Undernutrition in children & critical windows of opportunity in Indian context

It is intriguing to note that majority of the wasting among the under 5 yr in India is present at birth. The National Family Health Survey 4 (NFHS-4) data analysis shows 31.9 per cent wasting at birth, which is decreasing to 17.7 per cent in the under five children; clearly suggesting that any reduction in wasting should come from improvement in foetal growth. In addition, children with both severe wasting and severe stunting, in whom the risk of mortality increases many folds, are <1 per cent in almost all the States; and these are the children in whom special care is required under the community-based management of severe acute malnutrition. This article presents an overview of nutrition status in children, their antecedents, and the critical phases; especially, nutrition status before pregnancy that plays a crucial role in all the nutrition status indicators of children. More attention on the critical phases is crucial to maximize the benefits from national programmes.

Association between picky eating behaviors and growth in preschool children / 한국영양학회지

This study was conducted in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. In this study, picky eating behaviors were defined as containing four constructs of 'eating a small amount (ES),' 'neophoic behavior (NB),' 'refusal of specific food groups (RF),' and 'preference for specific food-preparation methods (PP).' A 7-point scale was used for the multi-item questionnaire, which consisted of 21 items (three items for ES, two items for NB, nine items for RF, and seven items for PP), in order to evaluate picky eating behaviors of children. Subjects were recruited among visitors at a medical clinic in Seoul. A total of 150 self-administered survey responses from parents of preschool children were analyzed in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. Height for age (HFA) and weight for height (WFH) z-scores were used for assessment of preschool children's growth. The prevalence of ES, NB, RF, and PP was 44%, 57%, 73%, and 53%, respectively. Children with ES had lower HFA (p < 0.05) and WFH (p < 0.0001) than those without ES, while children with NB, RF, or PP had HFA and WFH were similar to their counterparts. The mean HFA z-score of children with ES was less than 0 (p < 0.05) and the mean WFH z-scores of children with ES, NB, RF, or PP were less than 0 (p < 0.05). According to the study results, related growth outcome differed depending on constructs of picky eating behaviors. In particular, picky eating of ES showed a risk of faltering height growth in preschool children. Further comprehensive studies on the reason for ES and intervention approach is warranted.

Pattern of Growth Faltering and Recovery in Under-5 Children in India Using WHO Growth Standards - A Study on First and Third National Family Health Survey.

Objective: To examine the pattern of growth faltering in preschool children, using World Health Organization (WHO) growth standards 2006 from the available datasets of first and third National Family Health Survey (NFHS 1 and 3). Design: Data-analysis of two large-scale cross-sectional surveys done at a gap of 15 years. Setting: General community. Subjects: Preschool children included in NFHS 1 (n = 37,768) and NFHS 3 (n = 41,306). Main outcome measures: Weight for age Z-scores (WAZ), height for age Z scores (HAZ) and weight for height Z scores (WHZ) based on WHO growth standards for the first four years of life. Results: Mean WAZ score at ‘0’ month during first and third surveys were -1.15 (n=268) and -0.76 (n=184), respectively. Of the total growth faltering in weight for age Z (WAZ) score by the end of third year, 55% and 44% of the growth faltering was already present at birth for the first and third survey, respectively. There was no change in weight for height Z (WHZ) score for the first three years during both the surveys. Conclusions: A good part of the total growth faltering in India has already taken place at birth. Much of the growth faltering in early life can be attributed to faltering in HAZ scores or stunting. Understanding the causal role of stunting and its prevention as well as improving birth weight appears to be the key for better efficacy of public health programs in preventing under-5 malnutrition in India.