Growth standard curves of birth weight, length and head circumference of Chinese newborns of different gestation / 中华儿科杂志

To study and formulate the growth standards for birth weight, length and head circumference of Chinese newborns of different gestation. A cross-sectional survey was carried out by the stratified cluster sampling method from June 2015 to November 2018 in 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha and Shenzhen. A total of 24 375 newborns with gestational age between 24 to 42 weeks were included. The standard percentile-curves of birth weight, length and head circumference for newborn boys and girls in gestational weeks 24 to 42 were established by the generalized additive model for location, scale and shape (GAMLSS). The new reference standard developed in this study was compared with the reference values of China in 1988 and the international Fenton 2013. Among the 24 375 newborns (13 197 males (54.1%),11 178 females (45.9%)), 12 264 were preterm infants and 12 111 were full term infants. The 3(rd), 10(th), 25(th), 50(th), 75(th), 90(th) and 97(th) percentile reference values and curves of birth weight, length and head circumference were obtained for male and female newborns from 24 to 42 gestation weeks. The data showed that birth weight, length and head circumference increased rapidly with the gestational age, but the growth velocity decreased slightly from 37 weeks. For example, the median birth weight for males at 28 weeks, 32 weeks, 37 weeks and 40 weeks was 1 154, 1 805, 2 943 and 3 455 g, respectively. The birth weight, length and head circumference of males at all gestational ages were 87-133 g, 0.2-0.9 cm and 0.3-0.6 cm higher than those of females, respectively. Compared with the percentile curves of birth weight of Chinese reference in 1988, there were significant differences regarding the percentile lines of males and females, especially the 10(th), 50(th), and 90(th) percentile values of birth weight were significantly higher than the reference values in 1988 from 37 to 42 gestation weeks. For example, the median birth weight at 40 weeks in the study was 115-242 g higher than that in 1988. Compared with the standard reference of Fenton 2013, the reference curve at 50(th) percentile of birth weight in this study was 13-81 g slightly higher than that of Fenton 2013 before 33 weeks, and then it was gradually lower than that of Fenton 2013 and the difference was 148-367 g at 41 to 42 weeks of gestation. The 10(th) percentile curve of Fenton 2013 was 11-64 g lower than that of this study in both males and females before 40 weeks. This study created a new national growth standard of birth weight, body length and head circumference for Chinese neonates at 24 to 42 weeks of gestation, which can be used for the growth and nutrition evaluation of newborns at birth and preterm infants in the early postnatal period. The 10(th) percentile and the 3(rd) percentile of growth standards could be suggested as the cut-off point for identifying small for gestational age and severe small for gestational age, respectively.

Nutritional status of Children under Five Years of Age in a Rural Area of Pondicherry

Introduction: Malnutrition among children below 5 years hasserious long-term consequences. Three out of every 10 stuntedchildren in the world are in India. The objective of the studywas to assess malnutrition among under five years children ina rural community.Material and Methods: A community based cross-sectionalstudy was undertaken to assess the nutritional status ofchildren below 5 years by anthropometry. Weight for age,height for age and weight for height was calculated usingWHO growth standards.Results: The prevalence of underweight, stunting and wastingin the study population 18.3%, 31.6% and 20.1% respectively.Proportion of moderate and severe underweight and wastingwas highest in the age group of 11-23 months while proportionof moderate and severe stunting was highest in the age groupof 48-59 months.Conclusions: Malnutrition is a common problem in childrenbelow 5 years of age, especially chronic malnutrition

Regional variation in maternal and childhood undernutrition in Bangladesh: evidence from demographic and health surveys.

Background: Undernutrition among mothers and children is currently a major public health and development concern in Bangladesh. In literature relating to nutritional determinants, of particular interest is the geography, as regions with poor nutrition tend to pull down the overall nutritional status of the country. As such, reducing the regional gap can alone reduce overall undernutrition significantly, especially when regional gaps are high. The aim of this study is, therefore, to assess the magnitude of inequalities in undernutrition in children aged under 5 years in Bangladesh and their mothers, and relate this to the administrative divisions of the country. Methods: The Bangladesh Demographic and Health Surveys (1996–1997, 1999– 2000, 2004 and 2007) were the sources of data, and a total of 16 278 mother–child pairs whose records were complete for the required individual and household-level variables were included in the analysis. Maternal nutritional status was measured by the body mass index (BMI). Weight-for-age, height-for-age and weight-forheight z-scores were calculated by use of the World Health Organization (WHO) Child Growth Standards to assess the nutritional status of children aged under 5 years. General linear model, sequential linear and multinomial logistic regression analyses were done to assess the inequalities in maternal and child nutritional status among the six administrative divisions of Bangladesh. Socioeconomic variables that were controlled for were residency, education and occupation of the mothers and their husbands, house type and possession score in the household. Results: Maternal BMI and prevalence of underweight, stunting and wasting in children aged under 5 years were found to vary significantly according to administrative division. Of the six divisions, Sylhet was found to have highest prevalence of undernourished mothers and children. The trends from 1996 to 2007 also established Sylhet as the poorest-performing region overall. Conclusion: The Sylhet administrative division needs specially focused attention from policy-makers if the overall performance of the health, nutrition and population sector is to reach the targets set by the country.

The comparison of wasting, stunting, low weight, and overweight rate in infants by using the World Health Organi-zation Child Growth Standards and China Growth Standards / 临床儿科杂志

Objectives To compare the 2006 World Health Organization (WHO) growth standards and the 2005 China national growth standards for identification of the wasting, stunting, low weight and overweight in infants. Methods Data were drawn from“Infants’feeding and growth”project. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. Stunting was defined as having a length-for-age Z-score less than-2. Low weight was defined as having a weight-for-age Z-score less than-2. Wasting was defined as having a weight-for-length Z-score less than-2. Overweight was defined as having a weight-for-length Z-score more than+2. Results Data of a total of 3909 records from 959 health children aged from 2 to 12 months from June 2008 to May 2009 were analyzed. Of them, 53.88%(2106/3909)were from male and 46.12%(1803/3909)were from female. There was no difference in wasting rate and stunting rate between using two growth references. Fewer infants were identified as low weight by using WHO growth standard than using China growth stan-dard. The results were 0.57%at 0-3 months (0.85%vs.1.42), P>0.05, 0.72%at 4-6 months (0.39%vs. 1.11%) and 0.97%at 7-9 months (0.79% vs.1.76%), P0.05). Con-clusion Some differences were found in low weight and overweight rate by using two growth standards. Infant low weight rate was lower and overweight rate was higher by using WHO growth standard than that using China growth standard.

Reappraisal of Regional Growth Charts in the Era of WHO Growth Standards / 대한소아소화기영양학회지

After the WHO Growth Standards (WHOGS) was published in 2006, many countries in the world endorsed and adopted the new growth references as a standard measure for the growth of infants and young children. Certainly, the WHOGS has an impact on the global policy about obesity and underweight in children. Such WHOGS innovation has influenced many regional health authorities and academies, which have managed their own growth charts for a long time, in changing their strategies to develop and use regional growth charts. In Korea, along with the tradition to create a national growth chart every decade, we now face a new era of advancing with the WHOGS.

Clasificación de niños colombianos con desnutrición según la referencia NCHS o el estándar OMS

Se realizó un estudio descriptivo para evaluar la concordancia en la clasificación de niños colombianos con desnutrición según la referencia del National Center for Health Statistics (NCHS) y los estándares de la Organización Mundial de la Salud (OMS). Participaron 660 niños entre 0 y 59 meses con desnutrición aguda moderada (P/TZ<-2) y grave (P/TZ<-3 o edematizados), en recuperación nutricional hospitalaria entre 2000 y 2009. Se analizaron los indicadores talla para la edad (T/E) al ingreso y peso para la talla al ingreso (P/Tin) y egreso (P/Teg). Se compararon medias con la prueba t de Student pareada; la concordancia entre NCHS y OMS se estimó con Coeficiente de Correlación Intraclase (CCI) y el Índice Kappa; se evaluó el cambio de clasificación de los niños según el instrumento utilizado, con prueba de McNemar. Los instrumentos mostraron alta concordancia en los indicadores T/E (CCI=0,988; k=0,866) y P/Tin (CCI=0,901; k=0,578). Del total de niños clasificados con T/E normal por NCHS, 10,4% se clasificaron con retraso del crecimiento según OMS. Al ingreso 64,0% de los niños presentó desnutrición aguda moderada según NCHS, de éstos 44,8% clasificaron con emaciación severa según OMS, en consecuencia aumentó la emaciación severa de 36,0% hasta 63,3% con OMS. De los niños que egresaron 5% necesitarían más días de hospitalización si hubieran sido evaluados con OMS. En conclusión los estándares OMS captan más niños desnutridos y formas más severas de emaciación y baja talla, con su uso se espera hospitalizar más niños para recuperación nutricional y por más días.

A descriptive study was conducted to evaluate the concordance of National Center for Health Statistics reference (NCHS) used to classify undernourished children from Colombia with the WHO Child Growth Standards. We used data from children aged 6 to 59 months with acute malnutrition (Z <-2) and severe (Z <-3) who were admitted to the “Unidad Vida Infantil” nutrition program in Colombia. Indicators height-for-age, weight for-height were analyzed when they were admitted to the hospital and weight for-height leaving the hospital. A statistical method used to compare means was T-student. Correlation coefficient intraclass (CCI) and Kappa index evaluated the concordance between NCHS and OMS; McNemar method evaluated the changes on the nutritional classification for children according to growth devices used. Of the total number of children classified as normal by NCHS, 10.4% were classified as stunted by WHO. 64% of the children admitted to the hospital presented acute malnutrition according to NCHS, of these 44,8% presented severe emaciation according to OMS, indeed severe emaciation increased of 36,0% to 63,3% using OMS. 5% of children leaving the hospital could need to stay more days if they had been evaluated with OMS. Growth devices shown high concordance in height-for-age (CCI=0,988; k=0,866) and weight for-height (CCI=0,901; k=0,578). Concluded that OMS growth standards classified more malnourished children and more severe states, in addition more malnourished children could be hospitalized and they could stay more days.

Growth Pattern of Schoolchildren in Sagamu, Nigeria Using the CDC Standards and 2007 WHO Standards.

Objective: To compare the median weight, height and body mass index of school children with the 2000 CDC and 2007 WHO reference values. Settings: Schoolchildren in Sagamu, Nigeria. Design: Cross-sectional survey. Methods: Between November and December, 2008, 1690 school children aged 6 to 16 years from 8 primary schools were surveyed using multi-stage sampling methods. The weight, height and body mass index (BMI) were recorded for each child. The Z-scores of the median anthropometric parameters for each age and sex were determined with the LMS statistical method using the values of L, M and S provided on the CDC and WHO charts. Results: The weight, height and BMI Z-scores were less than the reference values provided on the CDC and WHO charts but were generally closer to the WHO standards compared to the CDC standards. The median weight, height and BMI for females generally plotted higher on CDC and WHO chart compared to the males. The prevalence of underweight and stunting were relatively lower while the prevalence of overweight and obesity was relatively higher among children aged 6 to 10 years using the WHO references compared to the CDC reference values. Conclusions: The WHO references would underdiagnose under-nutrition and over-diagnose overweight/ obesity in the population studied.

Assessment of nutritional status in Indian preschool children using WHO 2006 Growth Standards.

Background & objectives: This study attempts to compare the pattern of growth of Indian children as assessed by weight for age, height for age and BMI for age with the WHO standards for growth (2006) and to explore the implications of differences in undernutrition rates in the 0-59 months of age group as assessed by these three indices. Methods: From the National Family Health Survey -3 database, growth curves for height, weight and BMI for age in Indian preschool children were computed using LMS software and compared with the WHO (2006) standards. Using the WHO (2006) standards, trends in prevalence of undernutrition as assessed by height, weight and BMI for age in the 0-59 month age group were computed. Results: During the first three months there was no increase in underweight and stunting rates. There was progressive increase in underweight and stunting rates between 3-23 months of age. Low BMI for age and wasting rates were highest at birth. Interpretation & conclusions: Poor growth is an adaptation to chronic low energy intake and stunting is a measure of cumulative impact of chronic energy deficiency on linear growth. It is important to prevent stunting because it is not readily reversible. Low BMI is an indictor of current energy deficit. Early detection of energy deficit using BMI for age and expeditious interventions to correct the deficit might be effective in prevention of stunting.

Avance de la Junta Nacional de Jardines Infantiles en la incorporación de los estándares de crecimiento OMS 2006 / Transition of the chilean national nursery schools council program (JUNJI) to the use of who 2006 growth standards

This article describes the process of implementation of WHO growth standards in the Chilean National Nursery Schools Council Program (JUNJI) and how will influence the beneficiary's nutritional status estimates. Using the 2009 anthropometric data collected by the program, we compare nutritional estimates using the NCHS 1978 reference and the WHO 2006 growth standards. The use of the new WHO growth standards will determine a decrease in under nutrition (weight for height z score < -2 DS) in infants from 1.1 to 0.5 percent while in all children less than 5y of age will increase stunting (height for age z score < -2 SD; from 5.7 to 7.3 percent in children less than 2y and from 2.3 to 4.2 percent in children 2 to 5y), and overweight (weight for height > lSD from 19.6 to 29 percent in children less than 2y, and from 20.6 to 28.9 in children 2 to 5y) and obesity (weight for height>2 SD; from 8.2 to 11.4 percent in children less than 2y and from 8.3 to 13.5 percent in children 2 to 5y ). The WHO growth standards describe the growth of children that receive optimal feeding and that live in optimal conditions. The implementation of the WHO growth curves at the JUNJI program is taken place in a sequential and well-planned way that will allow not only to optimize growth monitoring at the program but also to promote short and long-term health of the beneficiaries.

En el presente artículo se describe el proceso de implementación de las nuevas curvas de crecimiento OMS a la Junta Nacional de Jardines Infantiles de Chile (JUNJI) y el efecto que tendrá esta incorporación en las estimaciones del estado nutricional de los beneficiarios. En base a la información antropométrica recolectada en el programa durante el año 2009 se realiza una comparación entre la referencia NCHS 1978 y las OMS 2006 y se muestra que con las nuevas curvas disminuirá la prevalencia de desnutrición (peso para la talla <-2 DS) en los lactantes de 1.1a 0.5 por ciento mientras que en todos los menores de 5 años aumentará la prevalencia de talla baja (< -2DS; de 5.7 a 7.3 por ciento en menores de 2 años y de 2.3 a 4.2 por ciento de 2 a 5 años), y de sobrepeso (> 1 DS peso talla, de 19.6 a 29.0 por ciento en menores de 2 años y de 20.6 a 28.9 por ciento de 2 a 5 años) y obesidad (> 2 DS peso talla, de 8.2 a 11.4 por ciento en menores de 2 años y de 8.3 a 13.5 por ciento de 2 a 5 años). Los estándares de crecimiento OMS describen la forma en que debieran crecer los niños de cualquier parte del mundo si es que fueran alimentados y vivieran en condiciones óptimas. Su implementación en la JUNJI, de manera programada y secuencial, permitirá optimizar el monitoreo del crecimiento de los beneficiarios promoviendo una mejor salud en el corto y largo plazo.

Avaliação antropométrica e análise dietética de pré-escolares em centros educacionais municipais no sul de Minas Gerais / Anthropometric evaluation and food intake of preschool children at municipal educational centers, in South of Minas Gerais State, Brazil

Objetivou-se avaliar as condições socioeconômicas, o estado nutricional e o consumo alimentar de pré-escolares assistidos pelos Centros Educacionais Municipais (CEM) de Alfenas (MG). Foi realizado um estudo transversal, com 186 crianças. Avaliou-se o perfil socioeconômico, peso, estatura, idade, sexo e o consumo alimentar pelo instrumento de pesagem direta dos alimentos. Observou-se renda familiar de um a três salários mínimos, ensino fundamental incompleto, casa própria com saneamento básico, quatro a cinco habitantes por domicílio, dos quais, na maioria dois trabalhavam. A média de idade foi de 49,2 ± 12,9 meses. A baixa estatura foi o desvio nutricional mais prevalente (20,5 por cento). 72,6 por cento das crianças apresentaram ingestão energética abaixo da necessidade energética estimada (EER). Ao estratificar por faixa etária, de um a três anos, 78,4 por cento das crianças apresentaram ingestão acima da EER e de quatro a seis anos, 74,1 por cento apresentaram ingestão abaixo da EER. Todas as crianças apresentaram baixo consumo de cálcio e a maioria apresentou consumo abaixo da necessidade média estimada (EAR) para ferro. Apesar de alguns fatores biossocioeconômicos serem favoráveis, os desvios nutricionais e a ingestão inadequada de nutrientes estavam presentes, tornando-se necessária implementação de programa de controle nutricional nos CEM.

The objective of this article is to evaluate socioeconomic conditions, nutritional status and food intake of preschool children assisted at Municipal Educational Centers (CEMs) of Alfenas, Minas Gerais State, Brazil. A transverse study involving 186 children was performed. The socioeconomic profile, weight, height, age, sex and food intake by a direct weighting tool were evaluated. It was observed an income family of one to three minimum wages, incomplete fundamental learning, private house with basic sanitation, four to five inhabitants per house of whom two worked at most. The average age was 49.2 ± 12.9 months. The stunting rates were more prevalent among the children (20.5 percent). The whole, 72.6 percent of children have energy intake below Estimated Energy Intake (EER). However, when stratifying for age group, 78.4 percent of the children from 1 to 3 years old have high energy intake and 74.1 percent from 4 to 6 years old have inadequate energy intake. All children presented consumption below the Adequate Intake (AI) of calcium and most of them below to Estimated Average Requirement (EAR) of iron. Despite some biosocioeconomic factors be favorable to the nutritional status, malnutrition, and inadequate nutrient intake were present, which demanded the implementation of nutritional programs in CEMs.