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Kruger HS, Visser M, Malan L, Zandberg L, Wicks M, Ricci C, Faber M. Anthropometric nutritional status of children (0-18 years) in South Africa 1997-2022: a systematic review and meta-analysis. Public Health Nutr 2023; 26:2226-2242. [PMID: 37800336 DOI: 10.1017/s1368980023001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To conduct a comprehensive systematic review and meta-analysis of the available literature on the anthropometric nutritional status of South African infants and children, 0-18 years old and to report on trends of changes in nutritional status over the period 1997-2022. DESIGN Systematic review and meta-analysis. SETTING Review of the available literature on the anthropometric nutritional status of South African infants and children, 0-18 years old, over the period 1997-2022. PARTICIPANTS South African infants and children, 0-18 years old. RESULTS Only quantitative data from ninety-five publications that described the nutritional status in terms of anthropometry were included. Most recent studies applied the WHO 2006 and 2007 definitions for malnutrition among children 0-5 years old and 5-19 years old, respectively. Meta-analysis of all prevalence data shows the highest stunting prevalence of 25·1 % among infants and preschool children, compared to 11·3 % among primary school-age children and 9·6 % among adolescents. Furthermore, the overweight and obesity prevalence was similar among children younger than 6 years and adolescents (19 %), compared to 12·5 % among primary school-age children. In national surveys, adolescent overweight prevalence increased from 16·9 % in 2002 to 23·1 % in 2011. Meta-regression analysis shows a decrease in stunting among children 6-18 years old and an increase in combined overweight and obesity in the 10-19 years age group. CONCLUSION The double burden of malnutrition remains evident in South Africa with stunting and overweight/obesity the most prevalent forms of malnutrition among children.
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Affiliation(s)
- Herculina Salome Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
- Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Marina Visser
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Mieke Faber
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Bocquet A, Brancato S, Turck D, Chalumeau M, Darmaun D, De Luca A, Feillet F, Frelut ML, Guimber D, Lapillonne A, Linglart A, Peretti N, Rozé JC, Simeoni U, Briend A, Dupont C, Chouraqui JP. "Baby-led weaning" - Progress in infant feeding or risky trend? Arch Pediatr 2022; 29:516-525. [PMID: 36109286 DOI: 10.1016/j.arcped.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/12/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Baby-led weaning (BLW), proposed as a new form of complementary feeding, has emerged as a real trend phenomenon in the media. Infants are seated at the family table from the age of 6 months, facing the foods they grab and bring to their mouth: they decide which foods they want to eat and what amount. The consumption of mashed foods and the use of a spoon are totally discouraged. BLW is increasingly used in nurseries and centers of young children. A bibliographic search carried out between 2000 and 2021 found 423 articles, of which 38 were selected. The clinical studies selected are 11 cross-sectional observational studies and two randomized controlled studies. BLW promotes breastfeeding, the early introduction of morsels, the respect of the child's appetite, the use of unprocessed foods, and the choice of "homemade" and friendliness. These benefits can nonetheless be reached with usual complementary feeding (SCF), according to current recommendations. Other benefits are claimed without scientific evidence such as easier achievement of dietary complementary feeding and an optimal growth with prevention of excess weight gain. BLW has some obvious downsides. The infant may not get enough energy, iron, zinc, vitamins, and other nutrients, or too much protein, saturated fat, salt, or sugar. The risk of choking, which must be distinguished from the physiological gagging reflex, has not been ruled out by scientific studies. Currently, the Nutrition Committee of the French Pediatric Society considers that the data published to date in terms of benefits and risks of BLW do not lend themselves to advice for this practice in preference over SCF carried out according to current recommendations.
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Affiliation(s)
- A Bocquet
- Université de Franche-Comté, 25000 Besançon, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France.
| | - S Brancato
- Cabinet de pédiatrie, 4, rue du puits Descarsses, 30190 Brignon, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France
| | - D Turck
- Université de Lille, INFINITE-Inserm U1286, 59000 Lille, France
| | - M Chalumeau
- Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker - Enfants malades, AP HP, France; Centre of Research in Epidemiology and Statistics (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team, INSERM; Université de Paris, Paris, France
| | - D Darmaun
- Inra UMR1280, Université Nantes-Atlantique, 44300 Nantes, France
| | - A De Luca
- Université de Tours, 37000 Tours, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Cabinet de pédiatrie, 16, rue Septfonds, 81000 Albi, France; Association française de pédiatrie ambulatoire, 30, rue Émile-Zola, 45000 Orléans, France
| | - D Guimber
- Université de Lille, 59000 Lille, France
| | - A Lapillonne
- Université de Paris,EA7328,AP-HP, hôpital Necker-Enfants-Malades, 75015 Paris, France
| | - A Linglart
- AP-HP, Université Paris Saclay, endocrinologie et diabète de l'enfant, Hôpital Bicêtre, le Kremlin Bicêtre, France
| | - N Peretti
- Université de Lyon, Hospices Civils de Lyon, CaRMEN, 69000 Lyon, France
| | - J-C Rozé
- Inra UMR1280, Université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Université of Lausanne, CHUV, 1011 Lausanne, Switzerland
| | - A Briend
- Institut de Recherche Pour le Développement, 13002 Marseille, France
| | - C Dupont
- Université de Paris 75015 Paris, France; Clinique Marcel-Sembat, 92100 Boulogne-Billancourt, France
| | - J-P Chouraqui
- Gastro-entérologie et nutrition pédiatriques DMCP, CHUV, rue du Bugnon, 46, 1011 Lausanne, Switzerland
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- Hôpital Necker - Enfants-Malades (NEM), 149, rue de Sèvres, 75015 Paris, France
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The risk of infectious pathogens in breast-feeding, donated human milk and breast milk substitutes. Public Health Nutr 2020; 24:1725-1740. [PMID: 32539885 DOI: 10.1017/s1368980020000555] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This review collates the published reports that focus on microbial and viral illnesses that can be transmitted by breast milk, donor milk and powdered infant formula (PIF). In this context, we attempt to define a risk framework encompassing those hazards, exposure scenarios, vulnerability and protective factors. DESIGN A literature search was performed for reported cases of morbidity and mortality associated with different infant feeding modes. SETTING Exclusive breast-feeding is the recommended for infant feeding under 6 months, or failing that, provision of donated human milk. However, the use of PIF remains high despite its intrinsic and extrinsic risk of microbial contamination, as well as the potential for adverse physiological effects, including infant gut dysbiosis. RESULTS Viable pathogen transmission via breast-feeding or donor milk (pasteurised and unpasteurised) is rare. However, transmission of HIV and human T-cell lymphotropic virus-1 is a concern for breast-feeding mothers, particularly for mothers undertaking a mixed feeding mode (PIF and breast-feeding). In PIF, intrinsic and extrinsic microbial contamination, such as Cronobacter and Salmonella, remain significant identifiable causes of infant morbidity and mortality. CONCLUSIONS Disease transmission through breast-feeding or donor human milk is rare, most likely owing to its complex intrinsically protective composition of human milk and protection of the infant gut lining. Contamination of PIF and the morbidity associated with this is likely underappreciated in terms of community risk. A better system of safe donor milk sharing that also establishes security of supply for non-hospitalised healthy infants in need of breast milk would reduce the reliance on PIF.
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Breast feeding and growth trajectories: importance of the time frame of observation. Pediatr Res 2020; 87:436-437. [PMID: 31683274 DOI: 10.1038/s41390-019-0617-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 11/09/2022]
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Reyes M, Burrows R, Blanco E, Lozoff B, Gahagan S. Greater early weight gain and shorter breastfeeding are associated with low adolescent adiponectin levels. Pediatr Obes 2018; 13:277-284. [PMID: 28303690 PMCID: PMC5600663 DOI: 10.1111/ijpo.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/06/2016] [Accepted: 01/05/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Early life factors can programme future risk for cardiovascular disease. OBJECTIVES We explored associations between adolescent adiponectin levels and concomitant metabolic alteration and also looked at the association between early life factors and adolescent adiponectin levels. METHODS We studied a longitudinal cohort of low-income to middle-income Chilean adolescents who were enroled in an infancy iron-deficiency anaemia preventive trial and follow-up studies at the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile. In the 577 adolescents who were assessed as part of the 16-year follow-up, we evaluated independent associations between adiponectin levels and metabolic disturbances during adolescence. We also assessed the association between early life factors [short breastfeeding {<6 months} and infancy weight gain] and adolescent adiponectin levels. RESULTS Participants were 16.8 years old (16.4-18.1), 48% female and 38% overweight/obese. Adolescent adiponectin levels were inversely associated with metabolic disturbances: altered homeostatic model assessment of insulin resistance and high-density lipoprotein cholesterol [odds ratios {95% confidence interval} = 0.87 {0.79-0.95}, p-value = 0.002, and 0.90 {0.87-0.94}, p-value < 0.001, respectively], adjusting for sex and fat mass index. Early life factors were independently associated with adolescent adiponectin levels, which decreased 0.88 ug mL-1 per each unit increase in weight-for-age z-score between 0 and 6 months and was 1.58 ug mL-1 lower among participants with short breastfeeding. CONCLUSIONS Higher adolescent adiponectin levels were independently associated with lower odds of metabolic disturbances. Greater weight gain during infancy and shorter breastfeeding were associated with lower adolescent adiponectin levels, supporting research indicating early life as a window of opportunity for prevention of later cardiovascular alterations. © 2017 World Obesity Federation.
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Affiliation(s)
- Marcela Reyes
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Raquel Burrows
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Estela Blanco
- Division of Child Development and Community Health, Department of Pediatrics, University of California, San Diego, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
| | - Sheila Gahagan
- Division of Child Development and Community Health, Department of Pediatrics, University of California, San Diego, USA,Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
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Huang X, Chang J, Feng W, Xu Y, Xu T, Tang H, Wang H, Pan X. Development of a New Growth Standard for Breastfed Chinese Infants: What Is the Difference from the WHO Growth Standards? PLoS One 2016; 11:e0167816. [PMID: 27977706 PMCID: PMC5158189 DOI: 10.1371/journal.pone.0167816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/21/2016] [Indexed: 11/18/2022] Open
Abstract
The objectives of this longitudinal study were to examine the trajectory of breastfed infants' growth in China to update growth standards for early childhood, and to compare these updated Chinese growth standards with the growth standards recommended by the World Health Organization (WHO) in 2006.This longitudinal cohort study enrolled 1,840 healthy breastfed infants living in an "optimal" environment favorable to growth and followed up until one year of age from 2007 to 2010. The study subjects were recruited from 60 communities in twelve cities in China. A participating infant's birth weight was measured within the first hour of the infant's life, and birth length and head circumference within 24 hours after birth. Repeated weekly and monthly anthropometric measurements were also taken. Multilevel (ML) modelling via MLwiN2.25 was fitted to estimate the growth curves of weight-for-age (WFA), length-for-age (LFA), and head circumference-for-age (HFA) for the study sample as a whole and by child sex, controlling for mode of delivery, the gravidity and parity of the mother, infant's physical measurements at birth, infant's daily food intaking frequency per day, infant's medical conditions, the season when the infant's physical measurement was taken, parents' ages, heights, and attained education, and family structure and income per month. During the first four weeks after birth, breastfed infants showed an increase in weight, length, and head circumference of 1110g, 4.9 cm, and 3.2 cm, respectively, among boys, and 980 g, 4.4 cm, and 2.8 cm, respectively, among girls. Throughout infancy, the total growth for these three was 6930 g, 26.4 cm, and 12.5 cm, respectively, among boys, and 6480 g, 25.5 cm, and 11.7 cm, respectively, among girls. As expected, there was a significant sex difference in growth during the first year. In comparison with the WHO growth standards, breastfed children in our study were heavier in weight, longer in length, and bigger in head circumference, with the exception of a few age points during the first two to four months on the upper two percentile curves.Our data suggested the growth curves for breastfed infants in China were significantly different in comparison with those based on the WHO standards. The adoption of the WHO infant growth standards among Chinese infants, as well as the methods used in the development of such growth standards in China, need careful and coordinated consideration.
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Affiliation(s)
- Xiaona Huang
- Department of Children Health, National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Jenjen Chang
- Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis. MO, United States of America
| | - Weiwei Feng
- Department of Children Health, National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Yiqun Xu
- Department of Children Health, National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Tao Xu
- Department of Children Health, National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - He Tang
- Department of Children Health, National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Huishan Wang
- Department of Children Health, National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
- * E-mail:
| | - Xiaoping Pan
- Department of Epidemiology, National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
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Rolland-Cachera MF, Akrout M, Péneau S. Nutrient Intakes in Early Life and Risk of Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060564. [PMID: 27275827 PMCID: PMC4924021 DOI: 10.3390/ijerph13060564] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 02/08/2023]
Abstract
There is increasing evidence that environmental factors in early life predict later health. The early adiposity rebound recorded in most obese subjects suggests that factors promoting body fat development have operated in the first years of life. Birth weight, growth velocity and body mass index (BMI) trajectories seem to be highly sensitive to the environmental conditions present during pregnancy and in early life (“The first 1000 days”). Particularly, nutritional exposure can have a long-term effect on health in adulthood. The high protein-low fat diet often recorded in young children may have contributed to the rapid rise of childhood obesity prevalence during the last decades. Metabolic programming by early nutrition could explain the development of later obesity and adult diseases.
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Affiliation(s)
- Marie Françoise Rolland-Cachera
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
| | - Mouna Akrout
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
| | - Sandrine Péneau
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche en Epidémiologie et Statistiques, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, Bobigny F-93017, France.
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8
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The impact of early growth patterns and infant feeding on body composition at 3 years of age. Br J Nutr 2015; 114:316-27. [PMID: 26131962 DOI: 10.1017/s0007114515001427] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Early excessive weight gain is positively associated with later obesity, and yet the effect of weight gain during specific periods and the impact of infant feeding practices are debated. The objective of the present study was to examine the impact of weight gain in periods of early childhood on body composition at 3 years, and whether infant feeding modified the relationship between early growth and body composition at 3 years. We studied 233 children from the prospective cohort study, SKOT (in Danish: Småbørns Kost og Trivsel). Birth weight z-scores (BWZ) and change in weight-for-age z-scores (WAZ) from 0 to 5, 5 to 9, 9 to 18 and 18 to 36 months were analysed for relations with body composition (anthropometry and bioelectrical impedance) at 3 years by multivariate regression analysis. BWZ and change in WAZ from 0 to 5 months were positively associated with BMI, fat mass index (FMI) and fat-free mass index (FFMI) at 3 years. Full breastfeeding for 6 months (compared to less than 1 month) eliminated the effect of early growth (P = 0.01). Full breastfeeding for 6 months (compared to less than 1 month) also eliminated the positive relation between BWZ and FMI (P = 0.009). No effect modification of infant feeding was found for FFMI. In conclusion, high birth weight and rapid growth from 0 to 5 months were associated with increased FMI and FFMI at 3 years. Longer duration of full breastfeeding reduced the effect of birth weight and early weight gain on fat mass.
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Carling SJ, Demment MM, Kjolhede CL, Olson CM. Breastfeeding duration and weight gain trajectory in infancy. Pediatrics 2015; 135:111-9. [PMID: 25554813 PMCID: PMC4279065 DOI: 10.1542/peds.2014-1392] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Short breastfeeding duration may exacerbate accelerated early growth, which is linked to higher obesity risk in later life. This study tested the hypothesis that infants at higher risk for obesity were more likely to be members of a rising weight-for-length (WFL) z score trajectory if breastfed for shorter durations. METHODS This prospective, observational study recruited women from an obstetric patient population in rural central New York. Medical records of children born to women in the cohort were audited for weight and length measurements (n = 595). We identified weight gain trajectories for infants' WFL z scores from 0 to 24 months by using maximum likelihood latent class models. Individual risk factors associated with weight gain trajectories (P ≤ .05) were included in an obesity risk index. Logistic regression analysis was performed to investigate whether the association between breastfeeding duration (<2 months, 2-4 months, >4 months) and weight gain trajectory varied across obesity risk groups. RESULTS Rising and stable weight gain trajectories emerged. The obesity risk index included maternal BMI, education, and smoking during pregnancy. High-risk infants breastfed for <2 months were more likely to belong to a rising rather than stable weight gain trajectory (odds ratio, 2.55; 95% confidence interval, 1.14-5.72; P = .02). CONCLUSIONS Infants at the highest risk for rising weight patterns appear to benefit the most from longer breastfeeding duration. Targeting mothers of high-risk infants for breastfeeding promotion and support may be protective against overweight and obesity during a critical window of development.
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Affiliation(s)
- Stacy J Carling
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; and
| | - Margaret M Demment
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; and
| | - Chris L Kjolhede
- Mary Imogene Bassett Hospital and Research Institute, Cooperstown, New York
| | - Christine M Olson
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; and
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Cha MA, Woo YR, Kim HJ, Kim MS, Ahn YH. Factors associated with obesity of acute bronchiolitis in infants: association of obesity with disease severity. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.4.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min Ah Cha
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeol Ryoon Woo
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Min Sub Kim
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Yeon Hwa Ahn
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Korea
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Sy SKB, Asin-Prieto E, Derendorf H, Samara E. Predicting pediatric age-matched weight and body mass index. AAPS JOURNAL 2014; 16:1372-9. [PMID: 25155824 DOI: 10.1208/s12248-014-9657-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/05/2014] [Indexed: 01/30/2023]
Abstract
The empirical scaling from adult to pediatric using allometric size adjustments based on body weight continued to be the mainstream method for pediatric dose selection. Due to the flexibility of a polynomial function to conform to the data trend, an empirical function for simulating age-matched weight and body mass index by gender in the pediatric population is developed by using a polynomial function and a constant coefficient to describe the interindividual variability in weight. A polynomial of up to fifth order sufficiently described the pediatric data from the Center for Disease Control (CDC) and the World Health Organization (WHO). The coefficients of variation to describe the variability were within 17%. The percentages of the CDC simulated weights for pediatrics between 0 and 5 years that fell outside the WHO 90% and 95% confidence boundaries were well within the expected percentage values, indicating that the CDC dataset can be used to substitute for the WHO dataset for the purpose of pediatric drug development. To illustrate the utility of this empirical function, the CDC-based age-matched weights were simulated and were used in the prediction of the concentration-time profiles of tenofovir in children based on a population pharmacokinetic model whose parameters were allometrically scaled. We have shown that the resulting 95% prediction interval of tenofovir in newborn to 5 years of age was almost identical whether the weights were simulated based on WHO or CDC dataset. The approach is simple and is broadly applicable in adjusting for pediatric dosages using allometry.
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Affiliation(s)
- Sherwin K B Sy
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, PO Box 100494, Gainesville, Florida, 32610, USA
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12
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Papadopoulou E, Stanner S. Early growth and obesity risk - What should health professionals be advising? NUTR BULL 2014. [DOI: 10.1111/nbu.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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13
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Thomson JL, Tussing-Humphreys LM, Goodman MH. Delta Healthy Sprouts: A randomized comparative effectiveness trial to promote maternal weight control and reduce childhood obesity in the Mississippi Delta. Contemp Clin Trials 2014; 38:82-91. [DOI: 10.1016/j.cct.2014.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/15/2014] [Accepted: 03/21/2014] [Indexed: 02/08/2023]
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Yasin A, Filler G. Evaluating Canadian children: WHO, NHANES or what? J Paediatr Child Health 2013; 49:282-90. [PMID: 23510240 DOI: 10.1111/jpc.12152] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2012] [Indexed: 11/30/2022]
Abstract
AIM The 2006 World Health Organization (WHO) growth charts have been widely adopted by Canadian dieticians for growth monitoring of Canadian children rather than the National Health and Nutrition Examination Survey (NHANES III) reference data. It has been unclear as to which is the most appropriate. METHODS We calculated height and weight z-scores of 3086 consecutive patients (1530 female, 49.6%) aged 0-5 years, attending outpatient clinics at a single tertiary care centre using reference data of the latest NHANES survey and the 2006 WHO growth charts. To address age dependency, data were stratified into age groups. Gender dependency was also investigated. RESULTS Using NHANES III reference intervals, medians of both height z-score (+0.24) and weight z-score (+0.32) were significantly non-zero. The WHO growth charts yielded medians of height z-score (-0.15) and weight z-score (+0.36) respectively, also significantly non-zero. When comparing both reference populations for the entire cohort, Canadian children had significantly different height z-scores whereas weight z-scores did not differ. Age classification revealed a significant age dependency with NHANES III charts yielding higher weight z-scores for up to 8 months and lower z-scores from 8 to 26 months. No significant differences were observed for older than 26 months. Throughout, height z-scores were significantly higher with NHANES III charts across all age groups, with a degree of overestimation higher in younger boys than older ones. CONCLUSION Our results reveal substantial differences between both reference populations and thus interpretation needs to be done with caution, especially when labelling results as abnormal.
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Affiliation(s)
- Abeer Yasin
- Department of Paediatrics, Division of Paediatric Nephrology, Children's Hospital, London Health Science Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Jaldin MDGM, Pinheiro FS, Santos AMD, Muniz NC. Crescimento infantil comparado com as referências NCHS e o padrão WHO/2006. REV NUTR 2013. [DOI: 10.1590/s1415-52732013000100002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Este trabalho teve como objetivo analisar o crescimento de crianças em regime de aleitamento materno exclusivo até o sexto mês, bem como comparar seu peso e comprimento com a referência do National Center for Health Statistics 1978 e com o padrão da World Health Organization 2006. MÉTODOS: Trata-se de estudo longitudinal realizado em um Banco de Leite Humano, na cidade de São Luís, Maranhão, entre outubro de 2007 e novembro de 2008. Foi feita amostragem não probabilística com 328 crianças nascidas a termo e submetidas a aleitamento materno exclusivo. Finalizaram o estudo 181 crianças. Avaliou-se o crescimento por meio de médias e desvio-padrão, comparando-se os resultados com aqueles dois parâmetros. RESULTADOS: Os meninos mostraram-se mais pesados que as meninas, do primeiro ao sexto mês (p<0,05). A maior velocidade no ganho ponderal ocorreu nos dois primeiros meses de vida, em ambos os sexos. Quanto ao peso, as meninas apresentaram peso médio superior ao padrão da World Health Organization 2006, ao nascer e do terceiro ao sexto mês (p<0,05), enquanto os meninos mostraram peso superior do quarto ao sexto mês (p<0.05). Já em relação à referência do National Center for Health Statistics 1978, ambos os sexos apresentaram peso superior desde o nascimento até o sexto mês (p<0,05), exceto os meninos ao nascer. Quanto ao tamanho, as meninas apresentaram comprimento médio semelhante ao padrão da World Health Organization 2006, porém menor do que a outra referência, ao nascer e no sexto mês (p<0,05). Já os meninos obtiveram comprimento médio inferior, tanto quando comparados ao padrão da World Health Organization 2006, do nascimento ao sexto mês (p<0,05), exceto o quinto; como quando comparados à referência da National Center for Health Statistics 1978, ao nascer e no primeiro, no quarto e no sexto meses de vida (p<0,05). CONCLUSÃO: O crescimento ponderal das crianças em aleitamento materno exclusivo assemelhou-se mais ao padrão World Health Organization 2006 que à referência National Center for Health Statistics 1978, ao passo que o crescimento linear mostrou-se compatível com os dois parâmetros.
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Mäkelä J, Linderborg K, Niinikoski H, Yang B, Lagström H. Breast milk fatty acid composition differs between overweight and normal weight women: the STEPS Study. Eur J Nutr 2012; 52:727-35. [PMID: 22639073 DOI: 10.1007/s00394-012-0378-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 05/07/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We studied differences in breast milk fatty acid (FA) composition between overweight and normal weight women and the effect of FA composition on children's cholesterol concentrations at 13 months and growth from birth to 13 months. METHODS Samples were collected from lactating women (n = 100) participating in STEPS study at infant's age of 3 months, and FA composition was analyzed with gas chromatography. Diet of mother was studied with Index of Diet Quality at third trimester of pregnancy and with food frequency questionnaire on sampling day. The children's weights and heights were collected from hospital records at birth and during study visits at 13 months. RESULTS Overweight women's breast milk compared to normal weight women's breast milk contained higher amount of saturated FAs (46.3 vs. 43.6 %, P = 0.012), lower amount of n-3FAs (2.2 vs. 2.7 %, P = 0.010), lower ratio of unsaturated to saturated FAs (1.1 vs. 1.3, P = 0.008), and higher ratio of n-6 to n-3 FAs (5.7 vs. 4.9, P = 0.031) than those of normal weight women even after adjusting for maternal diet (P < 0.05 for all). Normal weight women adhered more to dietary recommendations during pregnancy, whereas no differences were found in diet at sampling 3 months postpartum. The children's weight gains correlated with saturated FAs (R = 0.22, P = 0.04) and the ratio of unsaturated to saturated FAs (R = -0.23, P = 0.038) in milk; however, effects diminished after adjusting for total duration of breastfeeding. Milk FA composition was not associated with children's cholesterol concentrations at 13 months. CONCLUSIONS Breast milk FA composition differed between overweight and normal weight women.
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Affiliation(s)
- Johanna Mäkelä
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland.
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Ogden CL, Freedman DS. Secular trends in pediatric BMI. Am J Clin Nutr 2012; 95:999-1000. [PMID: 22492376 PMCID: PMC6350897 DOI: 10.3945/ajcn.112.035667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Binagwaho A, Agbonyitor M, Rukundo A, Ratnayake N, Ngabo F, Kayumba J, Dowdle B, Chopyak E, Smith Fawzi MC. Underdiagnosis of malnutrition in infants and young children in Rwanda: implications for attainment of the Millennium Development Goal to end poverty and hunger. Int J Equity Health 2011; 10:61. [PMID: 22206301 PMCID: PMC3265422 DOI: 10.1186/1475-9276-10-61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 12/29/2011] [Indexed: 11/25/2022] Open
Abstract
Progress towards the first Millennium Development Goal (MDG1) to end poverty and hunger has lagged behind attainment of other MDGs due to chronic poverty and worldwide inequity in access to adequate health care, food, clean water, and sanitation. Despite ongoing challenges, Rwanda has experienced economic progress and the expansion of the national public health system during the past 20 years. However, protein-energy malnutrition in children under five is still a major concern for physicians and government officials in Rwanda. Approximately 45% of children under the age of five in Rwanda suffer from chronic malnutrition, and one in four is undernourished. For years, health facilities in Rwanda have used incorrect growth references for measuring nutritional status of children despite the adoption of new standards by the World Health Organization in 2006. Under incorrect growth references used in Rwanda, a number of children under five who were severely underweight were not identified, and therefore were not treated for malnutrition, thus potentially contributing to the under five mortality rate. Given that one in ten children suffer from malnutrition worldwide, it is imperative that all countries with a burden of malnutrition adopt the most up-to-date international standards for measuring malnutrition, and that the problem is brought to the forefront of international public health initiatives. For low income countries in the process of improving economic conditions, as Rwanda is, increasing the identification and treatment of malnutrition can promote the advancement of MDG1 as well as physical and cognitive development in children, which is imperative for advancing future economic progress.
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Affiliation(s)
- Agnès Binagwaho
- Government of Rwanda, Ministry of Health, P,O, Box 3622, Kigali, Rwanda.
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Rolland-Cachera MF, Péneau S. Assessment of growth: variations according to references and growth parameters used. Am J Clin Nutr 2011; 94:1794S-1798S. [PMID: 21525200 DOI: 10.3945/ajcn.110.000703] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Numerous studies have investigated associations between early growth and future risk of obesity, but the methods used varied considerably. Different growth references or parameters can be considered. Growth references from France, the United States (the Centers for Disease Control and Prevention), the Netherlands, Belgium, and the United Kingdom were compared with World Health Organization (WHO) standards. For the first 3 mo of life, all references showed markedly lower values for weight, length, and body mass index (BMI) compared with WHO standards, but after the age of 6 mo references were generally higher than WHO standards. Compared with nonbreastfed infants, the growth of breastfed infants was generally closer to that of WHO standards. Because data in the WHO standards were collected on infants who were breastfed, the difference between references and WHO standards might be mainly attributable to feeding practices. Epidemiologic and clinical studies evaluated the consequences of using either WHO standards or national references and showed differences according to the reference used. Analyses of children's weight curves by physicians showed significant differences in the interpretation of child growth and therefore in the advice given to parents. Finally, the effect of using different growth parameters to predict future risk of obesity was examined and showed that weight and length gains may be good candidates to study future risks. In conclusion, because the reference or parameters used to assess growth have an important effect on the interpretation of growth, it is crucial to be aware of the consequences of the methods used in clinical or epidemiologic contexts.
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Selamat R, Zain F, Raib J, Zakaria R, Marzuki MS, Ibrahim TF. Sensitivity and Specificity of Visual Clinical Assessment as Compared to WHO 2006 Standard and NCHS 1977 Reference in Measuring the Growth Status of Malaysian Infants. J Am Coll Nutr 2011; 30:522-8. [DOI: 10.1080/07315724.2011.10719998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mihrshahi S, Battistutta D, Magarey A, Daniels LA. Determinants of rapid weight gain during infancy: baseline results from the NOURISH randomised controlled trial. BMC Pediatr 2011; 11:99. [PMID: 22054415 PMCID: PMC3226648 DOI: 10.1186/1471-2431-11-99] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 11/07/2011] [Indexed: 12/28/2022] Open
Abstract
Background Rapid weight gain in infancy is an important predictor of obesity in later childhood. Our aim was to determine which modifiable variables are associated with rapid weight gain in early life. Methods Subjects were healthy infants enrolled in NOURISH, a randomised, controlled trial evaluating an intervention to promote positive early feeding practices. This analysis used the birth and baseline data for NOURISH. Birthweight was collected from hospital records and infants were also weighed at baseline assessment when they were aged 4-7 months and before randomisation. Infant feeding practices and demographic variables were collected from the mother using a self administered questionnaire. Rapid weight gain was defined as an increase in weight-for-age Z-score (using WHO standards) above 0.67 SD from birth to baseline assessment, which is interpreted clinically as crossing centile lines on a growth chart. Variables associated with rapid weight gain were evaluated using a multivariable logistic regression model. Results Complete data were available for 612 infants (88% of the total sample recruited) with a mean (SD) age of 4.3 (1.0) months at baseline assessment. After adjusting for mother's age, smoking in pregnancy, BMI, and education and infant birthweight, age, gender and introduction of solid foods, the only two modifiable factors associated with rapid weight gain to attain statistical significance were formula feeding [OR = 1.72 (95%CI 1.01-2.94), P = 0.047] and feeding on schedule [OR = 2.29 (95%CI 1.14-4.61), P = 0.020]. Male gender and lower birthweight were non-modifiable factors associated with rapid weight gain. Conclusions This analysis supports the contention that there is an association between formula feeding, feeding to schedule and weight gain in the first months of life. Mechanisms may include the actual content of formula milk (e.g. higher protein intake) or differences in feeding styles, such as feeding to schedule, which increase the risk of overfeeding. Trial Registration Australian Clinical Trials Registry ACTRN12608000056392
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Affiliation(s)
- Seema Mihrshahi
- School of Public Health, Queensland University of Technology, Brisbane, Australia.
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The protein level of isoenergetic formulae does not modulate postprandial insulin secretion in piglets and has no consequences on later glucose tolerance. Br J Nutr 2011; 108:102-12. [DOI: 10.1017/s0007114511005253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Early postnatal nutrition is involved in metabolic programming, an excess of protein being suspected to enhance early growth and the propensity to later develop insulin resistance and type 2 diabetes mellitus. The aim of the present study was to test the hypothesis that excessive protein intake during the suckling period would overstimulate the endocrine pancreas in the short term and alter durably its maturation, contributing to the later disruption of glucose homeostasis. Normal-birth-weight and low-birth-weight piglets were fed isoenergetic formulae providing an adequate-protein (AP, equivalent to sow milk) or a high-protein (HP, +48 %) supply between 7 and 28 d of age and were fed a standard diet until 70 d of age. During the formula-feeding period, the HP formula did not modify postprandial insulin secretion but transiently increased fasting insulin and the homeostasis model assessment-insulin resistance index (HOMA-IR, P < 0·05). Fasting insulin and HOMA-IR were restored to AP piglets' values 1 month after weaning. The structure of the endocrine pancreas was not affected by the protein content of the formula. The weight at birth had no major effect on the studied parameters. We concluded that a high-protein supply during the suckling period does not interfere with insulin secretion and endocrine pancreas maturation in the short term. It has no consequences either on glucose tolerance 1 month after weaning. The present study demonstrated that up-regulation of postprandial insulin secretion is not involved in higher growth observed in piglets fed a HP formula.
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Mandić Z, Pirički AP, Kenjerić D, Haničar B, Tanasić I. Breast vs. bottle: differences in the growth of Croatian infants. MATERNAL & CHILD NUTRITION 2011; 7:389-96. [PMID: 21108738 PMCID: PMC6860865 DOI: 10.1111/j.1740-8709.2010.00246.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of the paper was to compare the growth of rural Croatian infants with 2000 Centers for Disease Control and Prevention (CDC) growth standards and to evaluate the potential preventive influence of breastfeeding on the development of obesity in infancy. Two hundred three infant-mother pairs from Baranja, an Eastern region of Croatia, were enrolled into this study. Retrospective evaluation of infants' medical charts was used to obtain anthropometric data recorded at the birth, 1, 3, 6, 9 and 12 months of age. Infant feeding mode was self-reported by mothers. Breastfed infants gained the least weight of all observed groups. Up to 6 months of age, formula fed infants had the highest weight gain and after 6 months of age, mixed milk fed infants had the highest weight gain. At 12 months of age, 6.4% of all study infants and 7.6% of mixed milk fed infants were at risk of overweight, while the same risk for the group of breastfed infants was 4%. Most of the study infants achieved higher values of body mass and length than the child growth standards. Exclusively breastfed infants, in comparison with other study groups (formula fed infants, mixed milk fed infants and cow's milk fed infants), had lower weight-for-length z-scores during the first year, which suggests that breastfeeding may have a preventive impact on obesity development.
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Affiliation(s)
- Zlatko Mandić
- Faculty of Medicine, Josipa Huttlera 4, HR‐31000 Osijek, Croatia
| | - Antonija Perl Pirički
- Department of Food and Nutrition Research, Faculty of Food Technology, Franje Kuhača 20, HR‐31000 Osijek, Croatia
| | - Daniela Kenjerić
- Department of Food and Nutrition Research, Faculty of Food Technology, Franje Kuhača 20, HR‐31000 Osijek, Croatia
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Mamidi RS, Shidhaye P, Radhakrishna KV, Babu JJ, Reddy PS. 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. Indian Pediatr 2011; 48:855-60. [PMID: 21555805 DOI: 10.1007/s13312-011-0139-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 10/19/2010] [Indexed: 10/15/2022]
Abstract
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.
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Affiliation(s)
- Raja Sriswan Mamidi
- Clinical Division, National Institute of Nutrition, Niloufer Hospital, Hyderabad, India.
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Abstract
OBJECTIVES To describe the pattern and variability of body weight with postmenstrual age (PMA) using nonlinear mixed effect modeling and to create a single mathematical function that can be used from prematurity to adulthood. BACKGROUND PMA has been shown to predict functional properties of humans such as glomerular filtration rate and drug clearance. Widely used growth charts use postnatal age to predict weight in an idealized population and are not available as a mathematical function. METHODS We modeled 7164 body weight and PMA observations from a pooled database of 5031 premature neonates, infants, children, and adults. All subjects were participants in pharmacokinetic or renal function studies. PMA ranged from 23 weeks to 82 years. A mixed effect model was used to describe fixed (PMA, sex) and random between-subject variability. RESULTS A model based on the sum of three sigmoid hyperbolic and one exponential functions described the data. Females were typically 12% lighter in weight. Part of the between-subject variability in weight decreased exponentially with a half-life of 3.5 PMA years, while the remainder stayed a constant fraction of the weight asymptote for each of the four functions. CONCLUSIONS The change of weight with PMA and sex can be described with a simple equation. This is suitable for simulation of typical weight-age distributions and may be useful for evaluation of appropriate weight for age in children requiring medical treatment.
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Affiliation(s)
- Anita L Sumpter
- Department of Anaesthesiology, University of Auckland School of Medicine, Auckland, New Zealand
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Marriott BP, White AJ, Hadden L, Davies JC, Wallingford JC. How well are infant and young child World Health Organization (WHO) feeding indicators associated with growth outcomes? An example from Cambodia. MATERNAL AND CHILD NUTRITION 2011; 6:358-73. [PMID: 21050390 DOI: 10.1111/j.1740-8709.2009.00217.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We assessed eight World Health Organization (WHO) core child feeding indicators for their association with stunting and underweight in Cambodia in 2000 and 2005. We compared the feeding data from the Cambodian Demographic and Health Surveys for 2000 with 2005 for 0-24 months children using the WHO feeding indicators, with stunting and underweight as outcomes. Prevalence of stunting and underweight was significantly less in 2005 than in 2000 among children aged 0-5 and 6-11 months, but stunting among children 18-23 months remained >50%. Prevalence of compliance with seven of the eight core healthy feeding indicators was higher in 2005. Exclusive breastfeeding among 0-5 months infants increased more than fivefold; among 6-11 and 12-17 months children, prevalence of feeding diversity and meeting a minimally acceptable diet, while improved, remained ≈25%. Modelling showed compliance with breastfeeding indicators was associated with reduced risk of underweight in 0-5 months infants, no association between compliance with feeding indicators and growth outcomes in other ages, and a significant association of higher relative wealth with growth outcomes overall. Between 2000 and 2005, Cambodia stabilized and focused resources on infant feeding. Prevalence of meeting the WHO feeding indicators improved, but modelling indicated that, in general, relative wealth, not feeding practices, was associated with improved growth outcomes. Yet, over 50% of children 18-23 months were stunted in 2005. Similar to the success with breastfeeding, focus on complementary feeding of 6-23 months children may reduce the risk of stunting in Cambodia.
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Affiliation(s)
- Bernadette P Marriott
- Abt Associates, Inc., 4620 Creekstone Drive, Maplewood Building, Suite 190, Durham, North Carolina 27703, USA.
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Breast-feeding and growth in children until the age of 3 years: the Generation R Study. Br J Nutr 2011; 105:1704-11. [PMID: 21276279 DOI: 10.1017/s0007114510005374] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Breast-feeding has been suggested to be associated with lower risks of obesity in older children and adults. We assessed whether the duration and exclusiveness of breast-feeding are associated with early postnatal growth rates and the risks of overweight and obesity in preschool children. The present study was embedded in a population-based prospective cohort study from early fetal life onwards, among 5047 children and their mothers in The Netherlands. Compared with children who were breast-fed, those who were never breast-fed had a lower weight at birth (difference 134 (95 % CI - 190, - 77) g). No associations between breast-feeding duration and exclusivity with growth rates before the age of 3 months were observed. Shorter breast-feeding duration was associated with an increased gain in age- and sex-adjusted standard deviation scores for length, weight and BMI (P for trend < 0·05) between 3 and 6 months of age. Similar tendencies were observed for the associations of breast-feeding exclusivity with change in length, weight and BMI. Breast-feeding duration and exclusivity were not consistently associated with the risks of overweight and obesity at the ages of 1, 2 and 3 years. In conclusion, shorter breast-feeding duration and exclusivity during the first 6 months tended to be associated with increased growth rates for length, weight and BMI between the age of 3 and 6 months but not with the risks of overweight and obesity until the age of 3 years.
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Fakharzadeh L, Javaherizadeh H, Sabeti F, Cheraghian B. Are growth curves for Iranian school-aged children different from the NCHS standards? J Egypt Public Health Assoc 2011; 86:90-94. [PMID: 22173111 DOI: 10.1097/01.epx.0000407135.39368.d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Assessment of physical growth in school-aged children is important for the assessment of nutritional status, promotion of health and learning ability of children. Assessment of physical growth is the main purpose of this research. PARTICIPANTS AND METHODS This cross-sectional study was performed on 2615 healthy school-aged children (6-11 years old) in the Autumn of 2006 using two-stage stratified cluster sampling for measurement of weight and height. Sample size calculation was performed using EPI info 6 software. Statistical calculations and calculation of raw growth percentiles were performed using Statistical Package of Social Science program 15.0. RESULTS The findings showed that boys less than 9.5 years of age were heavier than girls of the same age, while girls were heavier thereafter. Similarly, the average height of boys till 10 years was higher than the girls, but girls surpassed boys after 10 years of age. The fifth centile of boys' height at the ages of 6 and 7 years was higher than the same centile in the National Center for Health Statistics (NCHS). In all centiles and all ages, the height of Abadanian girls was below the age-matched NCHS centiles. This difference was significant in 6 (P=0.003), 7 (P=0.007), and 11 years (P=0.002). The results showed that at the age of 6 and 8 years, the 50th centile of the weight of Abadanian boys was slightly below the 50th centile of NCHS. At the age of 6 and 7 years, the 50th centile of girls weight was close to the 25th centile of NCHS, and as the age increased, it shifted upward, to come close to the 50th centile of NCHS. This difference between our study and NCHS girls' weight curve during the 6-11 age period was significant (Z-test, P<0.0001). CONCLUSION AND RECOMMENDATIONS There are some significant differences between the Iranian and NCHS growth parameters. It may be necessary to define new national growth parameters to assess our child health status.
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Affiliation(s)
- Leila Fakharzadeh
- aAbadan Faculty of Nursing bArvand International Division, Ahvaz Jundishapur University of Medical Sciences, Abadan, Iran
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Determinants of infant growth: Evidence from Hong Kong's "Children of 1997" birth cohort. Ann Epidemiol 2010; 20:827-35. [PMID: 20797875 DOI: 10.1016/j.annepidem.2010.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE A high rate of infant growth may be associated with adult cardiovascular disease. We investigated factors associated with infant weight growth in a large sample from the recently transitioned population of Hong Kong. METHODS We used a nonlinear shape invariant model with random effects among 5949 term, singletons (77% follow-up) from a population-representative Hong Kong Chinese birth cohort "Children of 1997" to investigate factors associated with weight growth in the first year of life. RESULTS Overall birth weight was lower but infant growth was more rapid than the 2006 WHO standards. Shorter gestation and lower birth order were associated with lower birth weight and faster infant growth. Female sex, maternal smoking in pregnancy, and a mother born in Hong Kong were associated with lower birth weight, but not with faster growth. Higher maternal education was associated with faster infant growth, grades 10-11 (1.03, 95% confidence interval [CI] = 1.03-1.05), greater than or equal to grade12 (1.07, CI = 1.04-1.09) compared with less than or equal to grade 9. CONCLUSIONS Infant growth may respond more rapidly to socio-economic development than birth weight. Whether mother's education is associated with rapid infant growth via current conditions or her own "constitution" is unclear, nevertheless we believe this study illustrates the importance of contextually specific research for understanding the determinants of population health.
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Borges MC, Rogero MM, Pires ISDO, Borelli P, Tirapegui J. Early weaning impairs body composition in male mice. BRAZ J PHARM SCI 2009. [DOI: 10.1590/s1984-82502009000400026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the effect of early weaning on body composition and on parameters related to nutritional status in mice. The experimental group consisted of male Swiss Webster mice that were weaned early (at postnatal day fourteen) and fed an appropriate diet for growing rodents until postnatal day twenty-one (EW group). The control group consisted of male mice breastfed until postnatal day twenty-one (CON group). All animals were sacrificed on the twenty-first day of life. The EW group showed a decrease in liver and muscle protein content and concentration, brain protein concentration, brain DNA content and concentration, as well as liver and muscle protein/RNA ratio (p<0.05). Concerning body composition, the EW mice showed increased moisture content, increased moisture and lipid percentage, and a smaller percentage and content of protein and ash in the carcass (p<0.05). These results indicate that early weaning impairs body composition and parameters related to nutritional status, which may be explained by retarded chemical maturation processes. This data may contribute to the overall understanding of the influence of breastfeeding versus feeding with artificial milk on body composition and on nutritional status.
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Ruben AR. Undernutrition and obesity in indigenous children: epidemiology, prevention, and treatment. Pediatr Clin North Am 2009; 56:1285-302. [PMID: 19962022 DOI: 10.1016/j.pcl.2009.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Over the past 50 years there has been a shift in nutritional problems amongst Indigenous children in developed countries from under-nutrition and growth faltering to overweight and obesity; the major exception is small numbers of Indigenous children predominately living in remote areas of Northern Australia. Nutritional problems reflect social disadvantage and occur with disproportionately high incidence in all disadvantaged subgroups. There is limited evidence of benefit from any strategies to prevent or treat undernutrition and obesity; there are a limited number of individual studies with generalizable high grade evidence of benefit. Potential solutions require a whole of society approach.
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Affiliation(s)
- Alan R Ruben
- Northern Territory Clinical School, P.O. Box 41326, Casuarina, NT 0811, Australia.
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Abstract
Understanding normal growth for the healthy breastfed infant is an important component of promoting and supporting child health in general and breastfeeding in particular. In this article, we summarize what is known regarding differences in growth between breastfed and formula-fed infants; we describe the development and use of infant growth references and growth standards; we introduce the new World Health Organization growth velocity standards for early infancy (which provide standards for gain in g/day during the first weeks of life); and, in closing, we present a snapshot of recent data from a cohort of breastfed newborns in Sacramento, CA, and examine how their early weight gain compares to the new growth velocity standards.
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Affiliation(s)
- Laurie A Nommsen-Rivers
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Corvalán C, Uauy R, Stein AD, Kain J, Martorell R. Effect of growth on cardiometabolic status at 4 y of age. Am J Clin Nutr 2009; 90:547-55. [PMID: 19640961 DOI: 10.3945/ajcn.2008.27318] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) risks are increasingly being diagnosed in children and track into adulthood. Growth is associated with CVD risk in adulthood; however, its contribution to CVD risks in children facing the obesity epidemic is unclear. OBJECTIVE The objective was to assess relations between growth from age 0 to 4 y and CVD status at 4 y in 323 Chilean children with normal birth weight. DESIGN From health records we obtained weight and height every 6 mo from age 0 to 3 y and calculated body mass index (BMI; weight/height(2)). At age 4 y, we measured height, waist circumference, insulin, glucose, and plasma lipids; infant feeding information was provided by the mothers. Outcomes were metabolic score (waist-to-height ratio + glucose + insulin + triglycerides - HDL-cholesterol z scores/5), total cholesterol (TC):HDL cholesterol, and homeostasis model of assessment of insulin resistance. RESULTS At 4 y, the prevalence of obesity was 13%. Changes in BMI, particularly from 6 to 24 mo, predicted a higher metabolic score (standardized regression coefficient = 0.29; 95% CI: 0.16, 0.42) but were unrelated to homeostasis model of assessment of insulin resistance and TC:HDL cholesterol. Height changes were not associated with CVD risks at the age of 4 y. Mode of infant feeding was unrelated to CVD status at 4 y; however, in children who were exclusively breastfed at 4 mo, an increase in BMI from 0 to 6 mo was positively associated with TC:HDL cholesterol at 4 y (standardized regression coefficient = 0.24; 95% CI: -0.02, 0.50), whereas in children who were partially or nonbreastfed at 4 mo, it was negatively associated with TC:HDL cholesterol at 4 y (standardized regression coefficient = -0.30; 95% CI: -0.52, -0.08). CONCLUSION In children with normal birth weight and a high prevalence of obesity at 4 y, changes in BMI after 6 mo predicted a higher overall CVD risk at 4 y.
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Kwok MK, Schooling CM, Lam TH, Leung GM. Does breastfeeding protect against childhood overweight? Hong Kong's 'Children of 1997' birth cohort. Int J Epidemiol 2009; 39:297-305. [DOI: 10.1093/ije/dyp274] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mraz KD, Dixon J, Dumont-Mathieu T, Fein D. Accelerated head and body growth in infants later diagnosed with autism spectrum disorders: a comparative study of optimal outcome children. J Child Neurol 2009; 24:833-45. [PMID: 19617459 DOI: 10.1177/0883073808331345] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous research has demonstrated accelerated head and body growth during infancy in children with autism spectrum disorders. No study has yet examined head growth in children who lose their autism spectrum disorder diagnoses. Head circumference, length, and weight growth during infancy for 24 children who maintained their diagnoses were compared with 15 children who lost their diagnoses, and to 37 typically developing controls. Results showed that head circumference and weight growth were significantly greater in both autism spectrum disorder groups compared with controls, with no significant differences between autism spectrum disorder groups. However, when length and weight were controlled for, accelerated head growth remained significant in the children who lost their diagnoses. Findings suggest that children who lose their autism spectrum disorder diagnoses and children who maintain their diagnoses show similar head circumference, length, and weight growth trajectories during infancy, although subtle differences in body growth between groups may exist.
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Affiliation(s)
- Krista D Mraz
- Department of Psychology, University of Connecticut, Connecticut, USA.
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Saha KK, Frongillo EA, Alam DS, Arifeen SE, Persson LA, Rasmussen KM. Use of the new World Health Organization child growth standards to describe longitudinal growth of breastfed rural Bangladeshi infants and young children. Food Nutr Bull 2009; 30:137-44. [PMID: 19689092 PMCID: PMC4425403 DOI: 10.1177/156482650903000205] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although the National Center for Health Statistics (NCHS) reference has been widely used, in 2006 the World Health Organization (WHO) released new standards for assessing growth of infants and children worldwide. OBJECTIVE To assess and compare the growth of breastfed rural Bangladeshi infants and young children based on the new WHO child growth standards and the NCHS reference. METHODS We followed 1343 children in the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) study from birth to 24 months of age. Weights and lengths of the children were measured monthly during infancy and quarterly in the second year of life. Anthropometric indices were calculated using both WHO standards and the NCHS reference. The growth pattern and estimates of undernutrition based on the WHO standards and the NCHS reference were compared. RESULTS The mean birthweight was 2697 +/- 401 g, with 30% weighing <2500 g. The growth pattern of the MINIMat children more closely tracked the WHO standards than it did the NCHS reference. The rates of stunting based on the WHO standards were higher than the rates based on the NCHS reference throughout the first 24 months. The rates of underweight and wasting based on the WHO standards were significantly different from those based on the NCHS reference. CONCLUSIONS This comparison confirms that use of the NCHS reference misidentifies undernutrition and the timing of growth faltering in infants and young children, which was a key rationale for constructing the new WHO standards. The new WHO child growth standards provide a benchmark for assessing the growth of breastfed infants and children.
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Affiliation(s)
- Kuntal K Saha
- Public Health Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
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Koletzko B, von Kries R, Closa R, Monasterolo RC, Escribano J, Subías JE, Scaglioni S, Giovannini M, Beyer J, Demmelmair H, Anton B, Gruszfeld D, Dobrzanska A, Sengier A, Langhendries JP, Rolland Cachera MF, Grote V. Can infant feeding choices modulate later obesity risk? Am J Clin Nutr 2009; 89:1502S-1508S. [PMID: 19321574 DOI: 10.3945/ajcn.2009.27113d] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Since the concept of lasting programming effects on disease risk in human adults by the action of hormones, metabolites, and neurotransmitters during sensitive periods of early development was proposed >3 decades ago, ample supporting evidence has evolved from epidemiologic and experimental studies and clinical trials. For example, numerous studies have reported programming effects of infant feeding choices on later obesity. Three meta-analyses of observational studies found that obesity risk at school age was reduced by 15-25% with early breastfeeding compared with formula feeding. We proposed that breastfeeding protects against later obesity by reducing the occurrence of high weight gain in infancy and that one causative factor is the lower protein content of human milk compared with most infant formula (the early protein hypothesis). We are testing this hypothesis in the European Childhood Obesity Project, a double-blind, randomized clinical trial that includes >1000 infants in 5 countries (Belgium, Germany, Italy, Poland, and Spain). We randomly assigned healthy infants who were born at term to receive for the first year infant formula and follow-on formula with higher or lower protein contents, respectively. The follow-up data obtained at age 2 y indicate that feeding formula with reduced protein content normalizes early growth relative to a breastfed reference group and the new World Health Organization growth standard, which may furnish a significant long-term protection against later obesity. We conclude that infant feeding practice has a high potential for long-term health effects, and the results obtained should stimulate the review of recommendations and policies for infant formula composition.
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Affiliation(s)
- Berthold Koletzko
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference. Public Health Nutr 2009; 12:716-22. [DOI: 10.1017/s1368980008002383] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo compare estimates of under-nutrition among pre-school Pakistani children using the WHO growth standard and the National Center for Health Statistics (NCHS) reference.DesignPrevalence of stunting, wasting and underweight as defined by WHO and NCHS standards are calculated and compared.SettingThe data are from two cross-sectional surveys conducted in the early 1990s, the time frame for setting the baseline for the Millennium Development Goals: (i) National Health Survey of Pakistan (NHSP) assessed the health status of a nationally representative sample and (ii) Thatta Health System Research Project (THSRP) was a survey in Thatta, a rural district of Sindh Province.SubjectsIn all, 1533 and 1051 children aged 0–35 months from national and Thatta surveys, respectively.ResultsWHO standard gave a significantly higher prevalence of stunting for both national [36·7 (95 % CI 33·2, 40·2)] and Thatta surveys [52·9 (95 % CI 48·9, 56·9)] compared to the NCHS reference [national: 29·1 (95 % CI 25·9, 32·2) and Thatta: 44·8 (95 % CI 41·1, 48·5), respectively]. It also gave significantly higher prevalence of wasting for the Thatta survey [22·9 (95 % CI 20·3, 25·5)] compared to the NCHS reference [15·7 (95 % CI 13·5, 17·8)]. Differences due to choice of standard were pronounced during infancy and for severely wasted and severely stunted children.ConclusionsPakistan should switch to the robustly constructed and up-to-date WHO growth standard for assessing under-nutrition. New growth charts should be introduced along with training of health workers. This has implications for nutritional intervention programmes, for resetting the country’s targets for Millennium Development Goal 1 and for monitoring nutritional trends.
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Oyama M, Nakamura K, Tsuchiya Y, Yamamoto M. Unhealthy Maternal Lifestyle Leads to Rapid Infant Weight Gain: Prevention of Future Chronic Diseases. TOHOKU J EXP MED 2009; 217:67-72. [DOI: 10.1620/tjem.217.67] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mari Oyama
- Division of Social and Environmental Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Kazutoshi Nakamura
- Division of Social and Environmental Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Yasuo Tsuchiya
- Division of Social and Environmental Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
| | - Masaharu Yamamoto
- Division of Social and Environmental Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences
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Comparison of the prevalence of shortness, underweight, and overweight among US children aged 0 to 59 months by using the CDC 2000 and the WHO 2006 growth charts. J Pediatr 2008; 153:622-8. [PMID: 18619613 DOI: 10.1016/j.jpeds.2008.05.048] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 04/16/2008] [Accepted: 05/22/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the prevalence of shortness, underweight, and overweight by using the Centers for Disease Control and Prevention (CDC) 2000 and the World Health Organization (WHO) 2006 growth charts. These comparisons are undertaken with 2 sets of cutoff values. STUDY DESIGN Data from the National Health and Nutrition Examination Survey 1999-2004 were used to calculate the prevalence estimates in US children aged 0 to 59 months (n = 3920). Cutoff values commonly used in the United States, on the basis of the 5th percentile of height-for-age to define shortness, the 5th percentile of weight-for-height or weight-for-age to define underweight, and the 95th percentile of weight-for-height or body mass index-for-age to define overweight were compared with the cutoff values recommended by WHO, which use <-2 z-score (equivalent to 2.3rd percentile) to define shortness and underweight and >or=2 z-score (equivalent to 97.7th percentile) to define overweight. A comparison with the same cutoff values (5th and 95th) in the 2 charts was also performed. RESULTS Applying the 5th or 95th percentile, we observed a higher prevalence of shortness and overweight for all the age groups when the WHO 2006 growth charts were used than when the CDC 2000 growth charts were used. Applying the 5th percentile to the WHO 2006 charts produced lower rates of underweight than did the CDC 2000 charts. However, applying the 5th or 95th percentiles to the CDC 2000 charts and the WHO-recommended cutoff values of -2 or +2 z-score to the WHO charts produced smaller differences in the prevalence of shortness and overweight than were seen when the 5th and 95th percentiles were applied to both the CDC and WHO charts. CONCLUSIONS Estimates of the prevalence of key descriptors of growth in children aged 0 to 59 months vary by the chart used and the cutoff values applied. The use of the 5th and 95th percentiles for the CDC growth charts and the 2.3rd and 97.7th percentiles for the WHO growth charts appear comparable in the prevalence of shortness and overweight, but not underweight. If practitioners were to use the WHO growth charts, it might be more appropriate to adopt the WHO recommended cutoff values as well, but this would be a change for office practice.
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Nash A, Secker D, Corey M, Dunn M, O'Connor DL. Field Testing of the 2006 World Health Organization Growth Charts From Birth to 2 Years: Assessment of Hospital Undernutrition and Overnutrition Rates and the Usefulness of BMI. JPEN J Parenter Enteral Nutr 2008; 32:145-53. [DOI: 10.1177/0148607108314386] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Nash
- From Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre; Research Institute and Division of Nephrology, The Hospital for Sick Children; and the Institute of Medical Sciences, Department of Nutritional Sciences and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Donna Secker
- From Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre; Research Institute and Division of Nephrology, The Hospital for Sick Children; and the Institute of Medical Sciences, Department of Nutritional Sciences and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mary Corey
- From Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre; Research Institute and Division of Nephrology, The Hospital for Sick Children; and the Institute of Medical Sciences, Department of Nutritional Sciences and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael Dunn
- From Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre; Research Institute and Division of Nephrology, The Hospital for Sick Children; and the Institute of Medical Sciences, Department of Nutritional Sciences and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L. O'Connor
- From Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre; Research Institute and Division of Nephrology, The Hospital for Sick Children; and the Institute of Medical Sciences, Department of Nutritional Sciences and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HPS, Shekar M. What works? Interventions for maternal and child undernutrition and survival. Lancet 2008; 371:417-40. [PMID: 18206226 DOI: 10.1016/s0140-6736(07)61693-6] [Citation(s) in RCA: 1217] [Impact Index Per Article: 76.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment.
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WHO 2006 child growth standards: implications for the prevalence of stunting and underweight-for-age in a birth cohort of Gabonese children in comparison to the Centers for Disease Control and Prevention 2000 growth charts and the National Center for Health Statistics 1978 growth references. Public Health Nutr 2008; 11:714-9. [PMID: 18167166 DOI: 10.1017/s1368980007001449] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references. DESIGN AND SETTING Prospective birth cohort in Lambaréné, Gabon. SUBJECTS Two hundred and eighty-nine children from birth to 15 months of age. METHODS Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below -2 SD of the corresponding reference median (Z score < or = -2) were classified as stunted or underweight-for-age, respectively. RESULTS With the new WHO 2006 standards a higher proportion (4.0%) of 3-month-old infants were underweight compared with the CDC (1.0%) or the NCHS (0.7%) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20%) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months. CONCLUSIONS The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.
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Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, Oh K, Jang MJ, Hwang SS, Yoo MH, Kim YT, Lee CG. 2007 Korean National Growth Charts: review of developmental process and an outlook. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.1.1] [Citation(s) in RCA: 367] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Jin Soo Moon
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- The Committee for School Health and Public Health Statistics, The Korean Pediatric Society, Korea
| | - Soon Young Lee
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
| | - Chung Mo Nam
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
| | - Joong-Myung Choi
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- The Committee for School Health and Public Health Statistics, The Korean Pediatric Society, Korea
| | - Bong-Keun Choe
- The Committee for School Health and Public Health Statistics, The Korean Pediatric Society, Korea
| | - Jeong-Wan Seo
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
| | - Kyungwon Oh
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, Korea
| | - Myoung-Jin Jang
- Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, Korea
| | - Seung-Sik Hwang
- Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, Korea
| | - Myung Hwan Yoo
- Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, Korea
| | - Young Taek Kim
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention, Korea
| | - Chong Guk Lee
- The Committee for the Development of Growth Standard for Korean Children and Adolescents, Korea
- The Committee for School Health and Public Health Statistics, The Korean Pediatric Society, Korea
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Abstract
The recent release of new growth charts by the World Health Organization (WHO) heralds a fresh understanding of what constitutes normal infant growth and development. The Multicenter Growth Reference Study that underpins these new growth standards 'establish[es] breastfed infants as the normative model for growth and development'. This is in contrast to past practice, which treated breastfeeding as the optimal, rather than the normal, way to feed babies. This idealization of breastfeeding has been counterproductive, because it has reinforced a perception that formula feeding is the standard way of feeding babies. It is, therefore, suggested that breastfeeding promotion and education programmes should abandon the 'breast is best' message in favour of messages that normalize breastfeeding, and that future research ought to use infants breastfed according to WHO recommendations as the norm reference or control group in every instance.
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Affiliation(s)
- Nina J Berry
- Centre for Health Initiatives, University of Wollongong, Wollongong, New South Wales, Australia.
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Lopriore C, Dop MC, Solal-Céligny A, Lagnado G. Excluding infants under 6 months of age from surveys: impact on prevalence of pre-school undernutrition. Public Health Nutr 2007; 10:79-87. [PMID: 17212846 DOI: 10.1017/s1368980007219676] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveInfants aged 0–5 months are not systematically included in assessments of child nutritional status and are generally excluded from surveys conducted in emergencies. We estimated the impact of excluding 0–5-month-old infants on the prevalence of stunting, wasting and underweight among children under 5 years (U5) and under 3 years (U3) of age.DesignComparison of the prevalence of stunting, wasting and underweight in U5 and U3 with or without inclusion of the age group 0–5 months.SettingDemographic and Health Surveys and Multiple Indicator Cluster Surveys from 76 developing countries and countries in transition.SubjectsChildren under 3 or under 5 years of age included in the surveys.ResultsExcluding 0–5-month-old infants resulted in an overestimation of the prevalence of stunting, wasting and underweight in U5 of 3.0, 0.3 and 2.6 percentage points, respectively, and of 4.8, 1.0 and 5.2 percentage points, respectively, in U3. The overestimation for wasting was negligible. The regions showing the highest overestimations for stunting and underweight were Asia and sub-Saharan Africa. Overall, countries with high prevalences of stunting and underweight showed especially large overestimations. The prevalence of underweight in infants aged 0–5 months was correlated with the prevalence of low maternal body mass index.ConclusionAll surveys, even in situations of nutrition emergency, should include 0–5-month-old infants. Strictly comparable age ranges are essential in nutrition surveys for monitoring trends and evaluating programme impact. Greater awareness of prenatal and early child undernutrition is needed among policy-makers.
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Affiliation(s)
- C Lopriore
- Nutrition Planning, Assessment and Evaluation Service, Nutrition and Consumer Protection Division, Food and Agriculture Organization of United Nations, Viale delle Terme di Caracalla, I-00100 Rome, Italy
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Baig-Ansari N, Rahbar MH, Bhutta ZA, Badruddin SH. Child's Gender and Household Food Insecurity are Associated with Stunting among Young Pakistani Children Residing in Urban Squatter Settlements. Food Nutr Bull 2006; 27:114-27. [PMID: 16786978 DOI: 10.1177/156482650602700203] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The nutritional status of children is a good indicator of the overall well-being of a society and reflects food security as well as existing health-care and environmental conditions. In Pakistan, it is estimated that nearly 40% to 50% of children under the age of five are stunted. Due to greater economic opportunities available to the urban population as compared to the rural, it was believed that economic resources existed in poor urban Pakistani households but that the households lacked the skills and knowledge to translate their resources into good care and feeding practices. Objective This study aimed 1) to assess the prevalent care and feeding practices among children aged 6 to 18 months residing in the squatter settlements of Karachi and 2) to identify care and feeding practices, as well as any other underlying factors, associated with stunting. Methods A cross-sectional survey was conducted in eight settlements between October and December 2000. A total of 433 mothers of eligible children were interviewed with the use of structured questionnaires. Final analysis using multiple logistic regression was conducted on 399 mother—child pairs. Results Female children were nearly three times more likely to be stunted than male children. Households that were food insecure with hunger were also three times more likely than other households to have a stunted child. Lack of maternal formal schooling (adjusted prevalence odds ratio, 2.9; 95% confidence interval, 1.4 to 3.8) and large household size (adjusted prevalence odds ratio, 1.7; 95% confidence interval, 1.0 to 3.8) were also associated with stunting. Even though certain care and feeding practices were significant at the univariate level, they were not significant in the final multivariate analysis and so were excluded from the final model. Conclusions In households where food insecurity exists, knowledge of care practices may not be sufficient, and interventions such as food subsidies must precede or accompany educational efforts. Further follow-up is required to explore the effect of gender differences on child care.
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Affiliation(s)
- Naila Baig-Ansari
- Program in International Nutrition, University of California, Davis, California 95616, USA.
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Roberfroid D, Kolsteren P, Hoerée T, Maire B. Do growth monitoring and promotion programs answer the performance criteria of a screening program? A critical analysis based on a systematic review. Trop Med Int Health 2005; 10:1121-33. [PMID: 16262737 DOI: 10.1111/j.1365-3156.2005.01498.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Growth Monitoring and Promotion programs (GMP) have been intensively promoted to improve children's health in developing countries. It has been hoped that regularly weighing children would result in the early detection of growth falterers, and that the growth chart would serve as an educational tool to make that state apparent to both health workers and caretakers in order to trigger improved caring practices. Our objective was to review whether GMP answers the theoretical grounds of a screening and intervention program. METHOD A systematic literature review was performed. The WHO framework developed by Wilson and Jungner for planning and evaluating screening programs guided the analysis. RESULTS Sixty-nine studies were retrieved. Overall, evidence is weak on the performance of GMP as a screening program for malnutrition through early detection of growth falterers. The main results are: (1) malnutrition remains a public health problem, but its importance is context specific; (2) the value of a low weight velocity to predict malnutrition is unknown and likely to vary in different contexts; (3) the performance of GMP for improving nutrition status of children and in reducing mortality and morbidity is unknown; (4) the performance of the screening is affected by the unreliability of weight measurements; (5) the promotional and educational effectiveness of GMP is low, in particular the growth chart is poorly understood by mothers; (6) the acceptability seems low in regards of low attendance rates; (7) evidence is lacking regarding cost-effectiveness. CONCLUSIONS We conclude that there is too little scientific evidence to indiscriminately support international promotion of GMP. However GMP could constitute a valid strategy of public nutrition in specific situations. We indicate paths for further research and how prevention programs could be developed.
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Affiliation(s)
- D Roberfroid
- Department of Public Health, Nutrition Unit, Institute of Tropical Medicine, Antwerp, Belgium.
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Moestue H, de Pee S, Hall A, Hye A, Sultana N, Ishtiaque MZ, Huq N, Bloem MW. Conclusions about differences in linear growth between Bangladeshi boys and girls depend on the growth reference used. Eur J Clin Nutr 2004; 58:725-31. [PMID: 15116075 DOI: 10.1038/sj.ejcn.1601870] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine sex differences in height-for-age z-scores and the percentage stunting among Bangladeshi children estimated using three growth references. DESIGN, SETTING AND SUBJECTS Data collected between 1990 and 1999 by Helen Keller International's nutritional surveillance system in rural Bangladesh were analyzed for 504 358 children aged 6-59 months. Height-for-age z-scores were estimated using the 1977 NCHS, 2000 CDC and 1990 British growth references. RESULTS The shape of the growth curves for Bangladeshi boys and girls, and their positions relative to one another, depend on which of the three growth references is used. At 6 months of age the British reference showed no sex difference whereas the NCHS and CDC showed girls to have higher average z-scores than boys by 0.14 and 0.28 s.d., respectively. While all references showed a faster deterioration of girls' z-scores from 6 to 24 months, the magnitude and direction of the sex differences, and how they changed with age, were different. There was greater disagreement about girls' z-scores than boys. Discontinuities at 24 months in the NCHS and CDC produced jagged curves whereas the British curves were smooth. CONCLUSIONS The assessment of sex differences in linear growth depends on the growth reference used. Reasons for the different results need to be determined and may aid the final development of the new WHO international growth reference and the guidelines for its use. The findings suggest that anthropometry as a tool to explore the effects of societal gender inequality must be used with caution.
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Affiliation(s)
- H Moestue
- Helen Keller International, Dhaka, Bangladesh.
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