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Objective: To assess possible effect of high altitude on early childhood growth in Tibet., Method: A cross-sectional survey on child health and nutrition was conducted in Tibet with stratified multistage cluster random sampling technique. Height and weight status of Tibetan children <36 months of age was measured. A questionnaire was administered to mothers of children for information on family background, child feeding practice and health care and maternal care. A total of 1458 children with complete information were used for analysis. A logistic regression model was used to control for selected potential confounding factors and then observed altitude effect on growth of Tibetan children., Results: Positive association of stunting with altitude was observed for each age group, even after controlling for selected potential affecting factors. Children above 3500 m had two to six times risk of getting stunting compared with those at 3000 m when socioeconomic and other factors were controlled. Effect of altitude on underweight was observed only among children <24 months old and significant increase in odds ratio appeared only above 4000 m after controlling for those confounding factors. Indicator of wasting was not related to altitude., Conclusions: Altitude might result in a delay in height of younger Tibetan children, independent of socioeconomic and other factors operating through nutrition and disease, and took adverse effect persistently through birth to 3 years old. Its adverse effect on weight could be limited. For comparison and assessment of nutritional status of Tibetan children, the effect of altitude on growth should be taken into account.

Objective: Few published data are available on the feeding practice of younger children in Tibet. Our study investigated feeding pattern of younger Tibetan children., Design and Subjects: The study was a cross-sectional survey conducted in Tibet. A sample of 1655 children younger than 36 months old and their mothers was obtained by stratified multistage cluster random sampling method. Mothers were interviewed to collect information on feeding practice by a designed family questionnaire including initial time and duration of breastfeeding and time, frequency and types of complementary foods introduced., Results: Most of the children was ever or being breastfed at the time of interview. The median duration of breastfeeding was 26 months. The prevalence of almost exclusive breastfeeding for 4 months was 20.1%. Mothers' age and education, child's residence, and introduction of egg, fresh milk and milk powder were strongly associated with the duration of breastfeeding. The partial feeding was a main pattern in the first 6 months of life. Zanban and porridge were offered at about 1 month after birth. By 6th month, less than 25% of children were fed protein foods such as egg and meats and only near 20% of children were fed fresh vegetables. Bean products, fish and chicken were seldom offered to children., Conclusions: We conclude that although they were breastfed for long time, complementary feeding practice of Tibetan children was disadvantaged, especially of rural children. Improvement of monotonous complementary foods and timely introduction should be stressed in local programmatic nutritional interventions.

Background: The growth, development and nutrition of children in Tibet with high-altitude and unique traditional culture have recently gained attention. However, few researches are available on the nutritional status of younger children of Tibet., Objective: The objective of the study was to evaluate the nutritional status of children below 36 months old in Tibet by means of anthropometry., Design: The cross-sectional survey was conducted between August and September in 1999 and a sample of 1655 children below 36 months old was obtained using a stratified multistage cluster random sampling method from a total of seven districts of Tibet. Height, weight and hemoglobin concentration were measured and at the same time related sociodemographic and environmental information were collected. NCHS/CDC/WHO reference data were used to evaluate the nutritional status of the entire study children population and estimate the prevalence of stunting, underweight and wasting., Results: Compared with the reference of NCHS/CDC/WHO, the distributions of HAZ and WAZ shifted to the left significantly and the means of HAZ and WAZ were -1.53 and -1.05, respectively, which were significantly lower than the reference value. The distribution of WHZ, however, was close to that of the reference. The reduction of Z-scores for height and weight occurred very early in life and was greatest in the second year after birth. The prevalence of malnutrition of children was 39.0% for stunting, 23.7% for underweight and 5.6% for wasting, respectively. Rural children had prevalence of stunting of 41.4% and underweight of 24.7%, as compared with prevalence of stunting of 25.3% and underweight of 18.1% for urban children. Stunting and underweight were associated with altitudes. The mean of hemoglobin (Hb) of children was 120.4 g/l and rural children had a significantly lower Hb concentration (119.9 g/l) than urban children (123.3 g/l). The prevalence of anemia seemed higher when using different altitude corrections for Hb to estimate the prevalence, but the consequences were uneven., Conclusions: For Tibetan young children, the nutritional status of the entire population is poor and the prevalence of malnutrition is higher, especially for stunting. Malnutrition is related to high altitudes. Although the Hb concentration is higher induced by high altitude, there must be quite a lot of anemic children at high altitudes. The relationship between altitude and Hb for children on the Tibetan plateau requires further study in order to determine correctly the magnitude of anemia of children.