Growth patterns in early childhood and the onset of menarche before age twelve

OBJECTIVE: To examine the relationship between growth patterns in early childhood and the onset of menarche before age 12. METHODS: The study included 2,083 women from a birth cohort study conducted in the city of Pelotas, Southern Brazil, starting in 1982. Anthropometric, behavioral, and pregnancy-related variables were collected through home interviews. Statistical analyses were performed using Pearson's chi-square and chi-square test for linear trends. A multivariable analysis was carried out using Poisson regression based on a hierarchical model. RESULTS: Mean age of menarche was 12.4 years old and the prevalence of menarche before age 12 was 24.3%. Higher weight-for-age, height-for-age, and weight-for-height z-scores at 19.4 and 43.1 months of age were associated with linear tendencies of increased prevalence and relative risks of the onset of menarche before age 12. Girls who experienced rapid growth in weight-for-age z-score from birth to 19.4 months of age and in weight-for-age or height-for-age z-scores from 19.4 to 43.1 months of age also showed higher risk of menarche before age 12. Higher risk was seen when rapid growth in weight-for-age z-score was seen during these age intervals and the highest risk was found among those in the first tertile of Williams' curve at birth. Rapid growth in weight-for-height z-score was not associated with menarche before age 12. CONCLUSIONS: Menarche is affected by nutritional status and growth patterns during early childhood. Preventing overweight and obesity during early childhood and keeping a "normal" growth pattern seem crucial for the prevention of health conditions during adulthood.

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Association of Whole Blood Fatty Acids and Growth in Southern Ghanaian Children 2–6 Years of Age

Nutrients ◽

10.3390/nu10080954 ◽

2018 ◽

Vol 10 (8) ◽

pp. 954 ◽

Cited By ~ 3

Author(s):

Mary Adjepong ◽

William Yakah ◽

William Harris ◽

Esi Colecraft ◽

Grace Marquis ◽

...

Keyword(s):

Fatty Acids ◽

Growth Parameters ◽

Dietary Fatty Acids ◽

Northern Ghana ◽

Z Score ◽

Omega 3 ◽

Omega 6 ◽

Z Scores ◽

Height For Age ◽

Weight For Age

In Ghana, stunting rates in children below 5 years of age vary regionally. Dietary fatty acids (FAs) are crucial for linear growth. The objective of this study was to determine the association between blood FAs and growth parameters in southern Ghanaian children 2–6 years of age. A drop of blood was collected on an antioxidant treated card and analyzed for FA composition. Weight and height were measured and z-scores calculated. Relationships between FAs and growth were analyzed by linear regressions and factor analysis. Of the 209 subjects, 22% were stunted and 10.6% were essential FA deficient (triene/tetraene ratio > 0.02). Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score or weight-for-age z-score. Similarly, no relationships between other blood fatty acids and growth parameters were observed in this population. However, when blood fatty acid levels in these children were compared to previously reported values from northern Ghana, the analysis showed that blood omega-3 FA levels were significantly higher and omega-6 FA levels lower in the southern Ghanaian children (p < 0.001). Fish and seafood consumption in this southern cohort was high and could account for the lower stunting rates observed in these children compared to other regions.

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Development of LMS and Z Score Growth References for Egyptian Children From Birth Up to 5 Years

Frontiers in Pediatrics ◽

10.3389/fped.2020.598499 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ali M. El Shafie ◽

Fady M. El-Gendy ◽

Dalia M. Allahony ◽

Hossam H. Hegran ◽

Zein A. Omar ◽

...

Keyword(s):

Nutritional Status ◽

Chronic Diseases ◽

Child Growth ◽

Z Score ◽

Egyptian Children ◽

Significant Difference ◽

Z Scores ◽

Growth References ◽

Height For Age ◽

Weight For Age

Background: The Lambda-Mu-Sigma (LMS) and Z score methods are important for assessment of growth and nutritional status. In Egypt, there is a lack of this tool for monitoring growth in preschool children.Objective: To develop LMS and Z score growth references for assessment of growth and nutritional status for Egyptian children from birth up to 5 years.Methods: A total of 27,537 children [13,888 boys (50.4%) and 13,649 girls (49.6%)] from birth up to 5 years were included in a multistage cross sectional randomized study from different Egyptian geographic districts to create LMS and Z score references for weight, length/height, and body mass index corresponding to age in addition to weight for length/height. Healthy term infants and children, exclusive breast feeding for at least 4 months and not suffering from any chronic diseases were included in this study. Children with dysmorphic features, preterm infants, admitted in neonatal or pediatric intensive care units and having any chronic diseases (hematological, cardiac, hepatic, and renal) were excluded. In addition any health condition that affects child growth including nutritional disorders was also excluded. Un-paired t-test was calculated to compare the means of weight for age, length/height for age, weight for length/height, and BMI for-age z scores of the Egyptian and WHO reference values.Results: Through detailed tables and graphs, LMS and Z scores for weight for age, length/height for age, weight for length/height, and BMI for age of both sexes were represented. Our findings showed no statistically significant difference between reference charts of WHO and Egyptian Z score charts (P > 0.05).Conclusion: This study provides the first reference for Egyptian children from birth up to 5 years based on Z score tool for assessment the growth and nutritional status in various clinical conditions and research, also allows comparison with references of other countries.

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Dental Caries Severity and Nutritional Status of Nigerian Preschool Children

JDR Clinical & Translational Research ◽

10.1177/23800844211002108 ◽

2021 ◽

pp. 238008442110021

Author(s):

O.O. Olatosi ◽

A.A. Alade ◽

T. Naicker ◽

T. Busch ◽

A. Oyapero ◽

...

Keyword(s):

Early Childhood ◽

Dental Caries ◽

Nutritional Status ◽

Early Childhood Caries ◽

Z Score ◽

Cross Sectional ◽

Risk Of Death ◽

Malnourished Children ◽

Z Scores ◽

Childhood Caries

Introduction: Malnutrition in children is one of the most prevalent global health challenges, and malnourished children have a higher risk of death from childhood diseases. Early childhood caries (ECC) is the most common chronic disease of childhood. Complications from ECC such as pain, loss of tooth/teeth, and infection can undermine a child’s nutrition and growth. Aim: This study aims to evaluate the severity of decay, missing, and filled tooth (dmft) by nutritional status using the z scores of the anthropometric measurements: height for age (HFA), weight for age (WFA), weight for height (WFH), and body mass index for age (BMIA) among children with ECC in Nigeria. Study Design: This is a cross-sectional study conducted in 5 local government areas (LGAs) in Lagos State, Nigeria. A multistage sampling technique was used. Results: A total of 273 cases of ECC were included in the analyses (mean age 4.19 ± 0.96 y). Overall, the mean dmft was 3.04 ± 2.28, and most (96%) were accounted for by untreated decay. The distribution of dmft within the different z score categories of BMIA (<–3 = severely wasted, –2 to –3 = wasted, –2 to +2 = normal, +2 to +3 = overweight and >+3 = obese) showed the highest dmft scores among the combined severely wasted and wasted groups, lowest among children with normal z scores, and intermediate in the overweight and obese groups. There was a significant negative correlation between BMIA z score, WFH z score, and dmft ( r = −0.181, P < 0.05 and r = −0.143, P < 0.05, respectively). However, the correlations between HFA z score, WFA z score, and dmft were positive but not significant ( r = 0.048, P = 0.44 and r = 0.022, P = 0.77, respectively). Conclusion: Our study showed an increased severity of dental caries among severely wasted or wasted children with ECC compared to those of normal or overweight. Knowledge Transfer Statement: The results from this study will raise awareness among clinicians and policy makers on the need for a primary prevention program for early childhood caries in countries with high burden of malnutrition and limited resources. Also, it will help draw the attention of clinicians to the caries status of malnourished children that can be managed to improve the nutritional outcomes.

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Associations of community, famliy and early individual factors with body mass index z-scores trajectories among Chinese children and adolescents

Scientific Reports ◽

10.1038/s41598-021-93949-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jing Liang ◽

Si Zheng ◽

Xuyang Li ◽

Dianmin Xiao ◽

Peigang Wang

Keyword(s):

Overweight And Obesity ◽

Growth Patterns ◽

Chinese Children ◽

School Age ◽

Critical Window ◽

Community Factors ◽

Targeted Interventions ◽

Individual Family ◽

Class 1 ◽

Z Scores

AbstractThe prevalence of childhood overweight and obesity is increasing. This study aimed to examine trajectories of BMI z-scores among Chinese children and the potential determinants including early individual, family and community factors. Group-based trajectory modeling was employed to identify BMI z-scores trajectories of children aged 2–18 years using the five waves data (2010, 2012, 2014, 2016, and 2018) of the China Family Panel Studies (CFPS). Multivariate logistic regression was conducted to determine the association between early individual, family, community factors and BMI z-scores trajectories of children. We identified three trajectories for boys and girls, named Class 1 as “not-overweight”, Class 2 as “persistent rapid descending but overweight during pre-school age”, and Class 3 as “rapid rising up to school age and then become-overweight” class. Macrosomia (OR 1.772; 95% CI 1.188–2.644) and being a single child (OR 2.038; 95% CI 1.453–2.859) were more likely to belong in Class 3 among boys. Girls living in the advantaged communities (OR 1.539; 95% CI 1.052–2.252), rural-living (OR 1.558; 95% CI 1.133–2.142) and with none social integration (OR 1.496; 95% CI 1.07–2.091) were more likely to belong in Class 2. There are heterogeneous BMI z-scores trajectories of children aged 2–18, and pre-school age is a critical window that could predict the long-term growth patterns. BMI z-scores trends need to be monitored during pre-school age, focusing on those at higher risk of later overweight obesity status, and targeted interventions at the early individual, family, community levels are essential.

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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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Water, sanitation and hygiene practices associated with improved height-for-age, weight-for-height and weight-for-age z-scores in Nepal.

10.21203/rs.2.17090/v3 ◽

2020 ◽

Author(s):

Som Kumar Shrestha ◽

Don Vicendese ◽

Bircan Erbas

Keyword(s):

Nutritional Status ◽

Water Purification ◽

Rural Areas ◽

Interactive Effects ◽

P Value ◽

Child Undernutrition ◽

Sanitation And Hygiene ◽

Z Scores ◽

Height For Age ◽

Weight For Age

Abstract Background: Evidence of the influence of water, sanitation and hygiene (WASH) behaviors on childhood nutritional status is inconsistent. Few studies have examined their interactive effects. This study aimed to examine associations and interactions between WASH variables and preschool child undernutrition. Methods: Data from a nationally representative sample of 2352 children assessed during the 2016 Nepal Demographic and Health Survey were analyzed by multi-variable linear regression to understand the association between height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores and WASH variables. Interactions between WASH variables, sex and area of residence on childhood nutritional status were also examined. Results: The mean z-score [standard deviation] for children’s WAZ, HAZ and WHZ scores were -1.33 [1.1], -1.52 [1.3] and -0.65 [1.1], respectively. A unit increase in cluster sanitation coverage was associated with an increase of 0.30 (95%CI: 0.12 to 0.48) for WAZ and 0.28 (95%CI: 0.001 to 0.56) for HAZ scores. Household water purification practice was associated with an increase of 0.24 (95%CI: 0.07 to 0.41) in WHZ score. Handwashing practice with water and soap was associated with an increase of 0.15 (95%CI: 0.04 to 0.25) in WAZ and 0.13 (95%CI: 0.01 to 0.24) in WHZ scores. The effect of water purification practice was higher for rural areas compared to urban settings for HAZ scores (p-value for interaction=0.02). Conclusions: Consistent with findings from other countries in the South Asian region, findings of this study highlight the potential importance of good WASH practices, and therefore the potential of WASH interventions, to contribute to improved nutritional status in rural Nepal.

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Midday Meals as an Early Childhood Nutrition Intervention: Evidence from Plantation Communities in Sri Lanka

10.21203/rs.3.rs-122527/v1 ◽

2020 ◽

Author(s):

Udeni De Silva Perera ◽

Brett A. Inder

Keyword(s):

Developing Countries ◽

Early Childhood ◽

Sri Lanka ◽

Random Effects ◽

Nutrition Intervention ◽

Child Malnutrition ◽

Vulnerable Communities ◽

Tea Plantations ◽

Height For Age ◽

Weight For Age

Abstract Background: High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of five years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children.Methods: The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data is regularly collected on heights and weights of children, between 2013-2015. Standardized weight-for-age, height-for-age, BMI-for-age and weight-for-height are calculated following WHO guidelines, and binary variables for stunting, wasting and underweight are constructed. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth variables whilst random-effects logistic regression is used for binary outcome variables. Robustness analysis involves different estimation methods and subsamples. Results: The dataset consists of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model estimations and across different subsamples by gender, birthweight and birth-year cohort. Qualitative data analysis suggests a high viability of implementing similar programs within tea plantations in Sri Lanka.Conclusions: Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.

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Size-adjustment techniques of lumbar spine dual energy X-ray absorptiometry measurements in assessing bone mineralization in children on maintenance hemodialysis

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0081 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Nanees Salem ◽

Ashraf Bakr

Keyword(s):

Bone Mineralization ◽

Dual Energy ◽

Maintenance Hemodialysis ◽

Z Score ◽

Normal Height ◽

X Ray ◽

Significant Difference ◽

Z Scores ◽

Size Adjustment ◽

Height For Age

Abstract Objectives Growing skeleton is uniquely vulnerable to impaired mineralization in chronic kidney disease (CKD). Continued debate exists about the optimal method to adjust for body size when interpreting dual energy X-ray absorptiometry (DXA) scans in children with CKD given the burden of poor growth. The study aimed to evaluate the clinical usefulness of size-adjustment techniques of lumber-spine DXA measurements in assessing bone mineralization in children with kidney failure on maintenance hemodialysis (HD). Methods Case-control study included 93 children on maintenance HD (9–18 years; 48 males). Participants were subjected to spinal-DXA-scan to obtain areal bone mineral density (aBMD; g/cm2). Volumetric-BMD (vBMD; g/cm3) was mathematically estimated. Z-scores of aBMD for chronological age (aBMDZ-CA), aBMD adjusted for height age (aBMDZ-HA), and vBMDZ-score were calculated using mean and SD values of age subgroups of 442 healthy controls (7–18 years). Results In short-for-age CKD patients, aBMDZ-CA was significantly lower than vBMDZ-score, while aBMDZ-HA was significantly higher than aBMDZ-CA and vBMDZ-score. In normal height-for-age CKD patients, no significant difference between aBMDZ-scores and vBMDZ-score was detected. aBMDZ-CA was significantly lower and aBMDZ-HA was significantly higher in short-for-age compared to normal height-for-age patients without significant differences in vBMDZ-score. We observed age-related decrements in the percentage of HD patients with normal densitometric Z-scores, the effect of age was less pronounced in aBMDZ-HA than vBMDZ-score. vBMDZ-score correlated negatively with age, but not with heightZ-score. Conclusions Estimated vBMD seems to be a convenient size-adjustment approach of spinal-DXA measurements in assessing BMD especially in older short-for-age children with CKD. aBMDZ-CA underestimates, while aBMDZ-HA overestimates BMD in such patients.

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FOOD INTAKE, NUTRITIONAL STATUS AND GASTROINTESTINAL SYMPTOMS IN CHILDREN WITH CEREBRAL PALSY

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-78 ◽

2018 ◽

Vol 55 (4) ◽

pp. 352-357 ◽

Cited By ~ 5

Author(s):

Deise Cristina Oliva CARAMICO-FAVERO ◽

Zelita Caldeira Ferreira GUEDES ◽

Mauro Batista de MORAIS

Keyword(s):

Cerebral Palsy ◽

Food Intake ◽

Gastroesophageal Reflux ◽

Nutritional Status ◽

Fluid Intake ◽

Gastrointestinal Symptoms ◽

Z Score ◽

Children With Cerebral Palsy ◽

Height For Age ◽

Weight For Age

ABSTRACT BACKGROUND: Cerebral palsy may be associated with comorbidities such as undernutrition, impaired growth and gastrointestinal symptoms. Children with cerebral palsy exhibit eating problems due to the effect on the anatomical and functional structures involved in the eating function resulting in malnutrition. OBJECTIVE: The aim of this study was to investigate the association between food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. METHODS: Cross-sectional study that included 40 children with cerebral palsy (35 with spastic tetraparetic form and 5 with non-spastic choreoathetoid form of cerebral palsy, all requiring wheelchairs or bedridden) aged from 4 to 10 years. The dietary assessment with the parents was performed using the usual household food intake inquiry. Anthropometric data were collected. Gastrointestinal symptoms associated with deglutition disorders, gastroesophageal reflux and chronic constipation were also recorded. RESULTS: The median of height-for-age Z-score (-4.05) was lower (P<0.05) than the median of weight-for-age (-3.29) and weight-for-height (-0.94). There was no statistical difference between weight-for-age and weight-for-height Z-scores. Three patients with cerebral palsy (7.5%) exhibited mild anemia, with normal ferritin levels in two. Symptoms of dysphagia, gastroesophageal reflux, and constipation were found in 82.5% (n=33), 40.0% (n=16), and 60.0% (n=24) of the sample, respectively. The patients with symptoms of dysphagia exhibited lower daily energy (1280.2±454.8 Kcal vs 1890.3±847.1 Kcal, P=0.009), carbohydrate (median: 170.9 g vs 234.5 g, P=0.023) and fluid intake (483.1±294.9 mL vs 992.9±292.2 mL, P=0.001). The patients with symptoms of gastrointestinal reflux exhibited greater daily fluid intake (720.0±362.9 mL) than the patients without symptoms of gastroesophageal reflux (483.7±320.0 mL, P=0.042) and a greater height-for-age deficit (Z-score: -4.9±1.7 vs 3.7±1.5, P=0.033). The patients with symptoms of constipation exhibited lower daily dietary fiber (9.2±4.3 g vs 12.3±4.3 g, P=0.031) and fluid (456.5±283.1 mL vs 741.1±379.2 mL, P=0.013) intake. CONCLUSION: Children with cerebral palsy exhibited wide variability in food intake which may partially account for their severe impaired growth and malnutrition. Symptoms of dysphagia, gastroesophageal reflux, and constipation are associated with different food intake patterns. Therefore, nutritional intervention should be tailored considering the gastrointestinal symptoms and nutritional status.

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Differences between WHO Growth Standards and China Growth Standards in Assessing the Nutritional Status of Children Aged 0–36 Months Old

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010251 ◽

2019 ◽

Vol 17 (1) ◽

pp. 251

Author(s):

Qianling Tian ◽

Xiao Gao ◽

Tingting Sha ◽

Qiong He ◽

Gang Cheng ◽

...

Keyword(s):

Nutritional Status ◽

World Health ◽

Growth Standards ◽

The World ◽

Z Scores ◽

Nutritional Status Of Children ◽

Height For Age ◽

Weight For Age ◽

China’S Growth

Background: At present, whether to use the World Health Organization’s (WHO) growth standards or native growth standards to assess the nutritional status in a given population is unclear. This study aimed to compare the differences between the WHO’s growth standards and China’s growth standards in assessing the nutritional status of children aged 0~36 months. Methods: We used z-scores to evaluate the nutritional status of children. The weight-for-age z-scores (WAZs), length/height-for-age z-scores (LAZ/HAZs), and weight-for-length/height z-scores (WLZ/WHZs) were calculated using the WHO’s growth standards and China’s growth standards. MeNemar’s test was used to compare the nutritional status of children. Results: The results in this study showed that there were differences between the WHO’s standards and China’s standards in assessing children’s nutritional status except for stunting and obesity. The prevalence of underweight assessed using China’s standards was higher than when using the WHO’s standards (except when 3 and 36 months old). The prevalence of wasting was significantly higher when assessed using China’s standards than when using the WHO’s standards from 12 to 36 months. The prevalence of overweight was higher when assessed using the WHO’s standards from 3 to 8 months. Conclusions: Both the WHO’s and China’s growth standards are useful measures in assessing children’s nutritional status but with key significant differences. Therefore, caution should be taken in selecting appropriate measures in a given population.

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