World Health Organization Reference Data Research Articles

The Influence of Treatment With Sofosbuvir/Velpatasvir on Children's Growth-Results of the PANDAA-PED Study.

The aim of this study was to evaluate the influence of treatment of hepatitis C with sofosbuvir and velpatasvir (SOF/VEL) on children's growth. Fifty children 6-18 years of age were successfully treated for hepatitis C with a 12-week course of SOF/VEL fixed dose adjusted to the body weight in the PANDAA-PED (Treatment of chronic hepatitis C in children aged 6-18 years of age using a pangenotypic direct-acting antiviral sofosbuvir/velpatasvir) project. Growth parameters were compared at 1 year after treatment with baseline (at the start of treatment) and 12-week-posttreatment values. Body mass index (BMI), weight and height Z scores adjusted to sex and age were calculated according to the World Health Organization reference data. Forty-nine participants (23 boys and 26 girls) completed all the visits. The mean age at 1 year after treatment was 10.9 ± 2.5 years, and all children had undetectable hepatitis C virus RNA at this point. Significant weight and height gains were observed after treatment irrespective of the patients' age and sex. Height Z scores did not vary significantly both at 12 weeks and 1 year after treatment, confirming a normal increase in participants' height. Weight Z scores for 16 children below 10 years of age decreased at 1 year after treatment. BMI Z score values decreased at 12 weeks after treatment compared to the baseline in boys, but no difference was found between 1-year posttreatment and baseline BMI Z scores in both girls and boys. Results of the PANDAA-PED study showed normal growth up to 1 year after successful treatment with SOF/VEL in children 6-18 years of age. Despite the decrease in BMI Z score in boys observed at 12 weeks after treatment, no differences were found between baseline and 1-year posttreatment values. Our observations confirm the long-term safety of the SOF/VEL treatment in children 6-18 years of age.

Metabolizable Energy Content of Breastmilk Supports Normal Growth in Exclusively Breastfed Icelandic Infants to Age 6 Months

BackgroundNeither the global population nor individual countries have reached the World Health Organization (WHO) target of ≥50% of infants exclusively breastfed (EBF) until 6 mo. This may partly be because of the perceptions of insufficient milk and energy supply to meet rapid growth and development needs. ObjectivesIn a longitudinal observational study, we aimed to determine whether breastmilk energy content is sufficient to support growth during EBF until 6 mo. MethodsA sample of 27 EBF infants was dosed with doubly labeled water (DLW) at 5.6 mo to measure body composition, breastmilk intake, energy intake, and the metabolizable energy (ME) content of their mother’s breastmilk over the following week. Z-scores were calculated for anthropometry using WHO reference data and for fat-free mass (FFM) and fat mass (FM) using United Kingdom reference data. ResultsAnthropometric z-scores from birth indicated normal weight and length growth patterns. At ∼6 mo, the mean ± standard deviation (SD) FFM z-score was 0.22 ± 1.07, and the FM z-score was 0.78 ± 0.70, significantly >0. In the 22 infants with acceptable data, the mean ± SD measured intake of breastmilk was 983 ± 170 g/d and of energy, 318 ± 60 kJ/kg/d, equivalent to 75.9 ± 14.3 kcal/kg/d. The mean ME content of breastmilk was 2.61 kJ/g [standard error (SE) 0.1], equivalent to 0.62 kcal/g (SE 0.02). Mothers were positive toward breastfeeding, on paid maternity leave (planned mean 10 mo), and many (56%) had received specialized breastfeeding support. ConclusionsThe evidence from this study confirms that when mothers are motivated and supported without economic restraints, breastmilk intake and the energy supplied by breastmilk to EBF infants at 6 mo of age is sufficient to support normal growth patterns. There was no evidence of constraint on FFM, and other studies show that high FM in EBF infants is likely to be transient. These data further support the recommendation for EBF ≤6 mo of age for body composition.This trial was registered at clinicaltrials.gov as NCT02586571.

Child Growth Curves in High-Altitude Ladakh: Results from a Cohort Study.

High prevalence of child underweight and stunting in high-altitude areas has often been reported. However, most previous studies on this topic were cross-sectional. Another critical concern is that using the World Health Organization (WHO) Child Growth Standards to evaluate child growth in high-altitude areas may lead to overestimations of underweight and stunting. Our study aimed to evaluate the long-term growth pattern of children (3 to 18 years) above the altitude of 3500 m in Ladakh, India. The participants’ body weight (BW), body height (BH), and body mass index (BMI) were measured annually according to the WHO Child Growth Standards for children under 5 years old and the WHO reference data for children aged 5 to 19 years. The generalized estimating equation (GEE) was used to estimate the means and z-scores of BW, BH, and BMI at different ages. A total of 401 children were enrolled from 2012 to 2018. Their mean z-scores of BW, BH, and BMI were −1.47, −1.44, and −0.85 in 2012 and increased to −0.74, −0.92, and −0.63 in 2018. This population’s specific growth curve was also depicted, which generally fell below the 85th percentile of the WHO standards. This is the first cohort study about long-term child growth patterns in a high-altitude area. The detailed underlying mechanisms of our findings need future research on more representative data of high-altitude populations.

Anthropometric evaluation of school-going native highlanders (4-19 years of age) from the Leh-Ladakh region in India.

The native population of the Ladakh region faces the unique challenges of a high-altitude environment with distinct physiological adaptations in comparison with lowlanders. However, no comprehensive data on standard anthropometric parameters for the school-going children in this populace is available. We aimed to study the various anthropometric parameters in the school-going native highlander population and computed measures of central tendency. The nutritional status of the community was also be determined by comparing with World Health Organization (WHO) scores for height for age (HFA), weight for age (WFA) and body mass index (BMI) for age. A cross-sectional, descriptive study was devised to assess the anthropometric parameters. We measured height, weight, mid-upper circumference (MUAC), triceps skinfold (TSF) thickness, sub-scapular skinfold (SSF) thickness, waist, hip and abdominal circumference. Statistical analysis was conducted to determine the mean [±2 standard deviation (SD)], median, range, minimum and maximum. The z-scores for HFA, WFA and BMI for age was computed using WHO reference data. A total of 346 school-going native highlander children (4-19 years of age) were studied. Among the study population, the mean height was 141.17 ± 39.08 cm, the mean weight was 38.27 ± 25.40 kg. The gender difference in height, MUAC, sub-scapular skinfold (SSF) thickness, TSF thickness and the abdominal circumference was found to be statistically significant. Of the subjects 23.46% were stunted (i.e. HFA below -2 SD of the WHO standard) and 7.01% were underweight (WFA below -2 SD of the WHO standard). The nutritional status of the Ladakhi population was assessed by comparison with the WHO reference data. Nomograms for anthropometric data in school-going children (4-19 years of age) of Ladakh were created. These can be used for further studies and planning targeted intervention strategies on this geographically isolated and evolutionary distinct highland population.

Nutrition Status of Primary School Students in Two Rural Regions of Guinea-Bissau.

The nutrition status of primary schoolchildren in Africa has received relatively little attention in comparison to that of younger children. We surveyed primary school students in Guinea-Bissau, a nation that is among the poorest in the world. Anthropometry and prevalence of anemia and vitamin A deficiency were assessed in schoolchildren participating in International Partnership for Human Development's school feeding program in 2 regions of Guinea-Bissau. A cross-sectional survey of 32 schools in the regions of Cacheu and Oio was conducted in November 2011. Variables included age, gender, weight, height, hemoglobin, and retinol-binding protein concentrations. Z scores for height for age (HAZ), body mass index for age (BAZ), and weight for age were calculated using World Health Organization reference data. Anthropometric assessment of 4784 students revealed stunting (HAZ < -2) in 15.5%, thinness (BAZ < -2) in 13.2%, and anemia in 42.0%. Stunting, thinness, and anemia were significantly more common in males, in students from Oio, and in older students. Vitamin A deficiency, detected in 21.5% of the population, was the only assessment that did not demonstrate significant differences between genders or regions. About 61.1% of all children had 1 or more indicators of undernutrition. There are substantial rates of stunting, thinness, underweight, anemia, and vitamin A deficiency in primary schoolchildren in Guinea-Bissau, even among those participating in a school lunch program and particularly among males and older students. The results suggest the need for evaluating feeding programs and other methods to improve nutrition status in primary school students, especially in older students.

Relationship between Soft Drink Consumption and Obesity in 9-11 Years Old Children in a Multi-National Study.

The purpose of this study was to determine the association between regular (sugar containing) and diet (artificially sweetened) soft drink consumption and obesity in children from 12 countries ranging in levels of economic and human development. The sample included 6162 children aged 9–11 years. Information on soft drink consumption was obtained using a food frequency questionnaire. Percentage body fat (%BF) was estimated by bio-electrical impedance analysis, body mass index (BMI) z-scores were computed using World Health Organization reference data, and obesity was defined as a BMI > +2 standard deviations (SD). Multi-level models were used to investigate trends in BMI z-scores, %BF and obesity across categories of soft drink consumption. Age, sex, study site, parental education and physical activity were included as covariates. There was a significant linear trend in BMI z-scores across categories of consumption of regular soft drinks in boys (p = 0.049), but not in girls; there were no significant trends in %BF or obesity observed in either boys or girls. There was no significant linear trend across categories of diet soft drink consumption in boys, but there was a graded, positive association in girls for BMI z-score (p = 0.0002) and %BF (p = 0.0001). Further research is required to explore these associations using longitudinal research designs.

Association Between Body Mass Index and Motor Competence in Santal Children of Purulia District, India

ABSTRACTThe purpose of this study was to evaluate the relationship between body mass index and motor competence in Santal children 5–12 years old. A total of 816 Santal children were studied. Children's adiposity status was assessed by body mass index (BMI) for age z-score based on World Health Organization reference data. Motor competence was measured using the Bruininks-Oseretsky Test of Motor Competence (BOT-2). There was no significant difference in mean BMI z-score between Santal boys (0.13 ± 0.07) and girls (−0.14 ± 0.07). Healthy weight (HW) children scored higher (p < .05) in some individual motor subtests (bilateral competence, balance, running speed and agility, upper limb competence, and strength) and in total BOT-2 score (p < .05) compared with scores for underweight (UW) and overweight (OW) children. Nonlinear regression analysis showed that BMI is a significant independent predictor of motor competence (p < .01). Motor competence showed a curvilinear relationship with BMI-z-score, with the lowest point motor scores in strength and upper limb competence (p < .05) for both UW and OW children compared to HW children who scored highest. The results also indicated that gross motor skills, but not fine motor skills, were poorer among children who were UW or OW compared with HW children.

Mid-upper arm circumference as a screening tool for identifying children with obesity: a 12-country study.

No studies have examined if mid-upper arm circumference (MUAC) can be an alternative screening tool for obesity in an international sample of children differing widely in levels of human development. Our aim is to determine whether MUAC could be used to identify obesity in children from 12 countries in five major geographic regions of the world. This observational, multinational cross-sectional study included 7337 children aged 9-11 years. Anthropometric measurements were objectively assessed, and obesity was defined according to the World Health Organization reference data. In the total sample, MUAC was strongly correlated with adiposity indicators in both boys and girls (r > 0.86, p < 0.001). The accuracy level of MUAC for identifying obesity was high in both sexes and across study sites (overall area under the curve of 0.97, sensitivity of 95% and specificity of 90%). The MUAC cut-off value to identify obesity was ~25 cm for both boys and girls. In country-specific analyses, the cut-off value to identify obesity ranged from 23.2 cm (boys in South Africa) to 26.2 cm (girls in the UK). Results from this 12-country study suggest that MUAC is a simple and accurate measurement that may be used to identify obesity in children aged 9-11 years. MUAC may be a promising screening tool for obesity in resource-limited settings.

Nutritional Status of Rural Bengali Adolescent Boys of Tripura

To the Editor: Assessment of nutritional status is significant in developing countries like India where the vast majority of the populations are undernourished and underprivileged. Studies describing the nutritional status of adolescents from northeastern part of India are limited. This community based cross-sectional study was conducted to determine the current nutritional status of rural adolescent Bengali boys of Tripura. A total of 550 school-going Bengali boys (aged 8–16 y) from 30 randomly selected villages, representing the state of Tripura, were included using multistage cluster sampling method. Standing height and body weight were measured; body mass index (BMI) was derived. Age specific prevalences of stunting, thinness, overweight and obesity were calculated according to the classification of World Health Organization (WHO) [1], using the new IAP growth charts [2]. Nutritional status was also assessed using the 2007 WHO growth reference data [3]. These boys had lower socio-economic status. Using the IAP growthcharts [2] as reference,the overall (agecombined) prevalence of stunting (height-for-age <3rd percentile) was found low: 9.09 %. Prevalence across age groups fluctuated from 0 to 21.31 % below the 3rd percentile. The overall prevalence of thinness (i.e., BMI-for-age <5th percentile) was 12 %, which is higher than that of stunting. Prevalence across age groups fluctuated from 6.45 to 16.67 % below the 5th percentile. The overall prevalence of overweight (i.e. ,B MIfor-age ≥23 adult equivalent) was 7.09 %. Prevalence across age groups fluctuated from 1.67 to 11.29 %. The overall age specific prevalence of obesity (i.e., BMI-for-age ≥27 adult equivalent) was very low (0.36 %). The overall prevalence of stunting and thinness (21.15 and 40.32 % respectively) was found higher and overweight (4.30 %) was found lower when WHO reference data [3] was used. The prevalence rate of undernutrition among the boys of the present study was comparatively lower than the urban Bengali boys of Kolkata [4] and rural tribal children of Tripura [5]. In general, the Bengali boys of Tripura had lower rates of undernutrition. The over diagnosis of undernutrition and under diagnosis of overnutrition may be avoided by using the new IAP growth charts. We propose that future studies should use these charts to determine the growth and nutritional status of children and adolescents from India.

Comparing Growth Assessments Using CDC and WHO Reference Data in Native Hawaiian Pacific Islander Children: Baseline Data from the Children's Healthy Living (CHL) Program in Hawaiʻi

In the diverse US Affiliated Pacific Centers for Disease Control (CDC) 2000 and 2006 World Health Organization (WHO) reference data are available to assess child growth. WHO reference data includes children who met recommended breastfeeding guidelines from six countries, while CDC data describes growth of US children where few were breastfed. Baseline data from the CHL program in Hawai'i (n=941) was used to calculate BMI z‐scores and percentiles to compare growth relative to the two reference data sets and identify the role of breastfeeding history, age, sex, and ethnicity on growth assessment. Mean BMI z‐scores calculated with CDC reference data were lower than WHO (z‐score difference=‐0.31, p&lt;0.001). A general linear model on BMI z differences against child age, sex, ethnicity and breastfeeding history showed the difference by CDC reference was greater in boys than girls (z score difference = 0.20, p&lt;0.001). No difference was found by breastfeeding history, age or ethnicity. Kappa statistics showed strong agreement between the two references on CDC defined BMI categories (weighted Kappa=0.50, p&lt;0.001), with percentage of agreement highest for healthy weight (92%), followed by obese (85%), then overweight (76%). CDC and WHO growth reference data samples differ by breastfeeding history and ethnicity; differences between BMI z‐scores calculated from the two reference data sets were not related to either factor. Researchers and practitioners can choose either reference data to analyze BMI and child growth in NHPI children but should be cautious that CDC growth references may underestimate childhood overweight and obesity, and delay early intervention.

Cesarean Delivery and Risk of Childhood Obesity

To investigate whether birth by cesarean delivery rather than vaginal delivery is a risk factor for later childhood obesity. Healthy, full-term infants were recruited. Overweight and obesity were defined using measured weight and height according to World Health Organization reference data. Associations between cesarean delivery and being overweight or obese were investigated at age 2, 6, and 10 years (n = 1734, 1244, and 1170, respectively) by multivariate logistic regression models adjusted for socioeconomic status, child characteristics, and maternal prepregnancy characteristics. Mothers who gave birth by cesarean delivery (∼17%) had a higher mean prepregnancy body mass index (23.7 kg/m(2) vs 22.5 kg/m(2)), greater mean gestational weight gain (15.3 kg vs 14.5 kg), and shorter mean duration of exclusive breastfeeding (3.4 months vs 3.8 months) compared with those who delivered vaginally. The proportion of obese children was greater in the cesarean delivery group compared with the vaginal delivery group at age 2 years (13.6% vs 8.3%), but not at older ages. Regression analyses revealed a greater likelihood of obesity at age 2 years in the cesarean delivery group compared with the vaginal delivery group at age 2 years (aOR, 1.68; 95% CI, 1.10-2.58), but not at age 6 years (aOR, 1.49; 95% CI, 0.55-4.05) or age 10 years (aOR, 1.16; 95% CI, 0.59-2.29). Cesarean delivery may increase the risk of obesity in early childhood. Our results do not support the hypothesis that an increasing rate of cesarean delivery contributes to obesity in childhood.

Growth Curves of Preschool Children in the Northeast of Iran: A Population Based Study Using Quantile Regression Approach

Introduction:Growth charts are widely used to assess children’s growth status and can provide a trajectory of growth during early important months of life. The objectives of this study are going to construct growth charts and normal values of weight-for-age for children aged 0 to 5 years using a powerful and applicable methodology. The results compare with the World Health Organization (WHO) references and semi-parametric LMS method of Cole and Green.Methods:A total of 70737 apparently healthy boys and girls aged 0 to 5 years were recruited in July 2004 for 20 days from those attending community clinics for routine health checks as a part of a national survey. Anthropometric measurements were done by trained health staff using WHO methodology. The nonparametric quantile regression method obtained by local constant kernel estimation of conditional quantiles curves using for estimation of curves and normal values.Results:The weight-for-age growth curves for boys and girls aged from 0 to 5 years were derived utilizing a population of children living in the northeast of Iran. The results were similar to the ones obtained by the semi-parametric LMS method in the same data. Among all age groups from 0 to 5 years, the median values of children’s weight living in the northeast of Iran were lower than the corresponding values in WHO reference data. The weight curves of boys were higher than those of girls in all age groups.Conclusion:The differences between growth patterns of children living in the northeast of Iran versus international ones necessitate using local and regional growth charts. International normal values may not properly recognize the populations at risk for growth problems in Iranian children. Quantile regression (QR) as a flexible method which doesn’t require restricted assumptions, proposed for estimation reference curves and normal values.

Physical growth in children with transfusion-dependent thalassemia

correspondence: Harish K Pemde Department of Pediatrics, Lady Hardinge Medical college, Kalawati saran children’s Hospital, Bangla sahib Marg, new Delhi 110001, india Tel +91 11 23363432 Fax +91 11 23365792 email harishpemde@gmail.com Objective: To describe physical growth and related factors in transfusion-dependent thalassemia patients. Methods: This is a cross-sectional analysis of the records of the patients registered at and being followed up by the Thalassemia Day Care Center (TDCC) at Kalawati Saran Children’s Hospital, New Delhi, India. Clinical and laboratory parameters were recorded on a spreadsheet for analysis. Clinical parameters included weight, height, sexual maturity ratings, and general and systemic physical examination. Laboratory parameters included pretransfusion hemoglobin (Hb), periodic serum ferritin, and tests for viral markers of human immunodeficiency virus (HIV) and hepatitis B and C. Z-scores for weight, height, and body mass index (BMI) were calculated using World Health Organization reference data. Statistical analysis was carried out using Microsoft Excel and Stata software. Results: Out of 214 patients registered at the TDCC since 2001, 154 were included in this study. The mean age of patients was 9.19 years (range 0.5–20 years). Pretransfusion Hb was well maintained (mean 9.21 g/dL; 95% confidence interval [CI]: 9.06–9.36), but the mean serum ferritin levels were approximately three times (3112 ng/mL) the desired value despite the patients being on deferiprone (72%) or deferasirox (25%). One-third (33.11%) of the patients had short stature, 13% were thin, and 10.82% were very thin (BMI z-score ,-3). No patient was overweight or obese. Linear regression coefficient showed that for every 1-year increase in age, the mean ferritin value increased by 186.21 pg/mL (95% CI: 143.31–228.27). Height z-scores had significant correlation with mean ferritin levels, whereas correlation with mean pretransfusion Hb was not significant statistically. Mean ferritin levels were significantly higher in patients with short stature than in the patients with normal height. Regression analysis showed that an increase of 3571 units of serum ferritin was associated with a decrease of one point in height z-scores. One-fifth (19.40%) of adolescent patients had delayed puberty. Conclusion: Approximately one-third (33.11%) of patients with transfusion-dependent thalassemia major were of short stature. In this group of patients with pretransfusion Hb levels maintained at desired levels, physical growth was correlated with status of iron overload.