Stunting and ‘overweight’ in the WHO Child Growth Standards – malnutrition among children in a poor area of China

AbstractObjectiveThe aims of the present paper were to assess the nutritional status of children under 5 years old using the 2006 WHO Child Growth Standards (‘the WHO standards’) and to compare the results with those obtained using the National Center for Health Statistics/WHO international growth reference (‘the NCHS reference’).DesignThis was a community-based cross-sectional survey. The WHO standards were used to calculate Z-scores of height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ) and BMI-for-age (BMIZ).SettingFifty counties of thirteen mid-western provinces, China.SubjectsA total 8041 children aged <5 years were measured during a 2-month period from August to October 2006.ResultsThe prevalence of stunting, underweight and wasting were 30·2 %, 10·2 % and 2·9 %, respectively. The prevalence of overweight and the possible risk of overweight were as high as 4·1 % and 16·8 %. Further analysis among the children with possible risk of overweight found that the percentage of stunting (HAZ < −2) was 57·6 %, the percentage with −2 ≤ HAZ ≤ 2 was 41·0 % and the percentage with HAZ > 2 was only 1·4 %. The prevalence of stunting was 21·9 % and of underweight was 12·7 % by the NCHS reference.ConclusionsStunting was the most serious problem that was impeding child growth and development. The high rate of ‘overweight’ was a false impression, the truth being ‘stunting overweight’, and the way to solve it should be to increase protein and other nutrients in the diet at an early age.

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WHO 2006 Child Growth Standards overestimate short stature and underestimate overweight in Japanese children

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2017-0303 ◽

2018 ◽

Vol 31 (1) ◽

pp. 33-38 ◽

Cited By ~ 6

Author(s):

Mikako Inokuchi ◽

Nobutake Matsuo ◽

John I. Takayama ◽

Tomonobu Hasegawa

Keyword(s):

Short Stature ◽

Care Center ◽

Standard Deviation Score ◽

Child Growth ◽

World Health ◽

Japanese Children ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Growth Standards ◽

Who Standards

AbstractBackground:It is unclear whether the World Health Organization (WHO) 2006 Child Growth Standards are applicable to East Asian populations. We investigated the applicability of the WHO standards of length/height and weight to a cohort representing middle-class children in Japan.Methods:A cohort of children aged 0–5 years (3430 boys, 3025 girls) in the Tokyo Child Care Center Survey consecutively recruited from 2007 to 2013 were studied. Age- and sex-specific z-scores of length/height, weight and weight for length/height were calculated relative to either the WHO standards or the Japanese 2000 Growth References (nationally representative cross sectional survey data).Results:Compared with the WHO standards, Japanese children at birth, 1, 3, 5 years were shorter (length/height standard deviation score [SDS] −0.26, −0.82, −0.81, −0.63 for boys, and −0.15, −0.67, −0.84, −0.62 for girls, respectively) and lighter (weight SDS −0.62, −0.36, −0.34, −0.42 for boys and −0.60, −0.17, −0.29, −0.43 for girls, respectively). Weight for length/height showed smaller differences at various length/height points (SDS −0.05 to 0.15 for boys, 0.01 to 0.29 for girls, respectively).Conclusions:Adoption of the WHO standards would substantially alter the prevalence of short stature, underweight and overweight in Japanese children 0–5 years of age. These findings advocate the use of the national references in Japan.

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Implications of the WHO Child Growth Standards in rural Honduras

Public Health Nutrition ◽

10.1017/s1368980011003570 ◽

2012 ◽

Vol 15 (6) ◽

pp. 1015-1022 ◽

Cited By ~ 4

Author(s):

Erin K Nichols ◽

Joseph S Nichols ◽

Beatrice J Selwyn ◽

Carol Coello-Gomez ◽

George R Parkerson ◽

...

Keyword(s):

Cross Sectional Study ◽

Child Growth ◽

Policy Implications ◽

Kappa Statistics ◽

Reference Standard ◽

Cross Sectional ◽

Growth Standards ◽

Growth Reference ◽

Who Standards ◽

The Impact

AbstractObjectiveThe present study analysed the impact of using the 2006 WHO Child Growth Standards (‘the WHO standards’) compared with the 1977 National Center for Health Statistics (NCHS) international growth reference (‘the NCHS reference’) on the calculated prevalence of chronic malnutrition in children aged 6·0–59·9 months.DesignAnthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland–Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories.SettingThe study was conducted in thirteen rural villages within Honduras's department of Intibucá.SubjectsChildren aged 6·0–59·9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study.ResultsThe WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24·0–35·9 months and WHZ among males aged >24·0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender.ConclusionsThe choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously.

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Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes

Public Health Nutrition ◽

10.1017/phn20062005 ◽

2006 ◽

Vol 9 (7) ◽

pp. 942-947 ◽

Cited By ~ 281

Author(s):

Mercedes de Onis ◽

Adelheid W Onyango ◽

Elaine Borghi ◽

Cutberto Garza ◽

Hong Yang ◽

...

Keyword(s):

Child Health ◽

Child Growth ◽

Growth Patterns ◽

World Health ◽

Growth Standards ◽

International Growth ◽

Growth Reference ◽

Who Standards ◽

Health Organization ◽

Health Programmes

AbstractObjectivesTo compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards (‘the WHO standards’) and the National Center for Health Statistics (NCHS)/WHO international growth reference (‘the NCHS reference’), and discuss implications for child health programmes.DesignSecondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives.SettingsBangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe.SubjectsRespectively 4787, 10 381 and 226 infants and children.ResultsHealthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%.ConclusionsThe WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.

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Variations in estimates of underweight, stunting, wasting, overweight and obesity in children from Argentina comparing three growth charts

Public Health Nutrition ◽

10.1017/s136898001200095x ◽

2012 ◽

Vol 15 (11) ◽

pp. 2086-2090 ◽

Cited By ~ 6

Author(s):

Gisel Padula ◽

Analía I Seoane ◽

Susana A Salceda

Keyword(s):

Cross Sectional Study ◽

Child Growth ◽

Overweight And Obesity ◽

Growth Charts ◽

Cross Sectional ◽

Mean Values ◽

Growth Standards ◽

Pediatric Society ◽

Who Standards ◽

Society Committee

AbstractObjectiveTo compare estimates of underweight, stunting, wasting, overweight and obesity based on three growth charts.DesignCross-sectional study to estimate weight-for-age, length/height-for-age and weight-for-height comparing the 2006 WHO Child Growth Standards (‘the WHO standards’), the 1977 National Center for Health Statistics (NCHS) international growth reference (‘the NCHS reference’) and the 1987 Argentine Pediatric Society Committee of Growth and Development reference (‘the APS reference’). Cut-off points were defined as mean values ±2 sd. Epi-Info software version 6·0 (Centers for Disease Control and Prevention) was used for statistical evaluations (χ2, P ≤ 0·05).SettingGreater La Plata conurbation, Buenos Aires, Argentina.SubjectsA total of 2644 healthy, full-term children from 0 to 5 years of age.ResultsPrevalence of underweight was higher with the WHO standards than with the other references up to the first 6 months. For the rest of the ages, prevalence was lower with the WHO standards. Stunting prevalence was higher with the WHO standards at all ages. Prevalence of wasting was higher with the WHO standards compared with the NCHS reference up to the first 6 months and lower at 2–5 years of age. Overweight and obesity prevalences were higher with the WHO standards at all ages.ConclusionsThe new WHO standards appear to be a solid and reliable tool for diagnosis and treatment of nutritional diseases, also being the only one built with infants fed according to WHO recommendations. Therefore, our results support the decision of the National Ministry of Health about the utilization of the new WHO standards to monitor the nutritional status of Argentinean children aged less than 5 years.

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Factors associated with the nutritional status of children under-five years of age with diarrhoea in Ohangwena Region, Namibia

International Journal of Healthcare ◽

10.5430/ijh.v6n2p23 ◽

2020 ◽

Vol 6 (2) ◽

pp. 23

Author(s):

Maria Francineth Bauleth ◽

Honore Kabwebwe Mitonga ◽

Lusia Ndahambelela Pinehas

Keyword(s):

Nutritional Status ◽

Acute Diarrhoea ◽

Child Growth ◽

Anthropometric Measures ◽

Cross Sectional ◽

Children Under Five ◽

Growth Standards ◽

Under Five ◽

Factors Associated ◽

Nutritional Status Of Children

Purpose: This study aims at assessing the nutritional status of children under-five years of age with acute diarrhoea, determine the prevalence of malnutrition and identifying factors associated with undernutrition among children under 5 years old in Ohangwena Region, Namibia.Methods: Cross-sectional, non-interventional study was conducted. A structured questionnaire was administered through face to face interviews. A total of 530 children under-five years from 530 households were included in this study. The nutritional index was measured based on Child Growth Standards proposed by WHO. The anthropometric measures used included mid-upper arm circumference (MUAC) and weight-for-age Z score (WAZ). Logistic regression was applied to determine the factors associated with the prevalence of malnutrition.Results: The overall prevalence of diarrhoea among the children under-five years was 24%, of these, 77% were suffering from malnutrition. Malnutrition prevalence was observed to be significantly associated with a child suffering from diarrhoea (p < .05) and children aged between 12-23 months p .001. Equally, the highest prevalence of malnutrition 29.4% [95% CI = 24.65; 34.15] was found amongst children under-five years old with mothers/caregivers aged 18-30 years. The strongest predictor of malnutrition was the mother/caregiver not being an educated recording odds ratio of 20.2.Conclusions: This study identified the need to develop and intensify strategies that may improve nutritional status in children under-five years such as health education, improved literacy, and women empowerment.

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Worldwide implementation of the WHO Child Growth Standards

Public Health Nutrition ◽

10.1017/s136898001200105x ◽

2012 ◽

Vol 15 (9) ◽

pp. 1603-1610 ◽

Cited By ~ 181

Author(s):

Mercedes de Onis ◽

Adelheid Onyango ◽

Elaine Borghi ◽

Amani Siyam ◽

Monika Blössner ◽

...

Keyword(s):

Child Growth ◽

Growth Potential ◽

Growth Standards ◽

Health Authorities ◽

Who Standards ◽

Service Training ◽

Age Range ◽

Growth Assessment ◽

Height For Age ◽

Roll Out

AbstractObjectiveTo describe the worldwide implementation of the WHO Child Growth Standards (‘WHO standards’).DesignA questionnaire on the adoption of the WHO standards was sent to health authorities. The questions concerned anthropometric indicators adopted, newly introduced indicators, age range, use of sex-specific charts, previously used references, classification system, activities undertaken to roll out the standards and reasons for non-adoption.SettingWorldwide.SubjectsTwo hundred and nineteen countries and territories.ResultsBy April 2011, 125 countries had adopted the WHO standards, another twenty-five were considering their adoption and thirty had not adopted them. Preference for local references was the main reason for non-adoption. Weight-for-age was adopted almost universally, followed by length/height-for-age (104 countries) and weight-for-length/height (eighty-eight countries). Several countries (thirty-six) reported newly introducing BMI-for-age. Most countries opted for sex-specific charts and the Z-score classification. Many redesigned their child health records and updated recommendations on infant feeding, immunization and other health messages. About two-thirds reported incorporating the standards into pre-service training. Other activities ranged from incorporating the standards into computerized information systems, to providing supplies of anthropometric equipment and mobilizing resources for the standards’ roll-out.ConclusionsFive years after their release, the WHO standards have been widely scrutinized and implemented. Countries have adopted and harmonized best practices in child growth assessment and established the breast-fed infant as the norm against which to assess compliance with children's right to achieve their full genetic growth potential.

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RISK FACTORS FOR UNDERNUTRITION IN CHILDREN UNDER FIVE YEARS OF AGE IN TENOM, SABAH, MALAYSIA

Malaysian Journal of Public Health Medicine ◽

10.37268/mjphm/vol.20/no.1/art.557 ◽

2020 ◽

Vol 20 (1) ◽

pp. 71-81

Author(s):

Eric Tan Chee How ◽

Suzana Shahar ◽

Fredie Robinson ◽

Abdul Marsudi bin Manah ◽

Mohd Yusof Ibrahim ◽

...

Keyword(s):

Composite Index ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

Child Growth ◽

Household Food Security ◽

Bivariate Analysis ◽

Cross Sectional ◽

Growth Standards ◽

Nutritional Status Of Children ◽

Children Under 5

Undernutrition is the result of complex interplay of factors such as household food security, childcare, feeding practices, nutrition and sanitation. Therefore, this study aimed to determine the prevalence of stunting, wasting, underweight based on WHO child growth standards 2006 and undernutrition based on Composite Index Anthropometric Failure (CIAF) and its association with the biological, behavioural, socio-economic and physical environment factors among children under-5 years. This was a cross sectional study involving children aged between 6 and 59 months recruited through stratified random sampling from the Tenom district. Sociodemographic background was obtained from mothers via a questionnaire. Height and weight measurements were measured using standardised instrument. The height-for-age, weight-for-age and BMI-for-age were classified according to the WHO Child Growth Standard 2006. Bivariate analysis and multivariate logistic regression analysis were conducted. The prevalence of undernutrition based on CIAF was 42.3%, underweight 34.7%, stunting 33.3% and wasting 10.0%. After adjusting for all confounders, childhood undernutrition was significantly associated with unimproved sanitation (adjusted OR 2.98, 95% CI: 1.082 to 8.225) and frequent illness (adjusted OR 2.07, 95% CI: 1.015 to 3.274). These findings support the association of biological and physical environmental factors with the nutritional status of children under-5 years old.

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Cross-sectional study of child and adolescent growth in Ecuador

Revista Argentina de Antropología Biológica ◽

10.24215/18536387e006 ◽

2019 ◽

Vol 21 (2) ◽

pp. 006

Author(s):

Wilmer Alexander Tarupi ◽

Yvan Lepage ◽

Roland Hauspie ◽

María Luisa Félix ◽

Claude Monnier ◽

...

Keyword(s):

Growth Curves ◽

Cross Sectional Study ◽

Child Growth ◽

World Health ◽

Growth Monitoring ◽

Cross Sectional ◽

Important Indicator ◽

Growth Standards ◽

Who Standards ◽

Health Organization

Child growth is internationally recognized as an important indicator for monitoring health in populations. There exists a wide controversy regarding the use of international growth standards versus local references. This study seeks to construct reference growth curves for school-age Ecuadorian children and adolescents, and to compare them with World Health Organization (WHO) standards, in order to identify the differences and their public health implications. The study authors enrolled 2891 children (1644 girls and 1247 boys) aged 5 to 18 years, from a variety of climatic zones and ethnic groups. LMS method was used to construct Ecuadorian curves for height, weight and Body Mass Index. Comparisons of Ecuadorian and WHO curves were graphically illustrated. U.S children were taller than Ecuadorian children across all age ranges, with larger differences between the two populations in children over 13 years. Consequently, estimates of low height and extremely low height, as well as overweight, obese and undernourished, were significantly different between WHO standards and the Ecuadorian references. Population-specific growth curves may be more adequate for growth monitoring of Ecuadorian children than WHO growth curves. We advocate for the construction of an Ecuadorian growth reference for clinical use based on national population, from conception to maturity, as an accurate instrument for monitoring growth.

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Maternal Dietary Diversity and Growth of Children Under 24 Months of Age in Rural Dodoma, Tanzania

Food and Nutrition Bulletin ◽

10.1177/0379572118761682 ◽

2018 ◽

Vol 39 (2) ◽

pp. 219-230 ◽

Cited By ~ 6

Author(s):

Megan Huang ◽

Christopher Sudfeld ◽

Abbas Ismail ◽

Said Vuai ◽

Julius Ntwenya ◽

...

Keyword(s):

Dietary Diversity ◽

Child Growth ◽

Mean Difference ◽

Z Score ◽

Cross Sectional Survey ◽

Anthropometric Measures ◽

Cross Sectional ◽

Growth Outcomes ◽

Height For Age ◽

Weight For Age

Objective: To identify predictors of maternal dietary diversity in rural Dodoma, Tanzania and assess its association with child growth outcomes. Methods: A cross-sectional survey of 361 mothers with children under 24 months of age was conducted in 5 villages in rural Dodoma, Tanzania. Maternal diets were assessed using food frequency questionnaires, and dietary diversity was categorized using Minimum Dietary Diversity for Women (MDD-W) guidelines. Child anthropometric measures were taken to calculate height-for-age z-score (HAZ), weight-for-height z-score (WHZ), and weight-for-age z-score (WAZ). Linear and logistic regressions were used to examine the association between maternal dietary diversity and children’s growth outcomes. Results: About 40% of mothers did not consume a diverse diet (MDD-W < 5), and 35% of children were stunted. Household production of greater number of crops was associated with greater MDD-W scores ( P < .01). Greater maternal dietary diversity was associated with significantly greater child WHZ (mean difference = 0.44; 95% confidence interval [CI]: 0.10-0.78; P = .01), WAZ (mean difference = 0.37; 95% CI: 0.08-0.65; P = .01), and reduced risk of wasting (odds ratio = 0.22; 95% CI: 0.07-0.66; P = .01). Conclusions: Greater maternal dietary diversity was associated with improved child WHZ and WAZ outcomes. Sustainable interventions to increase maternal dietary diversity may improve WHZ and WAZ in young children in similar settings.

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Sustained Positive Deviant Child Care Practices and Their Effects on Child Growth in Viet Nam

Food and Nutrition Bulletin ◽

10.1177/15648265020234s204 ◽

2002 ◽

Vol 23 (4_suppl2) ◽

pp. 16-25 ◽

Cited By ~ 40

Author(s):

U. Agnes Trinh Mackintosh ◽

David R. Marsh ◽

Dirk G. Schroeder

Keyword(s):

Child Growth ◽

Program Completion ◽

Viet Nam ◽

Nutrition Program ◽

Cross Sectional ◽

Total N ◽

Z Scores ◽

Growth Promoting ◽

Height For Age ◽

Weight For Age

Save the Children's (SC) successful integrated nutrition program in Viet Nam, the poverty alleviation and nutrition program (PANP), uses the positive deviance (PD) approach to identify key growth promoting behaviors and provides participatory adult education allowing mothers to develop skills related to these behaviors. We investigated whether improvements seen during a PANP intervention (1993–1995) were sustained three and four years after SC's departure. Cross-sectional surveys were administered to 46 randomly selected households in four communes that had previously participated in the PANP and 25 households in a neighboring comparison community in 1998 and 1999. Two children per household, an older child who had participated in the PANP and a younger sibling who had not, were measured (total n = 142 children), and their mothers were interviewed. Older SC children tended to be better nourished than their counterparts. Their younger siblings were significantly better nourished than those in the comparison group, with adjusted mean weight-for-age Z scores of −1.82 versus −2.45 ( p = .007), weight-for-height Z scores of −0.71 versus −1.45 ( p < .001), and height-for-age Z scores of −2.11 and −2.37 (ns, p = .4), respectively. SC mothers reporting feeding the younger siblings more than their counterparts did (2.9 versus 2.2 main meals per day, p < .001, and 96.2% versus 52% offering snacks, p < .01]. SC mothers reported washing their hands “often” more than comparison mothers (100% vs. 76%, p < .001). Growth-promoting behaviors identified through PD studies and practiced through neighborhood-based rehabilitation sessions persisted years after program completion. These sustained behaviors contributed to better growth of younger siblings never exposed to the program.

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