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Objective 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. Methods 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. Findings 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.sup.2] to 0.1 kg/[m.sup.2]. At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/[m.sup.2] for boys and 25.0 kg/[m.sup.2] for girls. These values are equivalent to the overweight cut-off for adults ([greater than or equal to] 25.0 kg/[m.sup.2]). Similarly, the +2 SD value (29.7 kg/[m.sup.2] for both sexes) compares closely with the cut-off for obesity ([greater than or equal to] 30.0 kg/[m.sup.2]). Conclusion 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. Objectif Construire des courbes de croissance pour les enfants d'age scolaire et les adolescents concordant avec la Norme OMS de croissance de l'enfant pour les enfants d'age prescolaire et avec les points de coupure pour l'indice de masse corporelle (IMC) s'appliquant aux adultes. Methodes Les donnees de reference NCHS/OMS pour la croissance (de 1 a 24 ans) de 1977 ont ete regroupees avec celles de l'echantillon transversal d'enfants de moins de 5 ans (18 a 71 mois) utilise pour la norme de croissance de maniere a lisser la transition entre les deux echantillons. Les methodes statistiques correspondant a l'etat de la technique [methode Box-Cox-power-exponential (BCPE), completee par des outils permettant de selectionner les meilleurs modeles], ayant servi a construire la norme OMS de croissance de l'enfant (0 a 5 ans), ont ete appliquees a cet echantillon combine. Resultats La fusion des jeux de donnees a permis d'obtenir une transition plus douce au niveau de 5 ans pour les courbes de taille, de poids et d'IMC en fonction de l'age. S'agissant de l'IMC en fonction de l'age, sur l'ensemble des centiles, l'ampleur de la difference entre les deux courbes a l'age de 5 ans se situe principalement entre 0,0 kg/[m.sup.2] et 0,1 kg/[m.sup.2]. A 19 ans, les nouvelles valeurs d'IMC correspondant a un ecart type de +1 sont de 25,4 kg/[m.sup.2] pour les garcons et de 25,0 kg/[m.sup.2] pour les filles. Ces valeurs concordent avec le point de coupure pour l'exces ponderal chez l'adulte ([superieur ou egal a] 25,0 kg/[m.sup.2]). De meme, les valeurs correspondant a plus de 2 ecarts types (29,7 kg/[m.sup.2] pour les deux sexes) sont tres proches du point de coupure pour l'obesite ([superieur ou egal a] 30,0 kg/[m.sup.2]). Conclusion Les nouvelles courbes coincident etroitement a 5 ans avec la norme OMS de croissance de l'enfant et a 19 ans avec les points de coupure recommandes chez l'adulte pour l'exces ponderal et l'obesite. Elles comblent les lacunes en matiere de courbes de croissance et fournissent une reference appropriee pour la tranche d'ages 5-19 ans. Objetivo Elaborar curvas de crecimiento para escolares y adolescentes que concuerden con los Patrones de Crecimiento Infantil de la OMS para preescolares y los valores de corte del indice de masa corporal (IMC) para adultos. Metodos Se fusionaron los datos del patron internacional de crecimiento del National Center for Health Statistics/OMS de 1977 (1-24 anos) con los datos de la muestra transversal de los patrones de crecimiento para menores de 5 anos (18-71 meses), con el fin de suavizar la transicion entre ambas muestras. A esta muestra combinada se le aplicaron los metodos estadisticos de vanguardia utilizados en la elaboracion de los Patrones de Crecimiento Infantil de la OMS (0-5 anos), es decir, la transformacion de potencia de Box-Cox exponencial, junto con instrumentos diagnosticos apropiados para seleccionar los mejores modelos. Resultados La fusion de los dos conjuntos de datos proporciono una transicion suave de la talla para la edad, el peso para la edad y el IMC para la edad a los 5 anos. Con respecto al IMC para la edad, la magnitud de la diferencia entre ambas curvas a los 5 anos fue generalmente de 0,0 kg/[m.sup.2] a 0,1 kg/[m.sup.2] en todos los centiles. A los 19 anos, los nuevos valores del IMC para +1 desviacion estandar (DE) fueron de 25,4 kg/[m.sup.2] para el sexo masculino y de 25,0 kg/[m.sup.2] para el sexo femenino, es decir, equivalentes al valor de corte del sobrepeso en adultos ([mayor que o igual a] 25,0 kg/[m.sup.2]). A su vez, el valor correspondiente a +2 DE (29,7 kg/[m.sup.2] en ambos sexos) fue muy similar al valor de corte de la obesidad ([mayor que o igual a] 30,0 kg/[m.sup.2]). Conclusion Las nuevas curvas se ajustan bien a los Patrones de Crecimiento Infantil de la OMS a los 5 anos y a los valores de corte del sobrepeso y de la obesidad recomendados para los adultos a los 19 anos, colman la laguna existente en las curvas de crecimiento y constituyen una referencia apropiada para el grupo de 5 a 19 anos de edad., Introduction The need to develop an appropriate single growth reference for the screening, surveillance and monitoring of school-aged children and adolescents has been stirred by two contemporary events: the increasing [...]

In April 2006 the WHO released a set of growth standards for children from birth to the age of 5 y. Prior to their release, the standards were field-tested in 4 countries. The main objective was to compare children's length/height-for-age and weight-for-length/height based on the new standards with clinician assessments of the same children. The study sampled children

The evaluation of child growth trajectories and the interventions designed to improve child health are highly dependent on the growth charts used. The U.S. CDC and the WHO, in May 2000 and April 2006, respectively, released new growth charts to replace the 1977 NCHS reference. The WHO charts are based for the first time on a prescriptive, prospective, international sample of infants selected to represent optimum growth. This article compares the WHO and CDC curves and evaluates the growth performance of healthy breast-fed infants according to both. As expected, there are important differences between the WHO and CDC charts that vary by age group, growth indicator, and specific Z-score curve. Differences are particularly important during infancy, which is likely due to differences in study design and characteristics of the sample, such as type of feeding. Overall, the CDC charts reflect a heavier, and somewhat shorter, sample than the WHO sample. This results in lower rates of undernutrition (except during the first 6 mo of life) and higher rates of overweight and obesity when based on the WHO standards. Healthy breast-fed infants track along the WHO standard's weight-for-age mean Z-score while appearing to falter on the CDC chart from 2 mo onwards. Shorter measurement intervals in the WHO standards result in a better tool for monitoring the rapid and changing rate of growth in early infancy. Their adoption would have important implications for the assessment of lactation performance and the adequacy of infant feeding and would bring coherence between the tools used to assess growth and U.S. national guidelines that recommend breast-feeding as the optimal source of nutrition during infancy.

The development of an international growth standard for the screening, surveillance, and monitoring of school-aged children and adolescents has been motivated by 2 contemporaneous events, the global surge in childhood obesity and the release of a new international growth standard for infants and preschool children by the WHO. If a prescriptive approach analogous to that taken by WHO for younger children is to be adopted for school-aged children and adolescents, several issues need to be addressed regarding the universality of growth potential across populations and the definition of optimal growth in children and adolescents. A working group of experts in growth and development and representatives from international organizations concluded that subpopulations exhibit similar patterns of growth when exposed to similar external conditioners of growth. However, based on available data, we cannot rule out that observed differences in linear growth across ethnic groups reflect true differences in genetic potential rather than environmental influences. Therefore, the sampling frame for the development of an international growth standard for children and adolescents must include multiethnic sampling strategies designed to capture the variation in human growth patterns. A single international growth standard for school-aged children and adolescents could be developed with careful consideration of the population and individual selection criteria, study design, sample size, measurements, and statistical modeling of primary growth and secondary ancillary data. The working group agreed that existing growth references for school-aged children and adolescents have shortcomings, particularly for assessing obesity, and that appropriate growth standards for these age groups should be developed for clinical and public health applications.

Stunting represents growth failure resulting from poor nutrition and health during the pre- and postnatal periods. Initiatives since 1980 have steadily reduced malnutrition and consequent retardation of child growth, but 1 of 3 preschool children worldwide remains stunted. Countries have varied substantially in progress achieved in reducing stunting. This study aimed to understand which underlying (i.e., proximal) and basic (i.e., distal) national factors have been most important in explaining this variation among countries, and the relation between the 2 sets of factors. Eighty-five developing countries with at least 2 surveys for stunting >4 y apart were included from the WHO Global Database on Child Growth. The analytic data set with independent variables from several sources was constructed to match closely by year for each country to initial and final stunting data. Full-information maximum likelihood estimated multiple linear regression models while accounting for missing data in independent variables. The final model explained 65.5% of the variance of change in stunting, and included both underlying and basic variables: initial and change in immunization rate, initial and change in safe water rate, initial female literacy rate, initial government consumption, initial income distribution, and the initial proportion of the economy devoted to agriculture. Although factors that were important for reducing stunting in the past may not necessarily be the ones that are important in the future, these results suggest that it possible for substantial progress to be made in reducing the current high prevalence of stunting by investing in both long-term development and in specific interventions. KEY WORDS: * stunting * malnutrition * growth * development

This paper reviews the efficacy of nutrition interventions to prevent or treat impaired fetal growth. Searches were made for Cochrane systematic reviews and randomized controlled trials published before October 2002. Balanced protein energy supplementation reduced the risk of small for gestational age (SGA) by 30% (95%Cl: 20% to 43%) while one trial conducted in New York, U.S., reported a negative effect of high protein supplementation on SGA (RR 1.58; 95%Cl: 1.03-2.41). Calcium supplementation protected against low birth weight (RR 0.83; 95%Cl: 0.71-0.98). Micronutrient supplements did not affect birth weight, except for magnesium supplementation, which reduced the risk of SGA by 30%. This finding, however, needs or be interpreted with caution because of methodological issues in the data analysis. Programmatic recommendations can be made only for intervening with balanced protein energy supplements, especially in population with a high prevalence of undernutrition. Research is needed to determine the efficacy of multiple micronutrient supplementation and the effect of single micronutrients supplementation on specific growth outcomes such as fetal organ and bone growth. In addition, the public health relevance of these outcomes and their relation to morbidity need to be evaluated. KEY WORDS: * nutritional interventions * fetal growth * birth weight * small for gestational age * randomized controlled trials

Objective To understand how social context affects the nutritional status of populations, as reflected by the prevalence of wasting in children under 5 years of age from Africa, Latin America, and Asia; to present a systematic way of building models for wasting prevalence, using a conceptual framework for the determinants of malnutrition; and to examine the feasibility of using readily available data collected over time to build models of wasting prevalence in populations. Methods Associations between prevalence of wasting and environmental variables were examined in the three regions. General linear mixed models were fitted using anthropometric survey data for countries within each region. Findings Low birth weight (LBW), measles incidence, and access to a safe water supply explained 64% of wasting variability in Asia. in Latin America, LBW and survey year explained 38%; in Africa, LBW, survey year, and adult literacy explained 7%. Conclusion LBW emerged as a predictor of wasting prevalence in all three regions. Actions regarding women's rights may have an effect on the nutritional status of children since LBW seems to reflect several aspects of the conditions of women in society. Databases have to be made compatible with each other to facilitate integrated analysis for nutritional research and policy decision-making. In addition, the validity of the variables representing the conceptual framework should be improved. Keywords Nutritional status; Body height; Weight loss; Infant, Low birth weight; Child; Risk factors; Nutrition surveys; Models, Statistical; Developing countries; Asia; Africa; Latin America (source; MeSH, NLM). Mots cles Etat nutritionnel; Taille corporelle; Perte poids; Nourrisson faible poids naissance; Enfant; Facteur risque; Enquete nutritionnelle; Modele statistique; Pays en developpement; Asie; Afrique; Amerique latine (source: MESH, INSERM). Palabras clave Estado nutricional; Estatura; Perdida de peso; Recien nacido de bajo peso; Nino; Factores de riesgo; Encuestas nutricionales; Modelos estadisticos; Paises en desarrollo; Asia; Africa; America Latina (fuente: DeCS, BIREME)., Introduction Malnutrition is a serious global issue. Each year, some 24 million babies are born too small to lead healthy lives because their mothers were either ill or malnourished (1, [...]

Objective A cross-sectional survey was conducted in order to determine whether an affluent population in south Delhi had a growth performance similar to that in developed countries and to identify socioeconomic factors that militated against optimal growth in this group. Methods The weights and lengths of 395 children aged 12-23 months and the heights of 331 mothers and 153 grandmothers were measured and information was obtained on family socioeconomic status and child-feeding practices. Children born prematurely, i.e. before 37 weeks of gestation, and those with illness adversely affecting growth, were excluded from the analysis, as with the NCHS/ WHO reference population. Results In 341 children included in the analysis, the mean Z-scores for weight-for-age, length-for-age and weight-for-length were -0.45, -0.28 and -0.32 respectively. About 6% of the children were underweight (weight-for-age Z-score [less than or equal to] -2), 3% were stunted (length-for-age Z-score [less than or equal to] -2), and 4% were wasted (weight-for-length Z-score [less than or equal to] -2). The factors that were significantly associated with higher length-for-age were one or both parents having 17 years or more of education (mean length-for-age Z-score -0.17) and non-vegetarian diet (mean length-for-age Z-score -0.18). No socioeconomic factors were associated with mean weight-for-length. Conclusion The children in this affluent population were close to the NCHS/WHO reference population with regard to anthropometric indicators. The subpopulation with higher parental education had even better growth. It is intended to include this subpopulation in the WHO Multicentre Growth Reference Study. Keywords Growth; Body weight; Body height; Socioeconomic factors; Breast feeding; Cross-sectional studies (source.' MESH, NLM). Mots cles Croissance; Poids corporel; Taille corporelle; Facteur socio-economique; Allaitement au sein; Etude section efficace (source: MESH,/NSERA/I). Palabras clave Crecimiento; Peso corporal; Estatura; Factores socioeconomicos; Lactancia materna; Estudios transversales (fuente: DeCS, BIREME)., Introduction There is evidence that growth patterns of well-fed healthy preschool children from diverse ethnic backgrounds are similar (1-3). Some variability exists between affluent populations in different countries but they [...]

We estimated the variability among nations in the prevalence of stunting and wasting, evaluated which national factors are associated with stunting and wasting and examined the relationship of stunting with wasting. The World Health Organization Global Database on Child Growth, a comprehensive conceptual model and a database of national factors were used with variance components and regression analyses. There was substantial variability among nations and among provinces within nations. Most national variability for stunting (76%) and wasting (66%) was explained by national factors and geographic region. Higher energy availability, female literacy and gross product were the most important factors associated with lower prevalence of stunting. The association of health expenditures and stunting differed by region. Higher immunization rate and, for Asia only, energy availability were the most important factors associated with lower prevalence of wasting. Regional differences in the relationship between stunting and wasting were accounted for by national factors. Some factors associated with stunting and wasting differ at the national level. Child malnutrition within a household is greatly influenced by issues at national and provincial levels, and intervention should be considered at all three levels. KEY WORDS: stunting wasting malnutrition humans children