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Rawal Medical Journal. 2018 Jul-Sep; 43(3):462-466.Objective: To evaluate the nutritional status of the Pakistani children aged 2-5 years. Methods: A cross-sectional study of 1474 children, aged 2-5 years, was undertaken from Multan, Lahore, Rawalpindi and Islamabad, Pakistan from March-June, 2016. The head circumference (HdC) measurement of each subject was taken. Following the WHO age and sex-specific cut-off points, nutritional status of children was determined. Results: The mean age and HdC of the total subjects was4.15±0.87 years and 48.51 ±1.79 cm, respectively. Mean HdC increased with advancement of age in both boys and girls. Moderate under-nutrition was more prevalent than severe under-nutrition in both genders. Based on the HdC, the overall (age and sex combined) percentage of under-nourishment was 16.2 while these percentages were 16.4 and 15.8 for girls and boys, respectively. Conclusion: The study showed that a considerable number of Pakistani children were undernourished. A high rate of under-nutrition was observed in girls than in boys.
Complementary Feeding Interventions Have a Small but Significant Impact on Linear and Ponderal Growth of Children in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.
Journal of Nutrition. 2017 Nov; 147(11):2169S-2178S.Background: World Health Assembly member states have committed to ambitious global targets for reductions in stunting and wasting by 2025. Improving complementary diets of children aged 6-23 mo is a recommended approach for reducing stunting in children <5 y old. Less is known about the potential of these interventions to prevent wasting.Objective: The aim of this article was to review and synthesize the current literature for the impact of complementary feeding interventions on linear [length-for-age z score (LAZ)] and ponderal [weight-for-length z score (WLZ)] growth of children aged 6-23 mo, with the specific goal of updating intervention-outcome linkages in the Lives Saved Tool (LiST).Methods: We started our review with studies included in the previous LiST review and searched for articles published since January 2012. We identified longitudinal trials that compared children aged 6-23 mo who received 1 of 2 types of complementary feeding interventions (nutrition education or counseling alone or complementary food supplementation with or without nutrition education or counseling) with a no-intervention control. We assessed study quality and generated pooled estimates of LAZ and WLZ change, as well as length and weight gain, for each category of intervention.Results: Interventions that provided nutrition education or counseling had a small but significant impact on linear growth in food-secure populations [LAZ standardized mean difference (SMD): 0.11; 95% CI: 0.01, 0.22] but not on ponderal growth. Complementary food supplementation interventions with or without nutrition education also had a small, significant effect in food-insecure settings on both LAZ (SMD: 0.08; 95% CI: 0.04, 0.13) and WLZ (SMD: 0.05; 95% CI: 0.01, 0.08).Conclusions: Nutrition education and complementary feeding interventions both had a small but significant impact on linear growth, and complementary feeding interventions also had an impact on ponderal growth of children aged 6-23 mo in low- and middle-income countries. The updated LiST model will support nutrition program planning and evaluation efforts by allowing users to model changes in intervention coverage on both stunting and wasting. (c) 2017 American Society for Nutrition.
Wei Sheng Yan Jiu. 2007 Mar; 36(2):203-6.OBJECTIVE: To compare children's growth patterns and estimates of malnutrition using the WHO standards versus the NCHS reference in China. METHODS: Data originated from China children nutrition surveillance in 2005, Z-scores and prevalence of malnutrition were compared between standards. RESULTS: There was substantial difference in Z-scores between standards in rural (P < 0.0001). According to the WHO standards, prevalence of underweight in rural was lower than that of underweight based on the NCHS reference (6.1% . vs. 8.6%, P < 0.0001). Except for children under 6 months, all age groups underweight rates were lower according to the WHO standards. Prevalence of stunting in rural was higher based on the WHO standards (16.3% . vs. 13.0%, P < 0.0001), prevalences of stunting under 6 months were 2.1 times of that based on NCHS reference. As for wasting, there were no differences between standards, but wasting was substantially higher during the first half of infancy. Overweight rates based on the WHO standards were higher than those based on NCHS reference in urban (6.7% . vs. 5.4%, P < 0.0001). CONCLUSION: In comparison with NCHS reference, population estimates of malnutrition would vary by age, growth indicator based on WHO standards. The WHO standards could provide a better tool to monitor the rapid and changing rate of growth in early infancy, further analysis on existing data was needed.
Are universal standards for optimal infant growth appropriate? Evidence from a Hong Kong Chinese birth cohort.
Archives of Disease in Childhood. 2008 Jul; 93(7):561-5.OBJECTIVE: In 2006 the World Health Organization (WHO) published new optimal growth standards for all healthy infants worldwide. To assess their general applicability to a recently transitioned Chinese population, we compared them with infant growth patterns in a representative sample of Hong Kong infants. Design and settings: Weight at birth and at 1, 3, 9, 12, 18 and 36 months, length at 3 and 9 months and height at 36 months were obtained for over 80% of all infants born in April and May 1997 (3880 boys and 3536 girls). Age and sex specific z scores were calculated relative to the WHO growth standards for term singletons. RESULTS: Weight for age was close to the 50th percentile of the WHO growth standards for both boys (mean z score: 0.00) and girls (0.04) at most time points before 3 years of age. However, our participants were shorter at 3 years, where the z scores in height were -0.34 and -0.38 for boys and girls, respectively. Restricting the analysis to a subset matching the WHO criteria for healthy infants without restrictions on growth gave similar results. CONCLUSIONS: Although the WHO study group concluded there was a striking similarity in length/height among different populations, Hong Kong Chinese toddlers are, on average, shorter. Epigenetic constraints on growth coupled with the rapid epidemiological transition in Hong Kong may not have allowed sufficient generations for infants and children to reach their full genetic height potential, and with it the WHO standards. A universal infant growth standard may not be appropriate across all populations.
Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh.
American Journal of Clinical Nutrition. 2008 Jun; 87(6):1852-1859.The World Health Organization and the United Nations International Children's Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health. We evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh. The prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change. Mean (+or- SD) birth weight was 2697 +or- 401 g; 30%weighed less than 2500 g. Mean body weight at 12 and 24 mo was 7.9 +or- 1.1 kg and 9.7 +or- 1.3 kg, respectively. More appropriate IFPs were associated (P less than 0.001) with greater gain in weight andlength during infancy. Prior IFPs were also positively associated (P less than 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P less than 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales. Our results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries. (author's)
Bulletin of the World Health Organization. 2007 Sep; 85(9):660-667.The objective was to construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1-24 years) were merged with data from the under-fives growth standards' cross-sectional sample (18-71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0-5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m/2 to 0.1 kg/m/2. At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m/2 for boys and 25.0 kg/m/2 for girls. These values are equivalent to the overweight cut-off for adults (>/= 25.0 kg/m/2). Similarly, the +2 SD value (29.7 kg/m/2 for both sexes) compares closely with the cut-off for obesity (>/= 30.0 kg/m/2). The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group. (author's)
BMJ. British Medical Journal. 2006 May 6; 332(7549):1052.New growth charts for infants and young children can be applied globally, says the World Health Organization. The charts will enable doctors and others to detect and tackle growth related conditions, such as undernutrition, overweight, and obesity, at an early stage. The new child growth standards confirm that children given healthy growth conditions born anywhere in the world--be it India, Brazil, or Norway--have the potential to develop to within the same range of height and weight. They prove that differences in children's growth to the age of 5 are influenced more by nutrition, feeding practices, environment, and health care than by genetics and ethnic group. "The WHO child growth standards provide new means to support every child to get the best chance to develop in the most important formative years," said Dr Lee Jong-wook, WHO's director general. "In this regard, this tool will serve to reduce death and disease in infants and young children." (excerpt)
International Journal of Epidemiology. 2004; 33(6):1260-1270.Child malnutrition is an important indicator for monitoring progress towards the Millennium Development Goals (MDG). This paper describes the methodology developed by the World Health Organization (WHO) to derive global and regional trends of child stunting and underweight, and reports trends in prevalence and numbers affected for 1990–2005. National prevalence data from 139 countries were extracted from the WHO Global Database on Child Growth and Malnutrition. A total of 419 and 388 survey data points were available for underweight and stunting, respectively. To estimate trends we used linear mixed-effect models allowing for random effects at country level and for heterogeneous covariance structures. One model was fitted for each United Nation’s region using the logit transform of the prevalence and results back-transformed to the original scale. Best models were selected based on explicit statistical and graphical criteria. During 1990–2000 global stunting and underweight prevalences declined from 34% to 27% and 27% to 22%, respectively. Large declines were achieved in Eastern and South-eastern Asia, while South-central Asia continued to suffer very high levels of malnutrition. Substantial improvements were also made in Latin America and the Caribbean, whereas in Africa numbers of stunted and underweight children increased from 40 to 45, and 25 to 31 million, respectively. Linear mixed-effect models made best use of all available information. Trends are uneven across regions, with some showing a need for more concerted and efficient interventions to meet the MDG of reducing levels of child malnutrition by half between 1990 and 2015. (author's)
The WHO dose pole for the administration of praziquantel is also accurate in non-African populations.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2005; 99:78-81.In 2001, WHO developed a pole for the administration of praziquantel without the use of weighing scales, with encouraging results in African populations. In the present study, the pole was tested on height/weight data from 9354 individuals from 11 non-African countries. In more than 98% of the individuals (95% CI 97.8—98.4) the pole estimated an acceptable dosage (30—60 mg/kg), a performance statistically similar to that observed in African populations. Reproducing the present pole in the form of a strip of paper and including it in each container of praziquantel would greatly facilitate the administration of the drug in large-scale interventions. (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)
Nutrition Research. 2003; 23(9):1165-1176.This study investigated the nutritional status and eating habits of Mongolian children in relation to dental health. Growth and oral health of 151 Ulaanbaatarian children under age five were examined, and their parents were interviewed on child’s health and eating habits. Every tenth child had a low weight for age and the mean energy intake of the weaned children was 89%-96% of the recommendation by WHO. Frequent eating exposed the teeth of children to many acid attacks. Every third child over age three had serious developmental defects in their teeth, which might be associated with deficient intakes of energy and calcium, highly variable vitamin D supplementation and gastrointestinal infections. All of the examined 4 to 5-year old children had caries and the average number of decayed teeth was 6.5. Severe caries was related to the abundant use of sugar, whereas proper dental health was related to use of hard cheese. (author's)
Nutritional status of vegetarian and omnivorous adolescent girls. [Estado nutricional de adolescentes vegetarianas y omnívoras]
Nutrition Research. 2001 May; 21(5):689-702.This study compared the dietary and anthropometric profile of 24 ovo-lacto-vegetarian and 36 omnivorous female adolescents, between 15 and 18 years old. Weight, height and skinfolds were measured. Food frequency questionnaires and a three day food record were used for dietary assessment. Vegetarians presented subscapular, suprailiac and midaxillary skinfolds statistically higher than omnivores, but the percent body fat was not different. The vegetarian diet provided smaller amounts of energy than that of the omnivores ( p < 0.05) and only 17% of the vegetarians was able to reach the recommended allowance for protein. Regarding calcium, 83% of the vegetarians and 69% of the omnivores ate less than 2/3 of the recommended allowances and a significantly higher percentage of vegetarians presented low ingestion of iron, riboflavin, and niacin than omnivores ( p < 0.05). It was concluded that the intake of vegetarians was lower in fat and cholesterol, and less adequate in micronutrients than the omnivores ones. (author's)
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1995; 73(2):165-74.In 1993 a World Health Organization (WHO) Working Group was established to evaluate infant growth with regard to the appropriate use and interpretation of anthropometry in infants, the identification of reference data for anthropometric indicators, and other crucial gaps in knowledge. Exclusive breast feeding is recommended by WHO from birth to 4-6 months of age, after which the child should continue breast feeding while receiving adequate complementary foods for up to 2 years of age. The Working Group focused mainly on the assessment of growth patterns of infants following WHO feeding recommendations, and the relevance of such patterns to developing growth references for infants. Seven data sets on the growth of breast-fed infants were surveyed from April to June 1992: 1 each from Canada, Denmark, Finland, Sweden and the United Kingdom, and 2 from the United States. 226 of the 453 infants followed in the 7 studies were breast-fed for at least 12 months, not receiving formula and solids until after the age of 4 months. 141 of these 226 infants were not given other milk or formulas regularly in the 1st year of life. More than half of them were not given solid foods until the age of 6 months. In the 12-month breast-fed pooled data set, the mean weight-for-age declined continuously from 2 to 12 months to a low of almost -0.6 standard deviation at 12 months. The decline in length-for-age was not so great, and the mean z-score tended to stabilize or increase after 8 months; the mean value at 12 months was approximately -0.3 standard deviation. The mean weight-for-length at 12 months was also below the current National Center for Health Statistics-World Health Organization (NCHS-WHO) growth reference mean. Comparison of growth between the 12-month breast-fed pooled data set and selected test populations in India, Peru, Egypt, Hungary, Kenya, Thailand, and Chile yielded substantial variance in growth interpretation, thus the NCHS-WHO reference needs to be revised.
Growth of the Czech child population 0-18 years compared to the World Health Organization growth reference.
American Journal of Human Biology. 1997; 9(4):459-68.A comparison of the findings of nationwide anthropometric surveys carried out in the Czech Republic at 10-year intervals in 1951-91 with World Health Organization (WHO) growth references identified an ongoing secular trend in the height of Czech children of both sexes and a decrease in weight, especially among older girls. Compared to the WHO reference data, Czech infants demonstrated a growth acceleration in the first 6 months of life. Mean weight values for Czech infants aged 0-2 years were insignificantly above the reference curve in all 5 surveys. The 1971 curve for height in boys 12-18 years and girls 11-18 years most closely mirrored the WHO reference. In 1991, in 17-year-old males, height increased an average of 3.8 cm compared to 1971 and 7.1 cm compared to 1951; in females, these average increases were 2.9 cm and 4.7 cm, respectively. As in other developed countries, overweight and obesity were more significant problems than malnutrition. Since the Czech Republic is still undergoing socioeconomic changes with the potential to increase population diversity, it is recommended that factors such as education, income, and occupation per household head be monitored to detect any trends that could have an adverse effect on the nutritional and health status of Czech children.
[Unpublished] 1991. Presented at the Society for Epidemiologic Research 24th Annual Meeting, Buffalo, New York, June 11-14, 1991. 12,  p.Health workers use anthropometry to determine the nutritional status of children. The accepted international growth reference curves provide the bases for the indices which include weight for height (W/H), height for age (H/A) and weight for age (W/A). Health workers must interpret these indices with caution, however. For example, W/H and H/A represent different physiological and biological processes while W/A combines the 2 processes. Further Z-scores, percentiles, or percent of median may be used as the scale for the indices and each scale has different statistical features. Specifically, Z-scores and percentiles acknowledge smoothed normalized distributions around the median, but the percent-of-median ignores the distribution around the median. Some researchers suggest using Z-scores rather than percentiles or percent-of-median since statisticians can interpret them more clearly and can calculate the proportion of children in the reference population who fall above or below a cut off point more easily. This cutoff should be only used to screen children who are likely to be malnourished since not all children below a cutoff are indeed malnourished. Some researchers have identified a leading limitation of the CDC/WHO based indices. A disjunction exists where the 2 smoothed based curves based on a population of <36 month old children from Ohio (longitudinal data) and another population of 2-18 year old children (cross sectional health surveys) meet. Further there is a reduction in age specific prevalences at 24 months. Thus some researchers recommend that anthropometry data be presented on an age specific basis, if age information is accurate. They further suggest that, if comparing data from different geographic areas, researchers should standardize age to have a summary measure. If age is not known the W/H summary measure should include 2 groups: <85 cm and =or+ 85 cm.
Maternal anthropometry for prediction of pregnancy outcomes: memorandum from a USAID/WHO/PAHO/MotherCare meeting.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(5):523-32.The memorandum is an abbreviated version of a prepared report on maternal anthropometry which summarizes the general recommendations of a consensus of 50 experts on field applications and priority research issues in developing countries. Consensus was reached at a meeting on Maternal Anthropometry for Prediction of Pregnancy Outcomes held in Washington, D.C. in April 1990. 15 general recommendations are identified for field applications and research priorities. Specific recommendations differentiating field applications from research priorities are provided for prepregnancy weight, weight gain in pregnancy, height, arm circumference, and weight for height and body mass index. For example, the discussion of arm circumference indicates that it is useful as an indicator of maternal nutritional status in nonpregnant women because of its correlation with maternal weight or weight for height. During pregnancy, it is useful as a screen for risk of low birth weight (LBW) and late fetal and infant mortality. Maternal arm circumference has been found to be stable during pregnancy in developing countries and is independent of gestational age. Field applications involve the use 1) to assess the nutritional status of pregnant and nonpregnant women, 2) to screen women at risk of poor maternal stores postpartum because it reflects maternal fat and lean tissue stores, for instance, 3) to screen women and refer to facilities for a more thorough assessment of nutritional risk, and 4) to assess the extent of undernutrition in an area, particularly for surveillance. Community level workers, especially birth attendants (TBA's) should be trained and have access to arm circumference tapes. The technology is simple enough also for use by women in the home. Cutoff points for assessing biological risk are fairly consistent across developing country populations, and range between 21-23.5 cm. Routine monitoring during pregnancy is not necessary because the changes are too small to detect. Where prepregnancy weight is unavailable and weight is monitored, arm circumference may serve as a proxy for prepregnancy weight. All women of childbearing age should be measured. Research priorities are to explore the functional significance with women of difference body compositions (fat versus lean upper arm), the relationship to pregnancy related outcomes, arm changes relative to stages throughout the reproductive period and to weight changes, different instruments such as color-coded tapes or 1 tape for arm measurement and uterine height, combinations of different measurements, the relationship with prepregnancy weight, and the development of arm circumference in weight gain charts as a proxy for prepregnancy weight.