The low prevalence of weight-for-height deficits in Brazilian children is related to body proportions

Nutritional health status: association of stunted and wasted children and their mothers

Background

Across the globe, 149 and 49 million children are stunted and wasted, respectively. Prevalence of stunting and wasting is 40.2 and 17.7% in children of Pakistan. Stunting and wasting are accompanied with genetics, dietary factor, lack of information, bottle feeding, illiterate parents, less birth interval, infection such as diarrhoea, low birth weight, mother suffering from malnutrition during pregnancy, breastfeeding, pharmaceutical, and hormonal, psychosocial, and low social-economic status.

Methods

Stunted and wasted children and their mothers were called on and detail discussions related to research plan were carried out. Informed consent was assured from mothers, for participation in the study. The demographics, anthropometrics, vital signs observations, body composition, clinical signs and symptoms, dietary intake and associated biomarkers (CBC, level of urea nitrogen in blood, serum albumin globulin and serum creatinine.) were tools for nutritional health status assessment. SPSS software was implied on data.

Results

The study found that 27.2% mothers were belonged to stunted children, 17.3% belonged to wasted children, and 50.9% belonged to those children who were suffering from both stunting and wasting condition.57.9% mothers who were illiterate belong to stunted and wasted children. CBC and Hb test was prominent, stunted and wasted children had Hb 9.88 mg/dL, whereas, their mothers had 10.8 mg/dL as average Hb. The average height and weight of stunted and wasted children was 68.6 cm and 7.11 kg respectively. Dietary patterns and diet quality of both mothers and children were poor, due to lack of affordability; they were not able to eat healthy food.

Conclusion

Stunting and wasting ultimately resulted in poor growth and development of children. Most of children were anemic, they height and weight less than WHO growth standards. They had less knowledge and poor intake of food diet pattern so children growth was poor.

Impact of Integration of Severe Acute Malnutrition Treatment in Primary Health Care Provided by Community Health Workers in Rural Niger

The present study aimed to assess the effectiveness and impact on treatment coverage of integrating severe acute malnutrition (SAM) treatment at the health hut level by community health workers (CHWs). This study was a non-randomized controlled trial, including two rural communes in the health district of Mayahi: Maïreyreye (control) and Guidan Amoumoune (intervention). The control group received outpatient treatment for uncomplicated SAM from health facilities (HFs), while the intervention group received outpatient treatment for uncomplicated SAM from HFs or CHWs. A total of 2789 children aged 6-59 months with SAM without medical complications were included in the study. The proportion of cured children was 72.1% in the control group, and 77.2% in the intervention group. Treatment coverage decreased by 8.3% in the control area, while the group of CHWs was able to mitigate that drop and even increase coverage by 3%. This decentralized treatment model of acute malnutrition with CHWs allowed an increase in treatment coverage while maintaining a good quality of care. It also allowed the early inclusion of children in less severe conditions. These results may enhance the Niger Ministry of Health to review the management of SAM protocol and allow CHWs to treat acute malnutrition.

Taller but thinner: trends in child anthropometry in Senegal, 1990-2015

OBJECTIVE

To investigate trends in child anthropometry in Senegal between 1990 and 2015 and relate them with potential causes. Several hypotheses were tested: changes in health status, income, diet and socio-economic status.

DESIGN

Statistical analysis of trends in anthropometric data: height, weight, BMI and associated Z-scores calculated with the CDC-2000 standard (Centers for Disease Control and Prevention): height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ). Trends were fitted with linear regression models and were related with changes in health and socio-economic status.

SETTING

Nine nationally representative samples of Senegalese children aged 12-59 months, taken between 1986 and 2017 by Demographic and Health Surveys (DHS).

PARTICIPANTS

Children aged 12-59 months.

RESULTS

Over the 25 years of investigation, the average height of children increased by +1·88 cm, their average weight by +0·10 kg, but their BMI decreased by -0·53 kg/m2. Corresponding changes expressed in Z-scores were +0·454 in HAZ, +0·109 in WAZ and -0·302 in WHZ. This pattern of decreasing stunting while increasing wasting was correlated with decreasing child mortality, despite small changes in income per capita and in adult heights or BMI. Largest improvements in HAZ were among the lower socio-economic strata, while largest declines in WHZ were among higher socio-economic strata.

CONCLUSIONS

Decline in stunting appeared associated primarily with the control of infectious diseases, also responsible for the mortality decline. Increase in wasting was surprising. It appears associated with small changes in income per capita, and therefore in diet, in a context of increasing height.

Comparison of anthropometric indicators to predict mortality in a population-based prospective study of children under 5 years in Niger

OBJECTIVE

In the present study, we aimed to compare anthropometric indicators as predictors of mortality in a community-based setting.

DESIGN

We conducted a population-based longitudinal study nested in a cluster-randomized trial. We assessed weight, height and mid-upper arm circumference (MUAC) on children 12 months after the trial began and used the trial's annual census and monitoring visits to assess mortality over 2 years.

SETTING

Niger.

PARTICIPANTS

Children aged 6-60 months during the study.

RESULTS

Of 1023 children included in the study at baseline, height-for-age Z-score, weight-for-age Z-score, weight-for-height Z-score and MUAC classified 777 (76·0 %), 630 (61·6 %), 131 (12·9 %) and eighty (7·8 %) children as moderately to severely malnourished, respectively. Over the 2-year study period, fifty-eight children (5·7 %) died. MUAC had the greatest AUC (0·68, 95 % CI 0·61, 0·75) and had the strongest association with mortality in this sample (hazard ratio = 2·21, 95 % CI 1·26, 3·89, P = 0·006).

CONCLUSIONS

MUAC appears to be a better predictor of mortality than other anthropometric indicators in this community-based, high-malnutrition setting in Niger.

Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality- policy implications

BACKGROUND

Severe acute malnutrition (SAM) is diagnosed when the weight-for-height Z-score (WHZ) is <-3Z of the WHO2006 standards, or a mid-upper-arm circumference (MUAC) of < 115 mm or there is nutritional oedema. Although there has been a move to eliminate WHZ as a diagnostic criterion we have shown that children with a low WHZ have at least as high a mortality risk as those with a low MUAC. Here we take the estimated case fatality rates and published case-loads to estimate the proportion of total SAM related deaths occurring in children that would be excluded from treatment with a MUAC-only policy.

METHODS

The effect of varying case-load and mortality rates on the proportion of all deaths that would occur in admitted children was examined. We used the same calculations to estimate the proportion of all SAM-related deaths that would be excluded with a MUAC-only policy in 48 countries with very different relative case loads for SAM by only MUAC, only WHZ and children with both deficits. The case fatality rates (CFR) are taken from simulations, empirical data and the literature.

RESULTS

The relative number of cases of SAM by MUAC alone, WHZ alone and those with both criteria have a dominant effect on the proportion of all SAM-related deaths that would occur in children excluded from treatment by a MUAC-only program. Many countries, particularly in the Sahel, West Africa and South East Asia would fail to identify the majority of SAM-related deaths if a MUAC only program were to be implemented. Globally, the estimated minimum number of deaths that would occur among children excluded from treatment in our analyses is 300,000 annually.

CONCLUSIONS

The number, proportion or attributable fraction of children excluded from treatment with any change of current policy are the correct indicators to guide policy change. CRFs alone should not be used to guide policy in choosing whether or not to drop WHZ as a diagnostic for SAM. All the criteria for diagnosis of malnutrition need to be retained. It is critical that methods are found to identify those children with a low WHZ, but not a low MUAC, in the community so that they will not remain undetected.

Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: I. Empirical data demonstrates Simpson's paradox

BACKGROUND

According to WHO childhood severe acute malnutrition (SAM) is diagnosed when the weight-for-height Z-score (WHZ) is <-3Z of the WHO2006 standards, the mid-upper-arm circumference (MUAC) is < 115 mm, there is nutritional oedema or any combination of these parameters. Recently there has been a move to eliminate WHZ as a diagnostic criterion on the assertion that children meeting the WHZ criterion are healthy, that MUAC is universally a superior prognostic indicator of mortality and that adding WHZ to the assessment does not improve the prediction; these assertions have lead to a controversy concerning the role of WHZ in the diagnosis of SAM.

METHODS

We examined the mortality experience of 76,887 6-60 month old severely malnourished children admitted for treatment to in-patient, out-patient or supplementary feeding facilities in 18 African countries, of whom 3588 died. They were divided into 7 different diagnostic categories for analysis of mortality rates by comparison of case fatality rates, relative risk of death and meta-analysis of the difference between children admitted using MUAC and WHZ criteria.

RESULTS

The mortality rate was higher in those children fulfilling the WHO2006 WHZ criterion than the MUAC criterion. This was the case for younger as well as older children and in all regions except for marasmic children in East Africa. Those fulfilling both criteria had a higher mortality. Nutritional oedema increased the risk of death. Having oedema and a low WHZ dramatically increased the mortality rate whereas addition of the MUAC criterion to either oedema-alone or oedema plus a low WHZ did not further increase the mortality rate. The data were subject to extreme confounding giving Simpson's paradox, which reversed the apparent mortality rates when children fulfilling both WHZ and MUAC criteria were included in the estimation of the risk of death of those fulfilling either the WHZ or MUAC criteria alone.

CONCLUSIONS

Children with a low WHZ, but a MUAC above the SAM cut-off point are at high risk of death. Simpson's paradox due to confounding from oedema and mathematical coupling may make previous statistical analyses which failed to distinguish the diagnostic groups an unreliable guide to policy. WHZ needs to be retained as an independent criterion for diagnosis of SAM and methods found to identify those children with a low WHZ, but not a low MUAC, in the community.

Spectrum of Disease and Prescription Pattern for Outpatients with Neurological Disorders: An Empirical Pilot Study in Bangladesh

BACKGROUND

Neurological disorders represent one of the most prominent causes of morbidity and mortality that adversely affect the lifestyle of patients and a major percentage of these diseases exists in developing countries.

PURPOSE

The objective of this study was to examine the prevalence and prescription pattern for outpatients with neurological disorders in Bangladesh.

METHODS

The study was conducted on 1,684 patients in 6 hospitals (National Institute of Neurosciences and Hospital, Dhaka Medical College and Hospital, Bangabandhu Sheikh Mujib Medical University, Shaheed Suhrawardy Medical College, Sir Salimullah Medical College, and Apollo Hospitals Dhaka) of the Dhaka City from March 2014 to June 2015. Data were collected through a predesigned questionnaire from the patients that contain information about gender, age, marital status, occupation, residential status, affected disease, self-medicated medicines, and prescribed medicines.

RESULTS

Out of 1,684 patients, 28.38% patients were aged 51-60 years and male, 57.19% predominance. The study exposed headache and migraine for 29.75% patients, followed by stroke for 23.93% patients and seizure for 7.07% patients. Genetic reason for the neurological disorders was seen only among 12.35% patients. In this study, 16.98% patients had been affected by neurological disorders for more than 2 years and 19% of patients for less than 6 months. Most extensively prescribed medicines were multivitamins and multiminerals used by 17.89% of patients followed by nonsteroidal anti-inflammatory drugs and other analgesic by 14.84%; afterwards antiulcerants were used by 12.62%, subsequently anticoagulants were used by 11.61% followed by antihyperlipidemic medicines by 10.26% and antiepileptic drugs by 8.08% of patients. The crucial reasons for the selection of prescribed medicines were the confidence that patients had with the physician's prescribed medicines, which was shown for 40.97% patients and knowledge of the medicines was reported for 35.04% patients. The period of prescribed medicine usage was 1-3 months for 39.73% patients and 3-6 months for 29.16% patients. The patient's compliance for prescribed medicines was satisfactory for 34.56% patients, good for 28.15% patients, and side effects were reported for 23.22% patients.

CONCLUSION

In Bangladesh, it is not surprising to note that neurological diseases are more prevalent than other different diseases among different age groups and genders. Headache and migraine, stroke and seizure are most frequently encountered neurological disorders here. Treatment procedure of these disorders is not quite suitable due to the anomalies of health care management systems. Appropriate management of the health care system, especially the placement of hospital and community pharmacy can overcome the existing inconsistencies as well as increase the knowledge, awareness, and perception of the patients about health and neurological disorders.

Weight-for-Height Z Score and Mid-Upper Arm Circumference as Predictors of Mortality in Children with Severe Acute Malnutrition

BACKGROUND

Mortality associated with severe acute malnutrition (SAM) could be reduced by screening malnourished children for those most vulnerable to death. We compared the weight-for-height Z score (WHZ) and mid-upper arm circumference (MUAC) as predictors of mortality in children with SAM.

METHODS

We conducted a retrospective study spanning over 8 years, using records of children aged 6-59 months, hospitalized for SAM and discharged alive or who died during hospitalization.

RESULTS

Area under the curve was greater for MUAC [0.809 (95% CI, 0.709-0.911, p = 0.001)] than WHZ [0.649 (95% CI, 0.524-0.774, p = 0.032)]. MUAC predicted death better [sensitivity: 95.5%, specificity: 25.0%, positive likelihood ratio (PLR): 1.27, negative likelihood ratio (NLR): 0.18] than WHZ (sensitivity: 86.4%, specificity: 21.4%, PLR: 1.10, NLR: 0.64). Best MUAC and WHZ cut-offs for predicting death (10.3 cm and -4, respectively) were most accurate in infants aged <12 months, the former being more accurate.

CONCLUSION

MUAC predicts death better than WHZ in children with SAM.

Heterogeneous effects of market integration on sub-adult body size and nutritional status among the Shuar of Amazonian Ecuador

BACKGROUND

Market integration (MI)-increasing production for and consumption from a market-based economy-is drastically altering traditional ways of life and environmental conditions among indigenous Amazonian peoples. The effects of MI on the biology and health of Amazonian children and adolescents, however, remain unclear.

AIM

This study examines the impact of MI on sub-adult body size and nutritional status at the population, regional and household levels among the Shuar of Amazonian Ecuador.

SUBJECTS AND METHODS

Anthropometric data were collected between 2005-2014 from 2164 Shuar (aged 2-19 years) living in two geographic regions differing in general degree of MI. High-resolution household economic, lifestyle and dietary data were collected from a sub-sample of 631 participants. Analyses were performed to investigate relationships between body size and year of data collection, region and specific aspects of household MI.

RESULTS

Results from temporal and regional analyses suggest that MI has a significant and overall positive impact on Shuar body size and nutritional status. However, household-level results exhibit nuanced and heterogeneous specific effects of MI underlying these overarching relationships.

CONCLUSION

This study provides novel insight into the complex socio-ecological pathways linking MI, physical growth and health among the Shuar and other indigenous Amazonian populations.

Stunting and the Prediction of Lung Volumes Among Tibetan Children and Adolescents at High Altitude

This study examines the extent to which stunting (height-for-age Z-scores ≤ -2) compromises the use of low altitude prediction equations to gauge the general increase in lung volumes during growth among high altitude populations. The forced vital capacity (FVC) and forced expiratory volume (FEV1) of 208 stunted and 365 non-stunted high-altitude Tibetan children and adolescents between the ages of 6 and 20 years are predicted using the Third National Health and Nutrition Examination Survey (NHANESIII) and the Global Lung Function Initiative (GLF) equations, and compared to observed lung volumes. Stunted Tibetan children show smaller positive deviations from both NHANESIII and GLF prediction equations at most ages than non-stunted children. Deviations from predictions do not correspond to differences in body proportions (sitting heights and chest circumferences relative to stature) between stunted and non-stunted children; but appear compatible with the effects of retarded growth and lung maturation that are likely to exist among stunted children. These results indicate that, before low altitude standards can be used to evaluate the effects of hypoxia, or before high altitude populations can be compared to any other group, it is necessary to assess the relative proportion of stunted children in the samples. If the proportion of stunted children in a high altitude population differs significantly from the proportion in the comparison group, lung function comparisons are unlikely to yield an accurate assessment of the hypoxia effect. The best solution to this problem is to (1) use stature and lung function standards based on the same low altitude population; and (2) assess the hypoxic effect by comparing observed and predicted values among high altitude children whose statures are most like those of children on whom the low altitude spirometric standard is based-preferably high altitude children with HAZ-scores ≥ -1.

Breastfeeding practices of Cameroonian mothers determined by dietary recall since birth and the dose-to-the-mother deuterium-oxide turnover technique

Exclusive breastfeeding during the first 6 months of infant's life is a public health recommendation and important factor for the promotion of optimal growth, health and behavioural development of each child. The accuracy of the mothers' self-reported past infant-feeding events was examined and compared with the isotopic dilution technique. Breastfeeding practices were assessed in a sample of 44 Cameroonian mother-infant pairs using dietary recall since birth. Intakes of breast milk and non-breast milk water were measured in the same sample using the dose-to-the-mother deuterium-oxide turnover technique and compared with questionnaire. Results showed that mothers' self-reported behaviour overestimates the exclusive breastfeeding rate. Seventy-five per cent of the mothers who claimed to be exclusively breastfeeding were found to be predominantly or partially breastfeeding by the dose-to-the-mother deuterium-oxide turnover technique. Only 11% of the infants were exclusively breastfed, and the breast milk output was not significantly affected (P ≤ 0.05) by the mother's body composition. Mean intakes of breast milk and non-breast milk water were 701 mL day(-1) and 268 mL day(-1), respectively. Introduction of non-breast milk foods is associated with a reduction in the level of breast milk intake, but the difference in breast milk intake was not significant between exclusively and predominantly breastfed infants. In conclusion, the dose-to-the-mother deuterium-oxide turnover technique can be applied to validate the mother's reports of infant-feeding practices, but non-breast milk water intake by breastfeeding category still needs to be normalized.

Prevalence and associated factors of Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents

BACKGROUND

Osgood-Schlatter (OS) syndrome is a disease of the musculoskeletal system often observed during the bone growth phase in adolescents. HYPOTHESIS/ PURPOSE: Demographic and anthropometric factors and those linked to the practice of sports may be related to the prevalence of OS. The aim of the present study was to describe the epidemiologic profile and associated factors of individuals with OS syndrome in a population-based sample of Brazilian adolescents.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A cross-sectional study was conducted with 956 adolescent students (474 boys, 482 girls) from 2008 to 2009 enrolled in the school system of Natal, Brazil. The age ranged between 12 and 15 years (13.7 ± 1.04 years). Tests were performed to assess the anthropometric and clinical aspects related to OS. To confirm the diagnosis of OS syndrome, the participant had to fulfill all the following clinical criteria: pain with direct pressure on the tibial apophysis; aforementioned pain before, during, and after physical activities; enlargement or prominence of the tibial apophysis; pain with resisted knee extension; and pain from jumping.

RESULTS

The prevalence of OS in the sample was 9.8% (11.0% of boys and 8.3% of girls; boys, 13.5 ± 1.07 years; girls, 13.6 ± 1.01 years). The results showed that 74.6% of the students suffered from muscle shortening. Multivariate analysis using logistic regression showed that the factors associated with the presence of OS were the regular practice of sport activity (odds ratio, 1.94; 95% confidence interval, 1.22-3.10) and the shortening of the rectus femoris muscle (odds ratio, 7.15; 95% confidence interval, 2.86-17.86).

CONCLUSIONS

The regular practice of sports in the pubertal phase and the shortening of the rectus femoris muscle were the main factors associated to the presence of OS syndrome in the students.

Persistence of growth stunting in a Peruvian high altitude community, 1964-1999

The growth of children living in Nuñoa, a Peruvian high-altitude community, was studied over a 35-year period using data collected in 1964 and 1999. There had been evidence of a secular trend in growth in the mid-1980s, but this was before a period of sociopolitical upheaval lasting until the late 1990s partly linked to the activities of the Shining Path group and the Peruvian government's response. Anthropometric data for 576 children examined in 1964-1966 were compared with data from 361 children examined in 1999. Data were converted to Z Scores using NCHS/WHO reference standards. Compared with the 1964 cohort, boys in 1999 had marginally greater height Z Scores, but among females, the trend was reversed. Stunting prevalence had decreased from 1964 levels, but still approached 60% in both sexes, among the highest rates recorded for a modern world population. The prevalence of low weight for height was less than expected, possibly because of the compensatory effect of enlarged chest diameter. This anatomical feature may represent the effect of chronic hypoxic stress, causing growth of the chest cavity at the expense of growth in height. In view of modest improvements during the late 1980s in this population, we believe that the relatively poor growth status of children a decade later may result from food disruption associated with later political instability. Compared with children in a nearby community, which benefits from the socioeconomic infrastructure associated with a large copper mine, Nuñoa children continue to fare relatively poorly.

Sex differences in the effect of birth order and parents' educational status on stunting: a study on Bengalee preschool children from eastern India

One of the greatest problems facing developing countries, including rural India, is undernutrition in terms of stunting among under 5-year-old children. However, there exists scanty information on the prevalence of stunting among preschool children in India and in particular in West Bengal. This study investigated prevalence of stunting and identified the predictor(s) of stunting among 1-5-year-old Bengalee rural preschool children of Integrated Child Development Services (ICDS) centres. This cross-sectional study was undertaken at different ICDS centres of Chapra Block, Nadia District, West Bengal, India. A total of 673 preschool children (323 boys and 350 girls), aged 1-5 years were selected from 30 randomly selected ICDS centres to study the impact of parents' educational status and child birth order on stunting. The overall (age and sex combined) rate of stunting was 39.2%. Child birth order (BO) (chi(2)=14.10, df=1, p<0.001), father educational status (FES) (chi(2)=21.11, p<0.001) and mother educational status (MES) (chi(2)=14.34, df=1, p>0.001) were significantly associated with the prevalence of stunting among girls. Logistic regression analyses revealed that both FES (Wald=19.97, p<0.001) as well as MES (Wald=13.95, p<0.001) were strong predictors of stunting among girls. Similarly BO (Wald=13.71, p<0.001) was a strong predictor of stunting among girls. Girls with >or=3rd BO had significantly higher risk (OR=2.49, CI=1.54-4.03) of stunting than those with <or=2nd BO. Moreover, girls with FES lower than secondary level had significantly (OR=3.30, CI=1.96-5.58) higher rate of stunting than those with FES>or=secondary level. Similarly, girls with MES<secondary level had significantly (OR=2.50, CI=1.54-4.03) higher rate of stunting than those with FES>or=secondary level. In conclusion our study revealed that BO as well as parents' educational status were strong predictors of stunting among girls but not boys. Sex discrimination could be a likely cause for this sex difference in the impact of BO and parents' educational status.

Growth and body composition of Peruvian infants in a periurban setting

BACKGROUND

Previous growth studies of Peruvian children have featured high stunting rates and limited information about body composition.

OBJECTIVE

We aimed to characterize anthropometric measures of Peruvian infants 0 to 12 months of age in relation to the international growth references and biological, environmental, and socioeconomic factors.

METHODS

Infants (n = 232) were followed longitudinally from birth through 12 months of age from a prenatal zinc supplementation trial conducted in Lima, Peru, between 1995 and 1997. Anthropometric measures of growth and body composition were obtained at enrollment from mothers and monthly through 1 year of age from infants. Weekly morbidity and dietary intake surveillance was carried out during the second half of infancy.

RESULTS

The prevalence rates of stunting, underweight, and wasting did not exceed 4% based on the World Health Organization growth references. Infants of mothers from high-altitude regions had larger chest circumference (p = .006) and greater length (p = .06) by 12 months. Significant predictors of growth and body composition throughout infancy were age, sex, anthropometric measurements at birth, breastfeeding, maternal anthropometric measurements, primiparity, prevalence of diarrhea among children, and the altitude of the region of maternal origin. No associations were found for maternal education, asset ownership, or sanitation and hygiene factors.

CONCLUSIONS

Peruvian infants in this urban setting had lower rates of stunting than expected. Proximal and familial conditions influenced growth throughout infancy.

Stunting: its relation to overweight, global or localized adiposity and risk factors for chronic non-communicable diseases

This article discloses and discusses recent findings that have associated stunting - which still represents the most prevalent deviation from normal body measurements among children living in developing countries - with overweight and higher adiposity, mainly in the central region of the body, and their clinical and physio-pathological consequences. Although there is need for further studies to clarify these associations, there is a tendency for the weight/height index and body fat topography to behave differently in short and normal stature individuals, mainly in females. This review, therefore, alerts health professionals this characteristic, given that this anthropometric profile may be linked to the widespread occurrence of chronic non-communicable diseases and/or to risk factors for these conditions and that stunting is still a reality in developing countries.

Stunting, underweight and wasting among Integrated Child Development Services (ICDS) scheme children aged 3-5 years of Chapra, Nadia District, West Bengal, India

This study investigated age and sex variations in height and weight, levels of stunting, underweight and wasting among 533 (254 boys; 279 girls) 3- to 5-year-old rural children of Bengalee ethnicity at 11 Integrated Child Development Services centres of Nadia District, West Bengal, India. Height-for-age, weight-for-age and weight-for-height < -2 z-scores were used to evaluate stunting, underweight and wasting, respectively, following the National Center for Health Statistics (NCHS) Guidelines. Results revealed that boys were significantly heavier than girls at age 3 years. Significant age differences existed in mean height and weight in both sexes. Mean z-scores of height-for-age, weight-for-age and weight-for-height were lower than those of NCHS for both sexes at all ages. The overall (age and sex combined) rates of stunting, underweight and wasting were 23.9%, 31.0% and 9.4%, respectively. The rate of underweight and wasting was higher among girls (underweight = 35.1%, wasting = 12.2%) compared with boys (underweight = 26.5%, wasting = 6.3%). In general, the frequency of stunting increased with increasing age in both sexes. Based on the World Health Organization classification of severity of malnutrition, the overall prevalence of underweight was very high (>or=30%). The prevalence rates of stunting (20-29%) and wasting (5-9%) were medium. In conclusion, the nutritional status of the subjects is unsatisfactory. There is scope for improvement in the form of enhanced supplementary nutrition.

Does zinc deficiency play a role in stunting among primary school children in NE Thailand?

Stunting in school-age years may result in a decrease in adult size, and thus reduced work capacity and adverse reproductive outcomes. We have compared the mean intakes of energy, protein and selected growth-limiting nutrients in fifty-eight stunted children and 172 non-stunted controls drawn from 567 children aged 6–13 years attending ten rural schools in NE Thailand. Control children were selected randomly after stratifying children by age in each school. Dietary data were calculated from 24-h recalls using nutrient values from Thai food composition data and chemical analysis. Inter-relationships between stunting and sociodemographic, anthropometric and biochemical variables were also examined. Biochemical variables investigated were serum albumin, zinc, ferritin, transferrin receptor and retinol, and iodine in casual urine samples. Significantly more males than females were stunted (males, n 38, 65·5 % v. females, n 20, 34·5 %; P = 0·025). Stunted males had lower mean intakes of energy, protein, calcium, phosphorus and zinc, and a lower mean (95 % CI) serum zinc (9·19 (8·53, 9·84) v. 9·70 (8·53, 9·29) μmol/l) than non-stunted males; no other biochemical differences were noted. Stunted males also had a lower mean arm muscle area (P = 0·015), after adjusting for age, than non-stunted males. In conclusion, the lower dietary intakes of the stunted males compared to their non-stunted counterparts may be associated with anorexia and hypogeusia induced by zinc deficiency. Hence, zinc deficiency may be a factor limiting linear growth, especially among boys in NE Thailand, but more research is needed to establish whether other factors also play a role.

Comparison of techniques to evaluate adiposity in stunted and nonstunted children

OBJECTIVE

The use of anthropometric measures (eg, skinfold thicknesses, BMI) to assess obesity is not without controversy and has not been explored with respect to the use among groups of children with growth retardation (ie, stunting). Therefore, the objective of this study was to determine whether growth retardation affects the accuracy of field methods for assessing body composition in children.

METHODS

A cross-sectional study was conducted in 30 stunted children and 30 nonstunted children who were matched for age- and weight-for-height z score and living in the shantytowns of São Paulo, Brazil. Body composition (fat mass, fat-free mass, and percentage of body fat [%BF]) was measured by H2(18)O dilution (reference technique) using group-specific values for the hydration of fat-free mass and dual-energy x-ray absorptiometry. BMI and body composition that were calculated from 3 pediatric skinfold prediction equations were evaluated for accuracy of %BF in comparison with the reference technique.

RESULTS

Stunted children were shorter and weighed less than nonstunted children, but BMI did not differ significantly between groups. All 3 skinfold equations tested resulted in a calculated %BF that was significantly lower than that measured by H2(18)O dilution for both stunted and nonstunted groups, and %BF as calculated by any of the skinfold equations tested did not significantly predict %BF by H2(18)O dilution. In contrast, BMI significantly predicted %BF in both stunted and nonstunted children, and this relationship did not differ by growth status.

CONCLUSION

BMI but not skinfolds significantly predicted %BF measured by H2(18)O dilution. The relationship between BMI and %BF did not differ between stunted and nonstunted children; this indicates that BMI can be used in field studies of obesity and stunting. However, the prediction of %BF by BMI is relatively poor in both groups of children, and continued investigation of more accurate field methods for measuring %BF is warranted.

Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men

OBJECTIVE

It is unknown whether waist circumference can predict a lipid profile beyond that predicted by body fatness alone, after adjustment for important confounding variables such as smoking, alcohol intake, and physical activity. The purpose of this non-clinical, healthy-subject study was to test this hypothesis.

METHODS

Data refer to 416 men, ages 20 to 58 y with a body mass index between 18.5 and 29.9 kg/m(2), who were blood donors living in a Brazilian city. Alcohol consumption, smoking, and physical activity were evaluated by interview; body fat was measured by electrical bioimpedance, and weight, height, and waist and hip circumferences were measured by trained anthropometrists. Multiple linear regression analysis was performed to quantify the association between measurements of fat distribution (waist circumference and waist-to-hip ratio) and the ratio of total cholesterol to high-density lipoprotein cholesterol and triacylglycerols independently of measurements of fatness and potentially confounding factors.

RESULTS

Waist circumference was strongly correlated with percentage of body fat (r = 0.90), whereas waist-to-hip ratio was less correlated (r = 0.55). After adjustment for age, percentage of body fat, smoking, alcohol intake, and physical activity, waist circumference was not significantly related to the ratio of total cholesterol high-density lipoprotein cholesterol, whereas the waist-to-hip ratio was strongly associated among the youngest subjects (beta = 3.51, P = 0.005).

CONCLUSION

Although several studies have analyzed the association between serum lipids with anthropometric markers, few, including the present one, support waist circumference as a good predictor of lipid profile.

Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo Province of South Africa

OBJECTIVE

We evaluated feeding practices and growth patterns of infants in the central region of the Limpopo Province over the first 12 mo of life.

METHODS

A follow-up study on a cohort of term infants born to 276 mothers recruited during their third trimester of pregnancy was undertaken. The mothers were recruited by the nursing staff at nine randomly selected clinics. From this sample, 219 women gave birth at the local hospital and the infants were followed from birth to 12 mo. Data collected included infant feeding practices and anthropometry at regular intervals (1, 3, 6, 9 and 12 mo). The anthropometric measurements taken were body weight, length, and head circumference.

RESULTS

At birth 8.8% of infants had a low birth weight, 9.6% were stunted, 48.9% were underweight, and 7.3% were wasted. Mothers in this study breastfed their infants for long periods with more than 80% still breastfeeding by the ninth month. However, exclusive breastfeeding during the first 3 mo was uncommon as mothers tended to introduce supplementary feeds at an early age, with 56% of the infants receiving some form of supplement by the end of the first month. The most common supplementary foods were maize meal porridge and mabella (sorghum). Stunting became increasingly apparent in the early months with 30% of infants being stunted (<-2 standard deviations [SD] of the National Center for Health Statistics [NCHS] reference curves) by the first month, and this percentage remained high for the 12-mo period, remaining at below - 1 SD NCHS height-for-age standard. Increased weight gain was seen during the first 3 mo and then declined until mean weight-for-age at 12 mo was below 0 SD NCHS. Twelve percent of infants were overweight (>2 SD NCHS) by the 12th month. Postnatally the infants showed a pattern of gradual stunting. Postnatal factors associated with this pattern were related to maternal socioeconomic status, and these included the mother's level of education, employment status, parity, and access to electricity.

CONCLUSION

There was a high frequency of underweight infants at birth but stunting was less common. With respect to feeding practices, the mothers tended to introduce supplementary feeds at an early age.

Undernutrition prevalence and social determinants in children aged 0-59 months, Niterói, Brazil

OBJECTIVE

With the aim of diagnosing the nutritional status and nutritional social-economic determinants in children aged 0-59 months, 2194 children were studied in the three Health Districts of the city of Niterói, Rio de Janeiro State, Brazil.

MATERIALS AND METHODS

Data were obtained through a random sampling survey performed in the city's vaccination centres. Variables collected were maternal schooling, family income, dwelling's connection to safe water, dwelling's sewage connection, birthweight and the anthropometric indicators height/age (H/A; for stunting), weight/height (W/H; for wasting) and weight/age (W/A; for underweight). Undernutrition risk factors were identified with the help of logistic regression models for the age ranges 0-12 and 13-36 months.

RESULTS

Stunting and underweight levels were found to be above those of the NCHS reference, although, in general, at levels better than those frequently found in Third World countries. Low birthweight prevalence in the city was 9%, also above common levels in more developed countries. Undernutrition risks were, in general, higher for the younger age range. The variables family income, maternal schooling, water connection and birthweight could be characterized as important undernutrition risk factors, being most noticeable the effects of family income and birthweight both for the '0-12 months' and for the 'above 13 months' age ranges.

CONCLUSIONS

Although the city's problems are mostly concentrated on chronic undernutrition, more attention should be given to children's birthweight deficits, which appear to have effects on children's growth that extend for years after birth.

Overweight and risk of overweight in schoolchildren in the city of Rio de Janeiro, Brazil: prevalence and characteristics

The association of overweight and risk of overweight with socio-economic and demographic variables was investigated among schoolchildren in the city of Rio de Janeiro, Brazil between 1995 and 1996. Data were obtained by direct interview and physical examination of boys and girls aged between 6 and 11 years in a two-stage, random sample, population-based survey. Univariate analysis was performed on the association between socio-economic and demographic predictors of overweight/risk of overweight and the dependent variables, i.e. body mass index (BMI), triceps skinfold and subscapular skinfold. Based on this analysis, logistic regression models were developed. The prevalence of overweight and risk of overweight was 37.8% in girls and 36.4% in boys. For the BMI model, the variables retained were age and number of persons per household; for the triceps skinfold model, the variables were age, gender and area of residence; and age, gender and persons/household were the variables for the subscapular skinfold model. The results suggest that both BMI and skinfold indicators should be used to assess overweight/risk of overweight and that public health programmes for schoolchildren should be developed to combat the alarming increase in obesity.