months. Height and weight were measured and plotted on World Health Organization and Indian Academy of Pediatrics charts. Results: In this study underweight was detected among 46.9% of the boys and 43.8% of the girls and stunting was detected among 50.4% of the boys and 43.8% of the girls by using World Health Organization Growth Charts. According to Indian academy of Pediatrics, 32.1% of the boys and 38% of the girls were found to be undernourished and Stunting was detected among 53.9% of the boys and 68.8% of the girls. Conclusion: In this study both the growth charts showed variation in the height and weight measurements.

Sibship Composition and BMI Z-Score Among Saudi Preschoolers: A Cross-Sectional Study.

Background and objective The association between sibship composition and child body mass index (BMI) has not been investigated in any Arab/Middle Eastern populations. In light of this, this study aimed to examine the association of the number of siblings, number of older siblings, and number of younger siblings with child BMI z-score (BMIz) among preschoolers in the Kingdom of Saudi Arabia (KSA). Methods A total of 209 mothers and their children were recruited from preschools in Jeddah, KSA. Mothers reported their responses to the study questionnaire via telephone. Child anthropometry was objectively measured; BMIz was calculated based on age- and sex-specific World Health Organization (WHO) growth standards and reference data. We used hierarchical multiple linear regression to examine the association between sibship composition variables and child BMIz, independent of the effect of potential confounders, and to evaluate changes in model fit. Results The number of siblings was negatively associated with child BMIz [b = -0.18, 95% confidence interval (CI) = -0.35, -0.06, p<0.01, adjusted R2= 0.16]. There was a negative association between the number of older siblings and child BMIz (b = -0.23, 95% CI = -0.38, -0.11, p<0.01, adjusted R2= 0.21) as well as between the number of older sisters and child BMIz (b = -0.18, 95% CI = -0.52, -0.09, p<0.01, adjusted R2= 0.19). However, there were no significant associations between the number of older brothers or the number of younger siblings and child BMIz. Conclusions Based on our findings, sibship composition was found to be associated with BMIz among a sample of preschoolers in KSA. More research is needed to further establish this association and to understand the underlying mechanism of the association of the greater number of older siblings and older sisters with lower BMIz.

Optimization of Ganciclovir and Valganciclovir Starting Dose in Children by Machine Learning.

Ganciclovir (GCV) and valganciclovir (VGCV) show large interindividual pharmacokinetic variability, particularly in children.The objectives of this study were (1) to develop machine learning (ML) algorithms trained on simulated pharmacokinetics profiles obtained by Monte Carlo simulations to estimate the best gancicloviror valganciclovirstarting dose in children and (2) to compare its performances on real-world profiles to previously published equation derived from literature population pharmacokinetic (POPPK) models achieving about 20% of profiles within the target. The pharmacokinetic parameters of four literature POPPK models in addition to the World Health Organization (WHO) growth curve for children were used in the mrgsolve R package to simulate 10,800 pharmacokinetic profiles. ML algorithms were developed and benchmarked to predict the probability to reach the steady-state, area-under-the-curve target (AUC0-24within 40-60 mg × h/L) based on demographic characteristics only. The best ML algorithm was then used to calculate the starting dose maximizing the target attainment. Performances were evaluated for ML and literature formula in a test set and in an external set of 32 and 31 actual patients (GCV and VGCV, respectively). A combination of Xgboost, neural network, and random forest algorithms yielded the best performances and highest target attainment in the test set (36.8% for GCV and 35.3% for the VGCV). In actual patients, the best GCV ML starting dose yielded the highest target attainment rate (25.8%) and performed equally for VGCV with the Franck model formula (35.3% for both). The ML algorithms exhibit good performances in comparison with previously validated models and should be evaluated prospectively.

Growth in height and its association with overweight and obesity in Mexican children: an evaluation based on a nationally representative sample (ENSANUT 2018).

Chronological age and height records (7,097 boys and 6,167 girls) were obtained from the Mexican National Survey of Health and Nutrition database. Height growth curves were fitted using the Preece-Baines 1 (PB1) model and the LMS method. Age at peak height velocity (APHV) was 12.4 and 12.7 years for overweight-obese and normal-weight boys, respectively, and was 9.6 and 10.4 years for overweight-obese and normal-weight girls, respectively. Growth velocity was higher at the age of take-off (TO) in overweight-obese children than in normal-weight children (5.2 cm/year vs. 5 cm/year in boys and 6.1 cm/year vs. 5.6 cm/year in girls); nevertheless, the growth velocity at APHV was higher for normal-weight children than for overweight-obese children (7.4 cm/year vs. 6.6 cm/year in boys and 6.8 cm/year vs. 6.6 cm/year in girls, respectively). Distance curves developed in the present study and by the World Health Organization (WHO) using LMS showed similar values for L and S parameters and a higher M value compared with the WHO reference values. This study concluded that overweight-obese children had earlier APHV and lower PHV than normal-weight children. Furthermore, Mexican children and adolescents were shorter than the WHO growth reference by age and sex.

Comparison of WHO 2006 Growth Standards and Synthetic Indian References in Assessing Growth in Normal Children and Children with Growth-Related Disorders

Abstract Introduction: A good screening tool, such as a growth chart, should distinguish between children with normal growth and those with perturbed growth. Suitability of synthetic Indian growth references for diagnosing growth-related disorders for under-five children has not been evaluated. To assess the validity of World Health Organization (WHO) 2006 standards vs synthetic Indian references (2019) (by comparing weight, height, body mass index (BMI), standard deviation scores (SDS) and the composite index of anthropometric failure (CIAF)) in differentiating normal children and children with growth-related disorders. Methods: Records of 2188 children (0–60 months) attending a tertiary centre paediatric outpatient department (OPD) were retrospectively studied; 1854 children were healthy and 334 were diagnosed with growth-related disorders as per the European Society for Paediatric Endocrinology (ESPE) classification. The anthropometric parameters converted to Z-scores for weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ) and a CIAF were computed using WHO and synthetic charts; Student’s t-test was used for assessing differences and Youden’s index for validity. Results: Disease status of children and anthropometric failure on WAZ, HAZ, BAZ and CIAF on both WHO and synthetic charts had a significant association (P-value &lt;0.05). WAZ, HAZ on both charts and CIAF on synthetic chart had a fair to moderate agreement (Kappa statistics) with disease status as per diagnosis (P-value &lt;0.05). The sensitivity and negative predictive value for all anthropometric parameters were higher for synthetic charts. Conclusion: Indian charts were more sensitive for diagnosing growth-related disorders from birth to 60 months of age when compared to WHO growth standards.

Identifying biologically implausible values in big longitudinal data: an example applied to child growth data from the Brazilian food and nutrition surveillance system

BackgroundSeveral strategies for identifying biologically implausible values in longitudinal anthropometric data have recently been proposed, but the suitability of these strategies for large population datasets needs to be better understood. This study evaluated the impact of removing population outliers and the additional value of identifying and removing longitudinal outliers on the trajectories of length/height and weight and on the prevalence of child growth indicators in a large longitudinal dataset of child growth data.MethodsLength/height and weight measurements of children aged 0 to 59 months from the Brazilian Food and Nutrition Surveillance System were analyzed. Population outliers were identified using z-scores from the World Health Organization (WHO) growth charts. After identifying and removing population outliers, residuals from linear mixed-effects models were used to flag longitudinal outliers. The following cutoffs for residuals were tested to flag those: -3/+3, -4/+4, -5/+5, -6/+6. The selected child growth indicators included length/height-for-age z-scores and weight-for-age z-scores, classified according to the WHO charts.ResultsThe dataset included 50,154,738 records from 10,775,496 children. Boys and girls had 5.74% and 5.31% of length/height and 5.19% and 4.74% of weight values flagged as population outliers, respectively. After removing those, the percentage of longitudinal outliers varied from 0.02% (<-6/>+6) to 1.47% (<-3/>+3) for length/height and from 0.07 to 1.44% for weight in boys. In girls, the percentage of longitudinal outliers varied from 0.01 to 1.50% for length/height and from 0.08 to 1.45% for weight. The initial removal of population outliers played the most substantial role in the growth trajectories as it was the first step in the cleaning process, while the additional removal of longitudinal outliers had lower influence on those, regardless of the cutoff adopted. The prevalence of the selected indicators were also affected by both population and longitudinal (to a lesser extent) outliers.ConclusionsAlthough both population and longitudinal outliers can detect biologically implausible values in child growth data, removing population outliers seemed more relevant in this large administrative dataset, especially in calculating summary statistics. However, both types of outliers need to be identified and removed for the proper evaluation of trajectories.

Prevalence, Incidence, and Reversal Pattern of Childhood Stunting From Birth to Age 2 Years in Ethiopia

Although there has been a reduction in stunting (low-height-for-age and low-length-for-age), a proxy of malnutrition, the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to increase awareness and resources to improve the potential for recovery. To estimate the prevalence, incidence, and reversal of stunting among children aged 0 to 24 months. This population-based cohort study of the Birhan Maternal and Child Health cohort in North Shewa Zone, Amhara, Ethiopia, was conducted between December 2018 and November 2020. Eligible participants included children aged 0 to 24 months who were enrolled during the study period and had their length measured at least once. Data analysis occurred from Month Year to Month Year. The primary outcome of this study was stunting, defined as length-for-age z score (LAZ) at least 2 SDs below the mean. Z scores were also used to determine the prevalence, incidence, and reversal of stunting at each key time point. Growth velocity was determined in centimeters per month between key time points and compared with global World Health Organization (WHO) standards for the same time periods. Heterogeneity was addressed by excluding outliers in sensitivity analyses using modeled growth trajectories for each child. A total of 4354 children were enrolled, out of which 3674 (84.4%; 1786 [48.7%] female) had their length measured at least once and were included in this study. The median population-level length was consistently below WHO growth standards from birth to 2 years of age. The observed prevalence of stunting was highest by 2 years of age at 57.4% (95% CI, 54.8%-9 60.0%). Incidence of stunting increased over time and reached 51.0% (95% CI, 45.3%-56.6%) between ages 12 and 24 months. Reversal was 63.5% (95% CI, 54.8%-71.4%) by age 6 months and 45.2% (95% CI, 36.0%-54.8%) by age 2 years. Growth velocity point estimate differences were slowest compared with WHO standards during the neonatal period (-1.4 cm/month for girls and -1.6 cm/month for boys). There was substantial heterogeneity in anthropometric measurements. The evidence from this cohort study highlights a chronically malnourished population with much of the burden associated with growth faltering during the neonatal periods as well as after 6 months of age. To end all forms of malnutrition, growth faltering in populations such as that in young children in Amhara, Ethiopia, needs to be addressed.

Levels of stunting associated factors among under-five children in Ethiopia: A multi-level ordinal logistic regression analysis.

Stunting is a major public health problem affecting more than one-third of under five year's old children in Ethiopia. It has short and long (irreversible) consequences, including stunted growth, never reaching physical and cognitive potential, struggles in school, and increased morbidity and mortality due to infections. Though stunting is the leading cause of child mortality in Ethiopia, evidence is scarce on the prevalence and predictors of stunting among under-five years old children in Ethiopia. Therefore, this study aimed to estimate the prevalence and predictors of stunting severity among under-5 children in Ethiopia. This study was based on 2019 Mini-Ethiopian Demographic and Health Survey (EDHS) data. A weighted total sample of 4972 under-five years old children was included in the study. Height measurement was collected for each child. Anthropometric indicator, height-for-age was determined for children using World Health Organization growth standards (Z-scores for Height-for-Age (HAZ)) to asses stunting level. Given the ordinal nature of stunting and the hierarchical nature of EDHS data, a multilevel ordinal logistic regression model was applied. Brant test was used to check the proportional odds assumption, which was satisfied (P-value ≥0.05). Moreover, deviance was used for model comparison. For the multivariable analysis, variables with a p-value ≤0.2 in the bivariable analysis were considered. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported as associated factor to the severity levels of stunting in the multivariable multilevel proportional odds model. The overall prevalence of stunting among under-5 children in Ethiopia was 35.7% [95% CI: 34.4%, 37.1%]. Of these, 12.1% were severely stunted, and 24.9% were moderately stunted. Being male [AOR = 0.83, 95% CI: 0.74, 0.93], children aged 6-23 months [AOR = 2.38, 95% CI: 1.84, 3.07], ≥ 24 months [AOR = 4.15, 95% CI: 3.26, 5.28], children whose maternal age 15-24 years [AOR = 0.73, 95% CI: 0.58, 0.92], children from the poorest, poorer, middle, and richer household wealth were [AOR = 1.84, 95% CI: 1.32, 2.57], [AOR = 1.66, 95% CI: 1.20, 2.31], [AOR = 1.78, 95% CI: 1.29, 2.44], and [AOR = 1.62, 95% CI: 1.20, 2.17], children whose maternal educational status of no formal education and primary education had [AOR = 1.90, 95% CI: 1.28, 2.82], [AOR = 1.78, 95% CI: 1.22, 2.60], Tigray [AOR = 2.95, 95% CI: 1.78, 4.86], Afar [AOR = 1.85, 95% CI: 1.11, 3.10], Amhara [AOR = 1.90, 95% CI: 1.14, 3.14] and Harari [AOR = 1.97, 95% CI: 1.20, 3.25]regions, low community maternal education [AOR = 0.76, 95% CI: 0.62, 0.92] were significantly associated with stunting severity levelling. Stunting among children under five years of old in Ethiopia remains a major public health issue. Improving access to maternal education is related to appropriate child feeding practices and health, particularly in younger and uneducated mothers. Strengthening the family's wealth status is also recommended to reduce stunting. In addition, it is better to support strategies of preconception care for mothers during pregnancy to reduce stunting in the long term.

Growth charts of Brazilian youngs: 20-years data of 95,000 children and adolescents from "Projeto Esporte Brasil".

This article aims to present growth curves for height, weight, and BMI of 95,000 Brazilian youths aged 6 to 17 years, including the five regions of the country, the Amazon region, and indigenous populations, and compare them with the World Health Organization (WHO) growth references. The final sample consisted of 52,729 boys and 42,731 girls from the "Projeto Esporte Brasil" database. Body mass and height information were used to derive the curves. The generalized additive model for location, scale, and shape was employed. In this study, we present smoothed weight-for-age, height-for-age, and BMI-for-age curves for boys and girls. Differences were observed between the results of the Brazilian curves and the WHO growth references. The developed curves will be valuable for professionals in medicine, public health, nutrition, physical education, and other related fields, regarding the assessment of physical growth in Brazilian children and adolescents and monitoring the nutritional status of this population. Additionally, these curves will facilitate the identification of individuals or subgroups at risk of diseases and delayed growth, with a greater focus on specific country-related factors.

The role of adipokines and ghrelin in interactions and clinical implications in childhood obesity.

Childhood obesity is a growing global health concern, especially prevalent in the Arabian Peninsula, and is known to contribute to metabolic syndrome and insulin resistance. This study aimed to investigate the interplay between adipokines (leptin and adiponectin), ghrelin, and insulin homeostasis in childhood obesity. A case-control study was conducted in Babylon involving 120 children/adolescents (7-17 years). The participants were divided into two groups: 60 obese and 60 healthy controls. Anthropometric and biochemical measures were examined, applying World Health Organization (WHO) growth standards to categorize weight status. Data on blood lipids, glucose, adipokines, and ghrelin were collected in Babylon (Merjan Medical City), ensuring accuracy and providing insights into pediatric obesity's metabolic and hormonal status. Clinical, anthropometric, and laboratory attributes of children were evaluated, with classification as normal-weight or obese based on BMI/Z-score and Waist Circumference. The obese group exhibited elevated triglycerides and insulin levels, as well as reduced adiponectin levels (P ≤ 0.001). Leptin levels showed a positive correlation with BMI/Z-score (r = 0.352, P = 0.006). A diagnostic model demonstrated the significant diagnostic capacity of leptin (AUC > 99%) and its importance in predicting childhood obesity. Each unit increase in leptin elevated the probability of obesity by a factor of 1.197 (95% CI: 1.0507-1.3632, P = 0.0068). The study revealed significant differences in clinical, biochemical, and biological markers of obesity between the research groups and the control group. Leptin emerged as a significant predictor of obesity, demonstrating high diagnostic accuracy. The complex interactions among these adipokines underscore the necessity for comprehensive obesity management strategies.

Gambaran Tingkat Pengetahuan Ibu Tentang Stunting Pada Balita Di Puskesmas Kota Manna Kabupaten Bengkulu Selatan

Globally, stunting remains one of the main nutritional problems in infants and children under five years old. Stunting is a condition in children marked by length or height for age and sex less than -2 SD based on the World Health Organization (WHO) growth curve, due to chronic malnutrition associated with low socioeconomic conditions, poor nutritional intake and maternal health, a history of recurrent illness, and/or inappropriate infant and young child feeding practices. The purpose of this study was to determine the level of knowledge of mothers about stunting in toddlers at the Puskesmas Kota Manna, South Bengkulu Regency. The method used in this research is quantitative research with descriptive research method. The population of this study were all mothers who had toddlers in the working area of the Puskesmas Kota Manna, South Bengkulu Regency in June 2023 with 20 samples selected using the random sampling method. The results of this study obtained the age of the majority of respondents aged in the range of 20-35 years as many as 18 people (90.0%), the minority aged&gt; 35 years as many as 2 people (10.0%). The majority of respondents' education is junior high school as many as 8 people (40.0%), the minority of SARJANA is 5 people (25.0%). The majority of respondents' occupations were housewives as many as 14 people (70.0%) and a minority of civil servants as many as 2 people (10.0%). the majority of respondents' knowledge was lacking, namely 9 people (45.0%) and a minority of sufficient knowledge as many as 7 people (35.0%). Based on the results of the study, the majority of mothers' knowledge about stunting in toddlers at the Puskesmas Kota Manna, South Bengkulu Regency in 2023 was less as many as 9 people (45.0%).

A comparison of mid-upper arm circumference and weight-for-height Z score of world health organization growth standards in detecting moderate and severe acute malnutrition in children aged 6-60 months

Background: World health organization (WHO) had defined severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) by weight for height Z score (WHZ) and mid upper arm circumference (MUAC) criteria. Several studies indicate discrepancies in the prevalence of malnutrition on using either WHZ or MUAC. The prevalence of SAM was nearly same when using either criterion and only 40% children showed overlapping by using both the criteria. Present study was taken to identify the overlapping of cases by applying both the WHO criteria in children aged 6-60 months. It also identifies the optimal screening cut off values of MUAC if used as a sole criterion. Method: It was a hospital based descriptive cross-sectional study done on 640 cases who were assessed for MAM /SAM by using anthropometric WHO criteria. Results: From 67 SAM cases who were identified by WHZ, only17 cases had SAM on using MUAC too. The sensitivity of MUAC was 25.4% and specificity of 92.0%. From 94 MAM cases, 19 cases showed overlapping by using both the WHO criteria. At MUAC of &lt;13.5 cm, the sensitivity increased to 86.6% for SAM and 81.6% for MAM cases at the cost of decreased specificity which was at around 36% for both the types of malnutrition. Conclusions: The number of malnourished cases, identified by using either of WHO criteria were nearly same but both these criteria detect different subgroups of malnourished children in most cases. A MUAC of &lt;13.5 cm may be used as a sole-criteria in the community by the health workers to detect acute malnutrition.

Stunting and Associated Factors among Children Under Five Years in Yemen during the Conflict Period

It remains a significant public health problem in many low and middle-income countries, particularly in Yemen, related to nutritional deficiencies during the most critical periods of growth and development in early childhood. The purpose of this study was to determine the predictors of stunting and the associated factors among Yemeni children under 5 years of age. This study was conducted using a cross-sectional design among 434 mothers and their children aged 6-59 months. Data were collected through face-to-face interview using the structured questionnaire that consists of 28 items. Anthropometric indicator, height-for-age was determined using the current World Health Organization (WHO) growth standards. An analysis of the data was conducted using a multivariable logistic regression model. Statistical significance was determined by the Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI) from the multivariable analysis. The prevalence of stunting among children under the age of five was 46.1%. According to the multivariable analysis, stunting is statistically associated with children aged 13-24 months (AOR 2.04), 25-36 months (AOR 2.27), 37-48 months (AOR 2.38), secondary education of the father (AOR 0.31), household size of five members (AOR 0.66), and flushed or poured toilets (AOR 1.91). In Yemen, family-specific factors are the primary contributors to stunted development in children. There is a need to emphasize interventions related to food, nutrition, and overall hygiene to reduce malnutrition in the studied region and the country as a whole.

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome.

Dengue-associated complications, including dengue shock syndrome, severe respiratory distress, and pediatric acute liver failure (PALF), are associated with high mortality rates in patients with dengue. There is increasing prevalence of overweight and obesity among children worldwide. Obesity may activate inflammatory mediators, leading to increased capillary permeability and plasma leakage in patients with dengue. Several studies have shown a correlation between obesity and DSS, but did not include dengue fatality or PALF. Therefore, we hypothesized possible associations between obesity and critical dengue-associated clinical outcomes among PICU-admitted children with DSS, including dengue-related mortality, mechanical ventilation (MV) requirements, and dengue-associated PALF. The nutritional status of the participants was assessed using World Health Organization growth charts. A total of 858 participants with complete nutritional data were enrolled in this study. Obesity was significantly associated with risk of severe respiratory failure and MV support (odds ratio = 2.3, 95% CI: 1.31-4.06, P < .01); however, it was not associated with dengue-associated mortality or acute liver failure. Obese pediatric patients with DSS should be closely monitored for severe respiratory distress and the need for high-flow oxygenation support, particularly MV, soon after hospitalization.