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Mondkar SA, Khadilkar V, Jahagirdar R, Kore V, Yewale S, Dange N, More C, Khadilkar A. Comparison of Nutritional Status of Healthy Under-Five Indian Children Using Composite Index of Anthropometric Failure on WHO 2006 versus 2019 Indian Synthetic Growth Charts. Indian J Pediatr 2024; 91:659-666. [PMID: 37880468 DOI: 10.1007/s12098-023-04865-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/01/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To assess nutritional status of apparently-healthy under-five Indian children using Composite Index of Anthropometric Failure (CIAF) and to compare anthropometric failure prevalence using conventional indices and CIAF on World Health Organization (WHO) vs. synthetic Indian growth charts. METHODS This observational study was conducted over 2 y. The inclusion criteria was apparently-healthy children (0-60 mo) and the exclusion criteria were acute/chronic illness and small for gestational age. RESULTS A total of 1557 children (762 girls) were included in the study. The mean age of the subjects was 21 mo. The Z-scores for height, weight, body mass index (BMI) for age and weight for height in children were lower on WHO vs. synthetic charts (p = 0.0001). Significantly higher proportion of children were moderately and severely underweight, stunted and wasted on WHO charts. Synthetic charts identified significantly higher proportion as normal for weight, height, BMI for age, weight for height, overweight (overall), and a higher prevalence of severe stunting, and severe acute malnutrition (SAM) was noted among girls compared to boys. Using CIAF, 54.1% children were normal on WHO charts vs. 78.0% on synthetic (p = 0.0001). Larger proportion of girls (8.8%) were stunted+underweight (category-E) vs. boys (4.3%) on synthetic charts (p = 0.0003). Significantly higher proportion of children demonstrated failure (single/dual/multiple) on WHO charts except category-Y (higher proportion of underweight on synthetic charts). Maximum difference in CIAF (WHO vs. synthetic) was observed between 0-24 mo age. Of 1215 children normal on synthetic charts, 837 (68.9%) were normal on WHO charts. Of 116 underweight children (category-Y) on synthetic charts, 20 (17.2%) were underweight on WHO charts; remaining had compound failure (wasting+underweight = 49.1%, wasting+stunting+underweight = 14.7%, stunting+underweight = 12.1%) on WHO charts. Among those stunted+underweight (category-E) on synthetic charts, WHO charts classified 1/4th as wasted+stunted+underweight (category-D). CONCLUSIONS Synthetic references are more representative of Indian growth patterns, and seem more appropriate for monitoring growth of Indian children to avoid mislabelling as malnourished.
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Affiliation(s)
- Shruti A Mondkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | | | - Vrushali Kore
- Bharati Vidyapeeth University Medical College, Pune, India
| | - Sushil Yewale
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Nimisha Dange
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Chidvilas More
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India.
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Sohn JA, Chang JY, Oh S, Hong J. Differences in Growth and Dietary and Nutrient Intake Patterns by Breastfeeding Status Over One Year Among Korean Children Aged 24-35 Months. J Korean Med Sci 2023; 38:e363. [PMID: 37967877 PMCID: PMC10643245 DOI: 10.3346/jkms.2023.38.e363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND A previous national study found that Korean children who were breastfed for at least one year had lesser weight gain, lower protein, calcium, and iron intake relative to calories, and different dietary patterns in the second year of life, compared with children weaned before 12 months of age or those who were never breastfed. Therefore, this study aimed to investigate whether growth status, dietary and nutrient intake patterns differed by prolonged breastfeeding (PBF) experience even in the third year of life, when weaning is considered complete. METHODS This cross-sectional study was based on the data of children aged 24 to 35 months from the National Health and Nutrition Examination Survey (2010-2020). Data on anthropometry, dietary behavior, food and nutrient intake, maternal education, and household income were extracted to analyze the association between PBF and growth, dietary and nutrient intake patterns. RESULTS In the final analysis, 31.6% of the 931 children with a birth weight of ≥ 2.5 kg continued to breastfeed for at least 12 months of age, and their mean breastfeeding (BF) duration was 15.9 months. Children with PBF had significantly less postnatal weight gain than those without (P = 0.006). Regarding food group intake, PBF was significantly associated with lower legume and soy product intake (β [95% confidence interval], -10.688 [-19.314, -2.062], P = 0.015) and higher fruit intake (32.978 [3.349, 62.608], P = 0.029), after adjusting for sex, age in month, total caloric intake, maternal education and household income. Regarding nutrient intake, after adjusting for these variables, PBF had significantly associated with higher dietary fiber (β [95% CI], 1.607 [0.218, 2.996], P = 0.023), iron (0.848 [0.317, 1.380], P = 0.002) and niacin (0.728 [0.222, 1.235], P = 0.005) intake and was significantly associated with lower saturated fatty acid intake (-1.217 [-2.364, -0.071], P = 0.037) and percentage of energy from fat (-1.351 [-2.666, -0.035], P = 0.044). CONCLUSION Even in the third year of life, children who have been breastfed for over one year continue to have relatively slow growth. However, they do appear to have better intake of some beneficial nutrients, which may be attributed to healthier dietary intake patterns in children with PBF. The results of this study can be used to support the recommendation of long-term BF for Korean infants and toddlers.
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Affiliation(s)
- Jin A Sohn
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju Young Chang
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Sohee Oh
- Medical Research Collaborating Center, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
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Kim SH, Park MJ, Park SK. Urinary concentrations of polycyclic aromatic hydrocarbon metabolites and childhood obesity. Heliyon 2023; 9:e19335. [PMID: 37674840 PMCID: PMC10477474 DOI: 10.1016/j.heliyon.2023.e19335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives Existing literature provides limited information on the association between childhood obesity and polycyclic aromatic hydrocarbons (PAHs), which are potentially obesogenic. We examined the association between urinary concentrations of PAH metabolites and obesity in the Korean pediatric population. Methods We analyzed the data of 2286 children/adolescents aged 3-17 years who participated in the Korean National Environmental Health Survey between 2015 and 2017. Urinary concentrations of 2-naphthol, 2-hydroxyfluorene, 1-hydroxyphenanthrene, and 1-hydroxypyrene were assayed using gas chromatography-mass spectrometry. Overweight/obesity was defined as a body mass index (BMI) for age ≥85th percentile. Multiple linear and logistic regression models were used to analyze the relationship of BMI z-score and overweight with urinary concentrations of PAH metabolites after adjusting for age, sex, household income, parental education level, physical activity, fast-food consumption, and environmental tobacco smoke exposure. Results BMI z-score was positively associated with 2-naphthol concentrations in children aged 6-11 and 12-17 years and with 1-hydroxypyrene concentrations in children aged 6-11 years. In the overall population, a significant rise in odds ratios for overweight/obesity across 2-naphthol quartiles was noted. Specifically, the 3rd and 4th quartiles displayed odds ratios of 1.39 [1.03, 1.88] and 1.46 [1.08, 1.99] respectively, compared to the 1st quartile (P-for-trend = 0.006). Similar associations between 2-naphthol and overweight/obesity status were observed in the 6-11- and 12-17-year age groups. There was little evidence of an association between overweight/obesity and other PAH hydroxy derivatives. Conclusions PAH exposure may be associated with increased childhood adiposity, a potential risk factor for adult obesity and adverse metabolic outcomes.
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Affiliation(s)
- Shin-Hye Kim
- Department of Pediatrics, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, South Korea
| | - Mi Jung Park
- Department of Pediatrics, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, South Korea
| | - Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Hong J, Chang JY, Oh S, Kwon SO. Growth, Nutritional Status, and Dietary Intake Patterns Associated With Prolonged Breastfeeding in Young Korean Children: A Nationwide Cross-Sectional Study. J Korean Med Sci 2023; 38:e116. [PMID: 37069810 PMCID: PMC10111041 DOI: 10.3346/jkms.2023.38.e116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Although the optimal duration of breastfeeding remains unclear, breastfeeding is generally recommended exclusively for the first 6 months of life, which continues into late infancy. However, the awareness regarding the effects of long-term breastfeeding is relatively low compared with that of breastfeeding in early infancy. We aimed to investigate the growth and nutritional characteristics of the children with prolonged breastfeeding (PBF) over 1 year. METHODS This cross-sectional study was based on the data of children aged 12 to 23 months from the National Health and Nutrition Examination Survey (2010-2020) conducted by the Korean Center for Disease Control and Prevention. Data on anthropometric measurements, dietary behavior, and food and nutrient intake were extracted, and the association between PBF and growth, nutritional status, and dietary patterns were analyzed. RESULTS Of the 872 children with a birth weight of ≥ 2.5 kg in the final analysis, 34.2% continued breastfeeding over 12 months of age, and their median breastfeeding duration was 14.2 months. Children with PBF were more likely to have lower current body weight (P < 0.001) and weight gain (P < 0.001), lower daily protein (P = 0.012), calcium (P < 0.001), and iron (P < 0.001) intake per calorie compared with children weaned by 12 months of age or those who were never breastfed. Furthermore, they were started on complementary food at 6 months or later rather than 4-5 months (P < 0.001), consumed cow's milk earlier (P = 0.012), and consumed probiotics as dietary supplements (P < 0.001) significantly less commonly. When comparing the intake of food groups, children with PBF had a significantly higher intake of cereals and grains (P = 0.023) and fruits (P = 0.020) and a significantly lower intake of bean products (P = 0.020) and milk and dairy products (P = 0.003). CONCLUSION Korean children who continued breastfeeding over 12 months of age showed distinct characteristics in terms of growth, nutritional status, and dietary patterns in the second year of life compared to children who did not. Long-term additional research on their growth and nutritional status may be needed; however, these findings are significant as important fundamental data for nutritional counseling to establish healthy PBF.
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Affiliation(s)
- Jeana Hong
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ju Young Chang
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Sohee Oh
- Medical Research Collaborating Center, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung Ok Kwon
- Research Institute of Human Ecology, Seoul National University, Seoul, Korea
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Na JY, Cha JH, Moon JH, Lee H, Kim YJ, Cho Y. Protective Effect of Breastfeeding Against Febrile Seizure: A Nationwide Study in Korea. Pediatr Neurol 2023; 138:52-57. [PMID: 36395574 DOI: 10.1016/j.pediatrneurol.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/22/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breastfeeding is known to protect against febrile seizure (FS). Whether its impact continues throughout the childhood period is still controversial. Our objective was to investigate the protective effect of breastfeeding against FS stratified by age. METHODS We included children who participated in the National Health Screening Program for Infants and Children (NHSPIC) aged between four and six months between 2008 and 2014. Feeding type was confirmed based on the NHSPIC questionnaire, and data from the Korean National Health Insurance Service were used to determine FS cases during a five-year follow-up period. RESULTS Among the 1,791,335 children, the most prevalent feeding type was exclusive breastfeeding (EB) (42.3%). FS occurred most frequently in the exclusive formula feeding (EF) group (12.2%), followed by the partial breastfeeding (PB) (11.3%) and EB groups (10.7%). Compared with the EF group, the adjusted odds ratio for FS was 0.87 (95% confidence interval, 0.86 to 0.88, P < 0.001) and 0.93 (0.92 to 0.94, P < 0.001) in the EB and PB groups, respectively. The protective effect by age 2.5 years was significant in both the EB (0.85; 0.84 to 0.86, P < 0.001) and PB (0.92; 0.90 to 0.93, P < 0.001) groups. In contrast, the protective effect was not significant in the PB group and inconsistent in the EB group after 2.5 years. CONCLUSION Breastfeeding has a protective effect against FS in the most prevalent age period, from 0 to 2.5 years. Despite the limited effect after age 2.5 years, we support the current recommendation for prolonged breastfeeding to promote childhood health.
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Affiliation(s)
- Jae Yoon Na
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jong Ho Cha
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jin-Hwa Moon
- Department of Pediatrics, College of Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Yong Joo Kim
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
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