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The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight.
PloS Medicine. 2017 Jan; 14(1):e1002220.BACKGROUND: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use. METHODS AND FINDINGS: We conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown-rump length measured at 8-13 wk of gestation. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Fifty-two participants withdrew consent, and 1,387 participated in the study. At study entry, median maternal age was 28 y (interquartile range [IQR] 25-31), median height was 162 cm (IQR 157-168), median weight was 61 kg (IQR 55-68), 58% of the women were nulliparous, and median daily caloric intake was 1,840 cal (IQR 1,487-2,222). The median pregnancy duration was 39 wk (IQR 38-40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8-16). The median birthweight was 3,300 g (IQR 2,980-3,615). There were differences in birthweight between countries, e.g., India had significantly smaller neonates than the other countries, even after adjusting for gestational age. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. The 8,203 sets of ultrasound measurements were scrutinized for outliers and leverage points, and those measurements taken at 14 to 40 wk were selected for analysis. A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy. Male fetuses were larger than female fetuses as measured by EFW, but the disparity was smaller in the lower quantiles of the distribution (3.5%) and larger in the upper quantiles (4.5%). Maternal age and maternal height were associated with a positive effect on EFW, particularly in the lower tail of the distribution, of the order of 2% to 3% for each additional 10 y of age of the mother and 1% to 2% for each additional 10 cm of height. Maternal weight was associated with a small positive effect on EFW, especially in the higher tail of the distribution, of the order of 1.0% to 1.5% for each additional 10 kg of bodyweight of the mother. Parous women had heavier fetuses than nulliparous women, with the disparity being greater in the lower quantiles of the distribution, of the order of 1% to 1.5%, and diminishing in the upper quantiles. There were also significant differences in growth of EFW between countries. In spite of the multinational nature of the study, sample size is a limiting factor for generalization of the charts. CONCLUSIONS: This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world.
What can we learn from nutrition impact evaluations? Lessons from a review of interventions to reduce child malnutrition in developing countries.
Washington, D.C., World Bank, 2010 Aug.  p.This paper reviews recent impact evaluations of interventions and programs to improve child anthropometric outcomes- height, weight, and birth weight-with an emphasis on both the findings and the limitations of the literature and on understanding what might happen in a non-research setting. It further reviews the experience and lessons from evaluations of the impact of the World Bank-supported programs on nutrition outcomes. Specifically, the review addresses the following four questions: 1) what can be said about the impact of different interventions on children's anthropometric outcomes? 2) How do these findings vary across settings and within target groups, and what accounts for this variability? 3) What is the evidence of the cost-effectiveness of these interventions? 4) What have been the lessons from implementing impact evaluations of Bank-supported programs with anthropometric impacts? Although many different dimensions of child nutrition could be explored, this report focuses on child anthropometric outcomes-weight, height, and birth weight. These are the most common nutrition outcome indicators in the literature and the ones most frequently monitored by national nutrition programs supported by the World Bank. Low weight for age (underweight) is also the indicator for one of the Millennium Development Goals.
Journal of Community Nutrition & Health. 2013; 2(1):68-75.Objective: This was a prospective comparative study carried out from April 2011 to February 2012 to assess the growth pattern of exclusively breast fed (EBF) and non-exclusively breast fed infants (NEBF) in the first six months of life. Methods: A total of 213 lactating mothers and their neonates (less than 7 days) weighing 2.5kg were consecutively recruited into the study and followed up at 6,14 and 24 weeks, Infants were classified into EBF and NEBF groups based on their current feeding pattern during the follow up. Anthropometric measurements of weight and length were taken and compared with WHO reference curves. Data analysis was carried out using frequencies, percentages, means (SD) and t-test. Results: The rate of exclusive breastfeeding declined from 82.5% at delivery to 23% at the end of 24 weeks. The NEBF infants were heavier and longer at birth (P>0.05). The EBF Infants had higher weight (28 vs 22 g/day) and length gain of (0.77 Vs 0.70 cm/week) from 0 to 14 weeks than their NEBF counterpart (p>0.05). Despite a decline in weight gain of EBF infants after the 14 week, they retained the higher mean weight achieved earlier. Average cumulative weight and length gain of 3.71 kg Vs 3.31 kg and 15.33 cm vs 14.56 cm were recorded for EBF and NEBF infants, respectively during the 24 weeks follow up. The mean weight and length of the EBF infants was comparable to the World Health organization (WHO) reference curve than for the NEBF infants. Conclusion: This study has shown that exclusive breastfeeding supported adequate growth in infants studied during the first six months of life.
Geneva, Switzerland, WHO, 2013.  p.This guideline provides global, evidence-informed recommendations on a number of specific issues related to the management of severe acute malnutrition in infants and children, including in the context of HIV. The guideline will help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions for severely malnourished children. It will also support Member States in their efforts to achieve global targets on the maternal, infant and young child nutrition comprehensive implementation plan, especially global target 1, which entails achieving 40% reduction by 2025 of the global number of children under 5 years who are stunted and global target 6 that aims to reduce and maintain childhood wasting to less than 5%. The guideline is intended for a wide audience, including policy-makers, their expert advisers, and technical and programme staff in organizations involved in the design, implementation and scaling-up of nutrition actions for public health. The guideline will form the basis for a revised manual on the management of severe malnutrition for physicians and other senior health workers, and a training course on the management of severe malnutrition..
World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings.
Maternal and Child Nutrition. 2014 Jan; 10(1):1-17.As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country-specific analyses of the indicators’ associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross-country patterns of associations of each of these indicators with child stunting, wasting, height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub-Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05).These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed.The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.
Levels and trends in child malnutrition. UNICEF-WHO-The World Bank joint child malnutrition estimates.
[New York, New York], UNICEF, 2012.  p.For the first time UNICEF, WHO and the World Bank report joint estimates of child malnutrition for 2011 and trends since 1990. Estimates of prevalence and numbers for child stunting, underweight, overweight and wasting are presented by United Nations, Millennium Development Goal, UNICEF, WHO regional and World Bank income group classifications. This is the result of the data harmonization effort which started in 2011.
Food and Nutrition Bulletin. 2010 Sep; 31(3 Suppl):S272-86.This report integrates the results from two working group meetings that were held to familiarize country teams of eastern and southern Africa with research findings to allow countries to develop plans to further reinforce national nutrition information systems. The meetings specifically focused on: reviewing recent trends in child malnutrition in eastern and southern Africa particularly in relation to drought and HIV/AIDS; making recommendations on key technical issues related to sampling, mortality estimation, and indicators used in small-scale nutrition surveys; and making recommendations for the next steps to further develop nutrition information systems in the region.
Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants.
PLoS One. 2008 Jul; 3(7): p.BACKGROUND: The World Health Organization (WHO) released new Child Growth Standards in 2006 to replace the current National Center for Health Statistics (NCHS) growth reference. We assessed how switching from the NCHS to the newly released WHO Growth Standards affects the estimated prevalence of wasting, underweight and stunting, and the pattern of risk factors identified. METHODOLOGY/PRINCIPAL FINDINGS: Data were drawn from a village-informant driven Demographic Surveillance System in Northern Malawi. Children (n = 1328) were visited twice at 0-4 months and 11-15 months. Data were collected on the demographic and socio-economic environment of the child, health history, maternal and child anthropometry and child feeding practices. Weight-for-length, weight-for-age and length-for-age were derived in z-scores using the two growth references. In early infancy, prevalence estimates were 2.9, 6.1, and 8.5 fold higher for stunting, underweight, and wasting respectively using the WHO standards compared to NCHS reference (p<0.001 for all). At one year, prevalence estimates for wasting and stunting did not differ significantly according to reference used, but the prevalence of underweight was half that with the NCHS reference (p<0.001). Patterns of risk factors were similar with the two growth references for all outcomes at one year although the strength of association was higher with WHO standards. CONCLUSIONS/SIGNIFICANCE: Differences in prevalence estimates differed in magnitude but not direction from previous studies. The scale of these differences depends on the population's nutritional status thus it should not be assumed a priori. The increase in estimated prevalence of wasting in early infancy has implications for feeding programs targeting lactating mothers and ante-natal multiple micronutrients supplementation to tackle small birth size. Risk factors identified using WHO standards remain comparable with findings based on the NCHS reference in similar settings. Further research should aim to identify whether the young infants additionally diagnosed as malnourished by this new standard are more appropriate targets for interventions than those identified with the NCHS reference.
Newly developed WHO growth standards: Implications for demographic surveys and child health programs.
Indian Journal of Pediatrics. 2007 Nov; 74(11):987-990.The objective was to compare estimates of undernutrition based on the World Health Organization (WHO) Child Growth Standards ('WHO standards') and the National Center for Health Statistics NCHS/ WHO international growth reference ('NCHS reference'), and discuss implications for child health programs and reporting of prevalence of underweight in demographic surveys. A cross-sectional study was carried out in 20 Anganwadi centers under Primary Health Centre, Anji. Total of 1491 under-six year children attending the Anganwadi centers were studied for nutritional status. Nutritional status was analyzed by NCHS standards by using EPI_INFO 6.04 software package and also by newly introduced WHO Child Growth Standards by Anthro 2005 software package. Chi-square test was used to compare the results. According to WHO standards, the prevalence of underweight and severe underweight for children 0-6 year was 47.4% and 16.9% respectively. By NCHS reference, the overall prevalence of underweight and severe underweight for children 0-6 years was 53% and 15% respectively. The prevalence of underweight as assessed by WHO standards was significantly lower when compared with the assessment based on NCHS reference (p<0.01). But, WHO standards gave higher prevalence of severe underweight than NCHS reference though the difference was not statistically significant (p>0.05). In the light of newly developed WHO Child growth standards, all the nutrition-related indicators in demographic surveys like NFHS should now be derived using the WHO standards. There is need to reanalyze NFHS-I and NFHS-II data using WHO standards and findings should be made available so that it becomes comparable and trends over the years can be studied. (author's)
Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: A cross country analysis.
Bulletin of the World Health Organization. 2007 Jun; 85(6):441-448.Height- and weight-based anthropometric indicators are used worldwide to characterize the nutritional status of populations. Based on the 1978 WHO/National Center for Health Statistics (NCHS) growth reference, the World Health Organization has previously indicated that the standard deviation (SD) of Z-scores of these indicators is relatively constant across populations, irrespective of nutritional status. As such, the SD of Z-scores can be used as quality indicators for anthropometric data. In 2006, WHO published new growth standards. Here, we aim to assess whether the SD of height- and weight-based Z-score indicators from the 2006 WHO growth standards can still be used to assess data quality. We examined data on children aged 0-59 months from 51 Demographic and Health Surveys (DHS) in 34 developing countries. We used 2006 growth standards to assign height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), weight-for-height Z-scores (WHZ) and body-mass-index-for-age Z-scores (BMIZ). We also did a stratified analysis by age group. The SD for all four indicators were independent of their respective mean Z-scores across countries. Overall, the 5th and 95th percentiles of the SD were 1.35 and 1.95 for HAZ, 1.17 and 1.46 for WAZ, 1.08 and 1.50 for WHZ and 1.08 and 1.55 for BMIZ. Our results concur with the WHO assertion that SD is in a relatively small range for each indicator irrespective of where the Z-score mean lies, and support the use of SD as a quality indicator for anthropometric data. However, the ranges of SDs for all four indicators analysed were consistently wider than those published previously by WHO. (author's)
Measuring malnutrition -- the role of Z scores and the composite index of anthropometric failure (CIAF).
Indian Journal of Community Medicine. 2007 Jan-Feb; 32(1): p.The current WHO recommendation is to use the Z-Score or SD system to grade undernutrition which allows us to measure all the three indices and express the results in terms of Z scores or standard deviation units from the median of the international reference population. The objectives were to estimate the prevalence of undernutrition among under-five children in Coimbatore slums, using the Z-Score system of classification and the recently constructed Composite Index of Anthropometric Failure (CIAF). 2. To compare the ZScore system with the Indian Academy of Pediatrics (IAP) classification of undernutrition. Nutritional assessment was done using anthropometry and clinical examination. Children were weighed and measured as per the WHO guidelines on Anthropometry. Epi-Info 2002 software package was used to calculate the Z scores and for statistical analysis. Only 31.4% of the children studied were normal; 68.6% were in a state of ?Anthropometric Failure?. As per the Z score system, 49.6% were underweight (21.7% severely); 48.4% were stunted (20.3% severely) and 20.2% were wasted (6.9% severely). Whereas, as per IAP criteria, 51.4% were undernourished and 3.2% were severely undernourished. Using Underweight (low weight-for-age) as the only criterion for identifying undernourished children (as done in the Integrated Child Development Services currently) may underestimate the true prevalence of undernutrition, by as much as 21.9%. More widespread use of the Z-Score system is recommended for identifying all the facets of undernutrition. Estimates of the true prevalence of undernutrition must incorporate a composite index of anthropometric failure. (author's)
BMJ. British Medical Journal. 2007 Apr 7; 334(7596):705-706.In April 2006, the World Health Organization released its new WHO child growth standards, 16 years after a WHO working group on infant growth recommended that these standards should describe how children should grow rather than how they actually grow. The basis for the new growth standards was six population based studies of infants and children from Ghana, India, Norway, Brazil, Oman, and North America, undertaken between 1997 and 2003. Participants were fed according to accepted international nutritional standards (including breast feeding), and their mothers were adequately nourished and avoided known adverse factors such as tobacco exposure. The new growth standards show that children born in different regions of the world can and should grow equally well, and they also show that sex and ethnic origin are minor determinants of growth compared with adequate nutrition, environment, and health. However, as expected, important differences in the diagnosis of malnutrition emerge when the standard cut-offs are applied using either the National Center for Health Statistics (NCHS)-WHO reference or the WHO 2006 growth standards. (excerpt)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S15-S26.The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development. (author's)
Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference.
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S27-S36.Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings. (author's)
Managing data for a multicountry longitudinal study: Experience from the WHO Multicentre Growth Reference Study.
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S46-S52.The World Health Organization (WHO) Multicentre Growth Reference (MGRS) data management protocol was designed to create and manage a large data bank of information collected from multiple sites over a period of several years. Data collection and processing instruments were prepared centrally and used in a standardized fashion across sites. The data management system contained internal validation features for timely detection of data errors, and its standard operating procedures stipulated a method of master file updating and correction that maintained a clear trail for data auditing purposes. Each site was responsible for collecting, entering, verifying, and validating data, and for creating site-level master files. Data from the sites were sent to the MGRS Coordinating Centre every month for master file consolidation and more extensive quality control checking. All errors identified at the Coordinating Centre were communicated to the site for correction at source. The protocol imposed transparency on the sites' data management activities but also ensured access to technical help with operation and maintenance of the system. Through the rigorous implementation of what has been a highly demanding protocol, the MGRS has accumulated a large body of very high-quality data. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S37-S45.The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings. This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS). Infants were followed from the age of four months until they could walk independently. Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone. The information was collected by both the children's caregivers and trained MGRS fieldworkers. The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria. Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits. To ensure standardized data collection, the sites conducted regular standardization sessions. Data collection and data quality control took place simultaneously. Data verification and cleaning were performed until all queries had been satisfactorily resolved. (author's)
Lancet. 2006 Nov 25; 368(9550):1868-1869.Exclusive breastfeeding for 6 months is the normal way to feed all infants. The new WHO growth reference released in April, 2006, is based on breastfed infants under optimum conditions. The sample is highly selected for the factors likely to promote growth in breastfed infants, and less than 10% of those initially surveyed were included in the final study. Most mothers and health professionals are concerned about their infants' growth, particularly for the first 6 months. If they believe their infants are not growing adequately, they are more likely to introduce supplementary foods, including "top-ups" with infant formula or even switching to formula completely. "Insufficient milk" is the most common reason for the early cessation of breastfeeding and mothers often self-diagnose this on the basis of perceived slower growth. (excerpt)
Journal of Nutrition. 2007 Jan; 137(1):149-152.In April 2006 the WHO released a set of growth standards for children from birth to the age of 5 y. Prior to their release, the standards were field-tested in 4 countries. The main objective was to compare children's length/height-for-age and weight-for-length/height based on the new standards with clinician assessments of the same children. The study sampled children < 5-y-old attending well-child clinics in 2 affluent populations (Argentina and Italy) and 2 less-affluent ones (Maldives and Pakistan). Length/height and weight were measured by doctors and epidemiologists who also recorded a clinical assessment of each child's length/height in relation to age and weight relative to length/height. Anthropometric indicators of nutritional status were generated based on the WHO standards. As expected, Pakistan and the Maldives had higher rates of stunting, wasting, and underweight than Italy and Argentina, and the reverse was true for overweight and obesity. Where stunting was prevalent, the children classified as short were a mean < -22 SD for height-for-age. In all sites, the children classified as thin were indeed wasted < -22 SD for weight-for-height) and a positive association in trend was evident between weight-for-height and the line-up of groups from thin to obese. The overall concordance between clinical assessments and the WHO standards-based indicators attested to the clinical soundness of the standards. (author's)
Journal of Nutrition. 2007 Jan; 137(1):142-143.Charts that depict expected ranges and trajectories of anthropometric measurements and indicators, e.g., length/height-forage, weight-for-age, and BMI (kg/m2) are among the principal tools used by researchers, clinicians, and policymakers to assist in assessing the health and nutritional well-being of individuals at nearly all life stages and/or the general well-being of communities and broader populations. The utility of these charts to diverse professional groups and the interest of parents, children, and the general population in the information that they convey make a strong case for assuring that growth charts are scientifically robust and effective for educational purposes and in advocacy arenas to motivate improved individual or population health. The articles that follow focus on a global effort to develop a new international growth standard to assess infant and young child growth and to establish an initiative that explores how best to respond to an increasing need for new tools that can assess growth in older children and adolescents. The WHO released a new growth standard for infants and young children in April 2006. The new standard is a response to the recognition of significant flaws in the previous international growth reference. The previous international growth reference was hampered by an inadequately low frequency of measurements during infancy (when growth is most rapid and dynamic) and outdated analytical methods. The new standard is based on the WHO Multicentre Growth Reference Study (MGRS) that was designed specifically to construct a standard. (excerpt)
Indian Pediatrics. 2006 Oct 17; 43(10):851-853.Anthropometric measurements are commonly used for assessing growth and nutritional status of children. These include weight for age, height for age and weight for height. Observed values are compared with standard or reference data to determine whether a child is growing normally. The terms growth standard and growth reference are used interchangeably, though their meaning is different. A standard reflects an optimum level, suggesting that all children have the potential to achieve that level, while a growth reference is simply used for comparison. The NCHS/WHO growth reference is currently used all over the world. However, its limitations are well recognized. The growth reference is based on formula fed children from a single community in the US. The children were measured every three months, which is not adequate to describe the rapid and changing rate of growth in early infancy. Also, shortcomings inherent in the statistical methods available at the time led to inappropriate modeling of growth patterns. (excerpt)
Acta Paediatrica. 2004 Aug; 93(8):1031-1032.The future revised WHO growth references for infancy and early childhood will have an international basis rather than just an American one, as is the case with the current NCHS/WHO ones. The anthropometric data for analysis will be collected from babies breastfed in accordance with WHO guidelines. An important stipulation, however, is that their growth must have been unrestricted by environmental factors. A paper from Ghana describes a quantitative provisional study that has revealed how such a condition can be satisfied within a developing country. Family income and especially the higher education of the father up to university level can still be important variables in the achievement of optimal growth of babies, even those brought up in situations of relative affluence. (author's)
Geneva, Switzerland, WHO, 1995.  p. (WHO Technical Report Series No. 854)The Expert Committee's report is intended to provide a framework and contexts for present and future uses and interpretation of anthropometry. Technical aspects of this framework are presented in section 2, and specific applications of anthropometry appropriate for a particular physical status or for particular age groups are dealt with in subsequent sections. For some groups, such as adolescents and the elderly, there has been little previous research, and the report provides a basis and impetus for future studies. For other age groups, such as infants and children, the report provides a re-evaluation in the light of current research, and allows for an integrated approach to anthropometry throughout life. It is intended to furnish scientists, clinicians, and public health professionals worldwide with an authoritative review, reference data, and recommendations for the use and interpretation of anthropometry that should be appropriate in many settings. (excerpt)
An evaluation of infant growth. A summary of analyses performed in preparation for the WHO Expert Committee on Physical Status: the Use and Interpretation of Anthropometry.
Geneva, Switzerland, WHO, Nutrition Unit, 1994.  p. (WHO/NUT/94.8)In preparation for the WHO Expert Committee meeting on Physical status: the use and interpretation of anthropometry, a Working Group on Infant Growth was established to assess the growth patterns of infants following current WHO feeding recommendations, and the relevance of such patterns to the development of growth reference data. This document presents the full report of the analyses carried out, which were the basis for the Working Group's recommendations to the Expert Committee. The information is being made available to the scientific community to encourage and support further research on the questions raised by the Expert Committee after its evaluation of present knowledge about infant-growth assessment. In providing this information, the Working Group seeks to improve the nutritional management of infants and children by motivating the development of new scientific information that will fill gaps in knowledge and resolve a number of crucial issues raised by the Group's analyses. (author's)
Journal of Biosocial Science. 2003 July; 35(3):335-351.Improved child health and survival are considered universal humanitarian goals. In this respect, understanding the nutritional status of children has far-reaching implications for the better development of future generations. The present study assessed, first, the nutritional status of children below 5 years using the three anthropometric measures weight-forage, height-for-age and weight-for-height in two states of India, Kerala and Goa. Secondly, it examined the confounding factors that influence the nutritional status of children in these states. The NFHS-I data for Kerala and Goa were used. The results showed that the relative prevalence of underweight and wasting was high in Kerala, but the prevalence of stunting was medium. In Goa, on the other hand, the relative prevalence of wasting and underweight was very high, and that of stunting was high. Both socioeconomic and family planning variables were significantly associated with malnutrition in these states, but at varied levels. The study recommends more area-specific policies for the development of nutritional intervention programmes. (author's)
World Health Organization hemoglobin cut-off points for the detection of anemia are valid for an Indonesian population.
Journal of Nutrition. 1999; 129:1669-1674.The study was designed to determine whether population-specific hemoglobin cut-off values for detection of iron deficiency are needed for Indonesia by comparing the hemoglobin distribution of healthy young Indonesians with that of an American population. This was a cross-sectional study in 203 males and 170 females recruited through a convenience sampling procedure. Hemoglobin, iron biochemistry tests and key infection indicators that can influence iron metabolism were analyzed. The hemoglobin distributions, based on individuals without evidence of clear iron deficiency and infectious process, were compared with the National Health and Nutrition Survey (NHANES) II population of the United States. Twenty percent of the Indonesian females had iron deficiency, but no male subjects were iron deficient. The mean hemoglobin of Indonesian males was similar to the American reference population at 152 g/L with comparable hemoglobin distribution. The mean hemoglobin of the Indonesian females was 2 g/L lower than that of the American reference population, which may be the result of incomplete exclusion of subjects with milder form of iron deficiency. When the WHO cutoff (Hb < 120 g/L) was applied to female subjects, the sensitivity of 34.2% and specificity of 89.4% were more comparable to the test performance for white American women, in contrast to those of the lower cut-off. On the basis of the finding of hemoglobin distribution of men and the test performance of anemia (Hb < 120 g/L) for detecting iron deficiency for women, it is concluded that there is no need to develop different cut-off points for anemia as a tool for iron-deficiency screening in this population. (author's)