Growth differences between children of highland and coastal Ecuador

This study examines patterns of growth in height and weight among children (<60 months) of highland and coastal agricultural communities of Ecuador. Highland children are significantly shorter, but not significantly lighter than their coastal peers. Linear growth rates (cm/6 months) are comparable between the two samples. Growth rates for body weight (kg/6 m) are similar in highland and coastal boys, whereas highland girls display larger weight gains than their coastal counterparts. In both regions, linear growth is compromised to a much greater extent than growth in body weight, and growth faltering for both height and weight is most pronounced between birth and 24 months of age. The similarity in growth rates between the highland and coastal samples suggests that high altitude hypoxia plays a relatively small role in shaping growth during the first five years after birth. Rather, it appears that most of the disparity in height between the two samples can be attributed to differences established by 6 months of age. The pattern of growth retardation seen in both regions during the first 24 postnatal months is similar to that observed among impoverished populations throughout the world and is likely associated with the influence of nutritional and disease stressors. After 2 years of age, little or no “catch up” growth is seen in height, whereas improvements in weight gain are more pronounced, especially among highland girls. Ongoing research is investigating the nutritional and socio-economic correlates of growth within each region. © Wiley-Liss, Inc.     

Excess mortality among children discharged from hospital after treatment for diarrhoea in rural Bangladesh.

Five hundred and fifty one children aged between 3 months and 3 years were followed up at home for 12 months after treatment of diarrhoea in a rural treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. During follow up the children were found to have a significantly higher mortality than generally observed in the community. The first three months after discharge appeared to be crucial, some 70% of the deaths occurring in that period. Severely malnourished children (nutritional state below 56% of the American National Center for Health Statistics (NCHS) standard of weight for age ratio) had a risk of death 14 times that of their well nourished counterparts (nutritional state 66% or more of the NCHS standard). The highest mortality occurred in 2 year olds, one in three of the severely malnourished children dying compared with one in 10 of the moderately malnourished. This pattern was not seen in children aged under 2 years. Immediate priority should be given to providing nutritional rehabilitation for malnourished children who contract diarrhoea.     

Accelerated Growth in Early Life and Obesity in Preschool Chilean Children

In Chile, childhood obesity rates are high. The purpose of this article is to compare BMI growth characteristics of normal (N), overweight (OW), and obese (OB) 5‐year olds from 0 to 5 years and explore the influence of some prenatal factors on these patterns of growth. The study was done on a retrospective cohort of 1,089 5‐year olds with birth weight >2,500 g. Weight and height were obtained from records at nine occasions (0–36 months); at 52 and 60 months, we measured them. At 60 months, children were classified as N, OW, and OB. At each age, BMI and z‐score of BMI (BMI Z) differences were compared among groups. The influence of birth weight, pre‐pregnancy BMI, and prenatal variables (weight gain, smoking, and presence of diabetes and preeclampsia) on BMI Z differences between N and OB was also explored. Adiposity rebound (AR) was not observed for the N, although for the OW, it occurred ～52 months and for the OB at ～24 months. BMI Z differences between N and OB were significant from birth, but were greatest between 6–12 and 36–52 months. Additional adjustment by birth weight, pre‐pregnancy BMI, and prenatal variables decreased the BMI Z differences for the first 24 months with virtually no effect after this age. Accelerated growth in OB children from post‐transition countries occurs immediately after birth, much earlier than the AR. The influence of prenatal factors on adiposity acquisition may extend at most until 2 years of life, although BMI gains thereafter are more related to postnatal variables.     

The effect of birth interval on malnutrition in Bangladeshi infants and young children

This study was undertaken to investigate the independent effect of the length of birth interval on malnutrition in infants, and children aged 6-39 months. Data for this study were drawn from a post-flood survey conducted during October-December 1988 at Sirajganj of the Sirajgani district and at Gopalpur of the Tangail district in Bangladesh. The survey recorded the individual weights of 1887 children. Cross-tabulations and logistic regression procedures were applied to analyse the data. The proportion of children whose weight-for-age was below 70% (moderate-to-severely malnourished) and 60% (severely malnourished) of the NCHS median was tabulated against various durations of previous and subsequent birth intervals. The odds of being moderately or severely malnourished were computed for various birth intervals, controlling for: the number of older surviving siblings; maternal education and age; housing area (a proxy for wealth); age and sex of the index child; and the prevalence of diarrhoea in the previous 2 weeks for the index child. About one-third of infants and young children were moderately malnourished and 15% were severely malnourished. The proportion of children who were under 60% weight-for-age decreased with the increase in the length of the subsequent birth interval, maternal education and housing area. The proportion of malnourished children increased with the number of older surviving children. Children were at higher risk of malnutrition if they were female, their mothers were less educated, they had several siblings, and either previous or subsequent siblings were born within 24 months. This study indicates the potential importance of longer birth intervals in reducing malnutrition in children.     

Physical growth of infants 7 to 13 months of age: results from a national survey

This study considers measurements of weight, recumbent length, head circumference, triceps skinfold, and arm circumference of 1,100 infants aged 7 to 13 months from a cross-sectional sample representative of the U.S. infant population. Based on these data, smoothed percentiles of weight, recumbent length, head circumference, triceps skinfold, and arm circumference by sex and age (in months) and weight for recumbent length were calculated. Compared with the percentile values from the National Center for Health Statistics (NCHS; Hamill et al., 1977, DHEW Publ. No. PHS 78-1650), percentile values from the 1984 Ross Laboratories Infant Nutrition Survey (RNS) for weight, recumbent length, and weight for recumbent length tended to be smaller (p less than .05). We attribute these variations to differences in sampling design and conclude that they are not of sufficient magnitude to warrant new growth charts. Smoothed percentiles for triceps skinfold and arm circumference presented herein are new reference values that can be used for assessment of the nutritional and growth status of older infants.     

Implication of new WHO growth standards on identification of risk factors and estimated prevalence of malnutrition in rural Malawian infants

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.     

Physical growth of children under five years of age in Nchelenge,Zambia: Results from a district survey

This study focuses on the physical growth of children aged 0–60 months in Nchelenge District, northeast Zambia. By means of a two-stage clustered and random sampling method, 193 households were selected. Weight, height, and mid-upper-arm circumference (MUAC) of children 0–60 months were measured. Underweight, stunting, and wasting were defined as weight for age, height for age, and weight for height (W/H), respectively, ≤2 z scores below the median of the National Center for Health Statistics (NCHS) reference population. Among 250 children, prevalence rates of 30% underweight, 69.2% stunting, and 4.4% wasting were found, with the highest rates at age 12–<24 months. Prevalence of stunting, underweight, and wasting in children aged 0–<6 months and 6–<12 months suggested that a substantial proportion of infants were premature and/or small for gestational age. The literature suggests that prematurity and intrauterine growth retardation may be quite common in Africa, and this may have important implications for the interpretation of growth data and under nutrition rates. Use of the MUAC < 125 mm as an indicator of wasting resulted in higher estimates of wasting compared to W/H ≤ −2 z scores, and seemed unsuitable as a screening test for wasting in this Zambian population. © 1996 Wiley-Liss, Inc.     

Longitudinal growth of head circumference in Punjabi infants in Chandigarh (India)

One hundred and fifty four (86 male and 68 female) Punjabi infants residing in Chandigarh (India) were longitudinally measured for head circumference at monthly age intervals during first year of life. The general pattern of growth of head circumference was characterised by initial sharp rise followed by slow gain during second half of infancy. Beyond birth male infants, possessed higher and statistically significant mean values than their female counterparts. The pattern-wise similarity between growth curves plotted for Punjabi and Western infants, may be attributed to protective effects of breast feeding. Head circumference velocity showed rapid deceleration immediately after birth up to about 4 months, thereafter, it declined slowly. Sex differences in monthly growth rates were found to be statistically significant (p<0.05) at a few of the age intervals during first year of life.     

Patterns of sexual dimorphism from birth to senescence

Sexual dimorphism is expressed as median of the female values in percent of the median of the male values, of 4 length measurements, 3 circumferences, and 5 measurements of corpulence respectively fat. Data were obtained from a cross-sectional sample of more than 41.000 German subjects, aged from birth to age 62. The pattern of sexual dimorphism is similar in the length measurements. Girls are shorter at birth, but they increase in length at higher rates than boys and even temporarily overgrow the boys up to age 12. Thereafter, males show an obvious growth advantage leading to some 6 to 9% more length in adult males. In contrast, female circumferences are always smaller, from birth to senescence. Though, the differences between the sexes are low in circumferences, up to age 13, sexual dimorphism increases to 17% in the thoracic circumference at adulthood. Sexual dimorphism in weight and BMI is comparably with that in length measurements while subcutaneous fat and total body fat content are always higher in females. The results highlight that sexual dimorphism develops at different pace in the various components of the body and that it associates with a sex specific growth tempo.     

Early influences on the tempo of puberty

Fetal growth retardation appears to be associated with an increased risk of premature adrenarche, early puberty, polycystic ovary syndrome and associated fertility problems. In a rat model of intrauterine growth retardation, based on ligation of the uterine arteries, the onset of puberty was delayed in female pups, with anovulation during the first cycle. The ovaries showed a lower number of follicles. The onset of puberty was also delayed in male pups. Testosterone production was lower in these growth-retarded rats compared with controls. The relationship between birth weight and the onset of puberty and pubertal progression in different cohorts of healthy children has been examined. In girls, no differences were observed in timing and progression of puberty, including age of menarche, between groups of different birth weights. In boys, a relatively delayed onset of puberty was observed in those with low birth weight, with a normally timed progression. In children with low birth weight, particularly boys, higher dehydroepiandrosterone levels were found compared with children with a normal birth weight, indicating an overactive adrenal gland in children with low birth weight. These data indicate that impaired fetal growth may have long-lasting effects on pubertal development. The fact that results of human studies on the relationship between fetal growth and the onset of puberty are often controversial may be explained by the heterogeneity of children born small for gestational age with respect to the intrauterine insult that they experience. From rat studies, it is clear that a serious intrauterine insult associated with growth failure can lead to dysregulation of puberty and gonadal function.     

Mode of Infant Feeding and Achieved Growth in Adolescence: Early Feeding Patterns in Relation to Growth and Body Composition in Adolescence

TULLDAHL, JENNY, KJELL PETTERSSON, SUSAN W. ANDERSSON, AND LENA HULTHÉN. Mode of infant feeding and achieved growth in adolescence: Early feeding patterns in relation to growth and body composition in adolescence. Obes Res. Objective: Feeding mode in infancy and differences in childhood growth have been studied in several longitudinal studies, but few studies have followed children up to adolescent age. There is evidence that formula-fed infants weigh more and are taller than their breast-fed counterparts, and indications that this difference may sustain. Research Methods and Procedures: We have studied the relations between length of breast-feeding, growth, and body composition in a group of 781 representatively chosen adolescents. Data on feeding pattern in infancy and on weight and height from birth up to 18 years were collected. We studied the relation between high body mass index (BMI) (defined as ≤85^th percentile) in adolescence and length of breast-feeding. Results: Girls who were not breast-fed or breast-fed for less than 3 months had a significantly higher height curve than girls exclusively breast-fed for more then 3 months. There were tendencies towards higher values of adipose tissue measured by skinfolds in girls breast-fed for 3 months or less. Short duration of exclusive breast-feeding was associated with higher BMI (p<0. 04). In a subgroup of 194 adolescents, body composition was measured with dual energy X-ray. Both boys and girls who were exclusively breast-fed for more than 3 months were leaner and showed a trend towards lower skinfold values. Conclusion: These results are important to include in the debate about optimal feeding in infancy. Regarding breastfeeding as a standard, our results imply that formula fed infants may be at risk for overfeeding, which might lead to overweight, even up to adolescent age.     

In memoriam: Maurice A. Bigelow

Abstract

Interracial children of white mothers and black fathers were compared to interracial children of black mothers and white fathers on growth rates during the first year of life. Results indicate that interracial children of white mothers gained less weight between birth and four months of age than did interracial children of black mothers or monoracial black or white children. By one year of age, catch‐up growth appears to have occurred, and there is little evidence for lasting effects of the growth retardation during the first four months of life.     

Birth defects interstate data exchange: a battle worth fighting?

BACKGROUND: Regardless of where infants and children are delivered, diagnosed, or treated, an important aspect of population-based birth defects surveillance is ensuring the inclusion of children with birth defects in the catchment area. However, little is known as to how the lack of interstate birth defects data exchange affects program surveillance, monitoring, prevention, and referral activities. The study objectives were to determine the status of interstate birth defects data exchange agreements and to quantify statewide data on resident births occurring in nonresident states. METHODS: In 2004, surveys were distributed to all population-based birth defects programs in the United States to determine: 1) the types of interstate birth defects data exchange agreements that exist among birth defects programs, 2) perceived barriers in establishing exchange agreements, and 3) the extent to which out-of-state births affect a program's catchment area. The National Center for Health Statistics (NCHS) data for 2002 on live birth residency were used to determine the actual frequency of out-of-state live birth occurrence. RESULTS: Of the 52 states and territories that were surveyed, 65% (n = 34) responded. Approximately 21% (n = 7) of those that responded had an interstate data exchange agreement that allowed sharing of birth defects data with another state or a facility within another state. Approximately 53% (n = 18) of responding states indicated plans to develop an interstate birth defects data exchange agreement with other states, hospitals, or both. The NCHS data showed that the actual percentage of resident out-of-state live births ranged from 0.16 to 11.51. NCHS data also reveal that 78% of states would be able to capture >75% of their out-of-state births by sharing data on out-of-state births with the three neighboring states ranking highest in terms of such occurrences. CONCLUSIONS: Few states have interstate birth defects data exchange agreements, though all states have resident births occurring out of state. While suggestive, data beyond residency of live births are needed to quantify the degree to which the objectives of state-based birth defects programs are compromised. Resources exist to guide programs in establishing interstate data exchange agreements. Efforts to establish such agreements with only a few neighboring states could be a large step toward improving birth defects surveillance on a state, regional, and national level.     

Longitudinal somatometrical study on the growth patterns of newborn Japanese monkeys

Growth of Japanese macaques during their first year was analyzed longitudinally, using body measurements. Measurements of 44 somatometrical characters were taken on seven animals. Work with the newborn data produced a formula which fits well. The formula is: y=a (x+b) ⁿ (y=size, x=age). At first, growth was analyzed, character by character, using birth sizes and incremental increases. The results show a major growth pattern for many characters: increments vary inversely with birth size. Application of the growth formula produced two further insights: (1) growth pattern is not so simple as imagined from the birth size-increment pattern; and (2) the characters which deviate from the birth size-increment pattern have large growth only at the earliest period (in few months), in spite of their small size. Sex differences were clear within the first year, especially for characters which differ greatly between adults.     

Birth interval, mortality and growth of children in a rural area in Kenya

The impact of the length of birth intervals on mortality and growth of children from the perinatal period to 2 years in the Northern Division of Machakos District, Eastern Province, Kenya, were analyzed. There are 2 types of birth intervals: 1) the prospective birth interval--between the birth concerned (the 1st birth of the interval pair) and the subsequent birth; and 2) the retrospective birth interval--between the birth considered (the 2nd of the interval pair) and the preceeding birth. This study includes 3019 women who had at least 1 live birth between April, 1974 and April, 1981. They gave birth to 6778 children (including stillbirths). Births occurring in 1974 are excluded in the analysis because of considerable underregistration. 102 stillbirths and 213 deaths in the 1st 2 years are analyzed. They have been grouped into deaths during the perimatal period; the 1st year after the 1st week of life (infant period); and the 2nd year of life. The most convient method of analysis of the relation between retrospective birth interval and mortality is multivariate analysis, as the intermedicate biological and behavioral factors through which birth intervals can affect health are simultaneously influenced by other variables like maternal age and birth order; the log linear model is applied here. The probability of dying is the dependent variable. The impact of short prospective intervals are closely associated. Only infant and child deaths occurring after the conception of the next child are included. The size of cohorts in which these deaths occur can be calculated with a life table approach. The mortality probability between 5 and 12 months for children with short prospective intervals is .034. This is higher than the corresponding rate for all children in the area (P0.05). It is shown that children with short retrospective or prospective birth intervals do not run a greater risk of mortality or growth retardation than children with longer intervals, neither during the perinatal period nor during the 1st 2 years of life.     

Length and weight in rural Guatemalan Ladino children: birth to seven years of age.

The present study reports 5,029 length and weight measurements as well as percentile distributions for a mixed longitudinal series of 1,119 rural Guatemalan Ladino children. The study sample, birth through seven years, is representative of children in clinically good health, but of suboptimal nutrition. Boys are longer and heavier than girls over the age range. Guatemalan children of both sexes are smaller than American white children from Denver. Differences are least at birth, and increase through two years of age. Between two and five years, differences between the rural Guatemalan Ladino and Denver samples are rather stable, but then increase through seven years. Despite these differences there is a linear weight for length relationship which is the same across all preschool ages, both sexes, and for both the Guatemalan and Denver populations. This implies that age, sex, ethnic differences between the two groups compared, and mild-to-moderate protein-calorie malnutrition do not affect the relationship between weight and length in preschool children.     

Determinants of intrauterine growth retardation: evidence against maternal depletion

This analysis examines the relationship between length of preceding birth interval and risk of intrauterine growth retardation using data on Swedish infants from the 1973 World Health Organization study of perinatal mortality. Results of a multivariate logit analysis demonstrate that the lower than average mean birth weight of infants born after short birth intervals cannot be completely attributed to their shorter mean gestation length. Infants born after birth intervals of 12 months or less are 30% more likely to be small for gestational age (SGA) than infants born 18-59 months after the previous birth, even when the effects of maternal age and parity are controlled. The results obtained here do not support maternal depletion as an explanation for the association between short birth intervals and elevated risk of SGA, since there is no evidence of an attenuation of the risk of SGA with increasing length of interval in the under 18 month birth interval range.     

Growth and development of the Kaiapit children of the Markham Valley, New Guinea

The growth and development of Markham Valley children was studied by examining over 800 children of known age, ranging from birth to maturity. Although growth in height and weight is slower than that of European children, it is faster than that so far recorded for some New Guinea populations. This is associated with the tallest adult stature reported to date for New Guinea and supports the previous finding that adult height in a New Guinea society is proportional to the growth rate of children in that society. Skin fold thickness values for age are lower than both New Guinea Highland and European children, despite reasonable availability of food. Menarche occurs at a mean age of 15.6 years, which is much earlier than some other New Guinea figures. Dental eruption times, in keeping with other New Guinea and African figures, are earlier than those of Europeans. Parent/child correlations for height and weight do not differ significantly from those obtained for European children, suggesting that environmental factors have a minimal effect in frustrating the fulfilment of genetic growth potential.