Irrigation improves weight‐for‐height z‐scores of children under five,and Women's and Household Dietary Diversity Scores in Ethiopia and Tanzania

Evidence on the potential for agricultural intensification to improve nutrition has grown considerably. While small‐scale irrigation is a key factor driving agricultural intensification in sub‐Saharan Africa, its impact on nutrition has not yet been thoroughly explored. In this study, we assess the impact of adoption of small‐scale irrigation in Ethiopia and Tanzania on household and women''s dietary diversity, as well as children''s nutrition. We use two rounds of primary data collected from irrigators and nonirrigators in Ethiopia and Tanzania. We used a panel fixed effects econometric approach to control for observed household, women and children specific characteristics as well as observed and unobserved time‐invariant confounding factors. The results show that among Ethiopian households who reported having faced drought, women in irrigating households have higher Women''s Dietary Diversity Score (WDDS) compared to women in nonirrigating households. In Tanzania, women in irrigating households have higher WDDS compared to nonirrigators and the impact of irrigation on WDDS more than doubles among households facing drought. In addition, among Tanzanian households who reported having faced a drought shock, irrigating households have higher Household Dietary Diversity Score compared to nonirrigators. Children in irrigating households in Ethiopia have weight‐for‐height z‐scores (WHZ) that are 0.87 SDs higher, on average, than WHZ of children in nonirrigating households. In Tanzania, irrigation leads to higher WHZ‐scores in children under‐five among households who reported having experienced a drought in the 5 years preceding the survey. The study shows small‐scale irrigation has a strong effect on households'' economic access to food and on nutritional outcomes of women and children.     

WHO Child Growth Standards based on length/height, weight and age

Aim: To describe the methods used to construct the WHO Child Growth Standards based on length/height, weight and age, and to present resulting growth charts. Methods: The WHO Child Growth Standards were derived from an international sample of healthy breastfed infants and young children raised in environments that do not constrain growth. Rigorous methods of data collection and standardized procedures across study sites yielded very high-quality data. The generation of the standards followed methodical, state-of-the-art statistical methodologies. The Box-Cox power exponential (BCPE) method, with curve smoothing by cubic splines, was used to construct the curves. The BCPE accommodates various kinds of distributions, from normal to skewed or kurtotic, as necessary. A set of diagnostic tools was used to detect possible biases in estimated percentiles or z-score curves. Results: There was wide variability in the degrees of freedom required for the cubic splines to achieve the best model. Except for length/height-for-age, which followed a normal distribution, all other standards needed to model skewness but not kurtosis. Length-for-age and height-for-age standards were constructed by fitting a unique model that reflected the 0.7-cm average difference between these two measurements. The concordance between smoothed percentile curves and empirical percentiles was excellent and free of bias. Percentiles and z-score curves for boys and girls aged 0–60 mo were generated for weight-for-age, length/height-for-age, weight-for-length/height (45 to 110 cm and 65 to 120 cm, respectively) and body mass index-for-age.
Conclusion: The WHO Child Growth Standards depict normal growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socio-economic status and type of feeding.     

Optimal birth weight percentile cut‐offs in defining small‐ or large‐for‐gestational‐age

Aims: It remains questionable what birth weight for gestational age percentile cut‐offs should be used in defining clinically important poor or excessive foetal growth. We aimed to evaluate the optimal birth weight percentile cut‐offs for defining small‐ or large‐for‐gestational‐age (SGA or LGA). Methods: In a birth cohort‐based analysis of 17 979 120 non‐malformation singleton live births, U.S. 1995–2001, we assessed the optimal birth weight percentile cut‐offs for defining SGA and LGA. The 25th–75th percentile group served as the reference. Primary outcomes are the risk ratios (RR) of neonatal death and low 5‐min Apgar score (<4) comparing SGA or LGA versus the reference group. More than 2‐fold risk elevations were considered clinically significant. Results: The 15th birth weight cut‐off already identified SGA infants at more than 2‐fold risk of neonatal death at pre‐term, term or post‐term, except for extremely pre‐term births <28 weeks (continuous risk reductions over increasing birth weight percentiles). LGA was associated with a reduced risk of low 5‐min Apgar score at pre‐term, but an elevated risk at term and post‐term. The 97th cut‐off identified LGA infants at 2‐fold risk of low 5‐min Apgar at term. Conclusion: The commonly used 10th and 90th birth weight percentile cut‐offs for defining SGA and LGA respectively seem largely arbitrary. The 15th and 97th percentiles may be the optimal cut‐offs to define SGA and LGA respectively.     

Relationship between height, sitting height and subisehial leg length in Dutch children: presentation of normal values

A widely used method of judging body proportions is to consider the ratio of sitting height to height (SH/H) related to age. A drawback of this method is that only one derived variable is used. A pairwise consideration of the original measurements provides more information. In this study data from the cross–sectional Oosterwolde I growth study are used to present normal values for the ratio SH/H for age, as well as values for sitting height related to height and subisehial leg length. A comparison is made with other studies.     

Diurnal variation of height in children

BACKGROUND: Diurnal variation of height is largely ignored in the assessment of growth in children. Diurnal decrease in stature may effect the reliability of height measurement. In this study, the degree of differences in daily height measurement were evaluated. METHODS: A total of 478 children, aged 3-15 years (mean age 9.9 +/- 2.3 years) were enrolled in the study. The height of children were measured twice in a day. The first measurements were taken between 09:00 and 10:00 h and the second measurements between 15:00 and 16:00 h. RESULTS: Children's height measurements differences were +1.8 to -2.7 cm, and a mean of 0.47 +/- 0.05 cm decrease was determined. CONCLUSIONS: Little differences of height measurement could be very important in evaluating the short child. When the result of height measurement is recorded, recording the time of day is offered.     

Seasonality in lower leg length velocity in prepubertal children

Despite low measuring error, annual growth is poorly predicted by short-term measurements of the lower leg. In order to study if this low correlation can be explained by seasonal changes in lower leg length (LLL) velocity, we followed short-term growth longitudinally in 50 prepubertal children with normal height and growth velocities. Height measurements were performed at 4-week intervals and LLL measurements at 1–2-week intervals. Analysis of annual growth showed seasonality in the monthly mean height velocity values: 5.06 (SD 5.02) cm/year during the autumn and 8.15 (SD 5.22) cm/year in the spring. Similarly, the monthly mean LLL velocity values changed from 1.80 (SD 1.07) cm/year in the autumn to 2.63 (SD 0.92) cm/year in the spring. The correlation between monthly LLL and annual height velocity was low (r = 0.27). The technical error of the LLL measurement was 7–8% of the mean monthly LLL velocity, while the mean values changed by 31 % over the seasons. The annual height velocity was virtually independent of the variation in growth rate over the seasons. It is concluded that there is significant seasonality both in height and LLL velocity and that it takes place at the same time for both measures. Seasonality in LLL has not been reported previously and must be considered when studying short-term growth, for example when LLL is used for prediction of annual height velocity or when a short-term treatment effect is examined using LLL.     

中国七岁以下儿童体重、身长/身高和头围的生长标准值及标准化生长曲线

目的 制定中国7岁以下儿童体重、身长/身高和头围的生长标准值及标准化生长曲线.方法 选择"2005年九市7岁以下儿童体格发育调查"中城区儿童为参照人群,采用0～7岁69 760名健康男女儿童的体重、身高(3岁以下为身长)和头围的实际测量值建立数据库.测量数据用标准化的测量方法和质量控制程序获得.采用LMS方法对原始数据进行拟合修匀,通过L、M、S 3个参数计算产生所需要的百分位和标准差单位数值并绘制相应的曲线图.曲线的拟合效果评估采用拟合优度χ2检验.结果 制定出了中国7岁以下男、女童按每月龄的年龄的体重、年龄的身长/身高和年龄的头围第3、10、25、50、75、90及97百分位及-3、-2、-1、0、+1、+2、+3倍标准差单位的生长标准图表(数值表和曲线图).此标准略高于世界卫生组织(WHO)新的5岁以下儿童生长标准.结论 该套生长标准代表了中国营养良好儿童的生长水平,样本量大、具有国家代表性,测量数据精确,研究方法与国际接轨,可作为21世纪中国儿童的生长参照标准在全国范围推广使用.     

Factors associated with dietary diversity and length‐for‐age z‐score in rural Ethiopian children aged 6–23 months: A novel approach to the analysis of baseline data from the Sustainable Undernutrition Reduction in Ethiopia evaluation

Infants and young children need diets high in nutrient density and diversity to meet the requirements of rapid growth and development. Our aim was to evaluate sociodemographic, agricultural diversity, and women's empowerment factors associated with child dietary diversity and length‐for‐age z‐score (LAZ) in children 6–23 months using data collected as part of the Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study baseline survey in May–June 2016. We here present a novel analysis using directed acyclic graphs (DAGs) to represent our assumptions about the causal influences between the factors of interest and the outcomes. The causal diagrams enabled the identification of variables to be included in multivariable analysis to estimate the total effects of factors of interest using ordinal logistic/linear regression models. We found that child dietary diversity was positively associated with LAZ with children consuming 4 or more food groups having on average an LAZ score 0.42 (95% CI [0.08, 0.77]) higher than those consuming no complementary foods. Household production of fruits and vegetables was associated with both increased child dietary diversity (adjusted OR 1.16; 95% CI [1.09, 1.24]) and LAZ (adjusted mean difference 0.05; 95% CI [0.005, 0.10]). Other factors positively associated with child dietary diversity included age in months, socio‐economic status, maternal education, women's empowerment and dietary diversity, paternal childcare support, household food security, fruit and vegetable cultivation, and land ownership. LAZ was positively associated with age, socio‐economic status, maternal education, fruit and vegetable production, and land ownership.     

A case–control study to examine the association between breastfeeding during late pregnancy and risk of a small‐for‐gestational‐age birth in Lima,Peru

Excessive demands on maternal nutritional status may be a risk factor for poor birth outcomes. This study examined the association between breastfeeding during late pregnancy (≥28 weeks) and the risk of having a small‐for‐gestational‐age (SGA) newborn, using a matched case–control design (78 SGA cases: birthweight <10th percentile for gestational age; 150 non‐SGA controls: 50th percentile <birthweight <90th percentile for gestational age). Between March 2006 and April 2007, project midwives visited daily three government hospitals in Lima, Peru and identified cases and matched controls based on hospital, gestational age, and inter‐gestational period. Mothers were interviewed and clinical chart extractions were completed. Factors associated with risk of SGA were assessed by their adjusted odds ratios (aOR) from conditional logistic regression. Exposure to an overlap of breastfeeding during late pregnancy was not associated with an increased risk of having a SGA newborn [aOR = 0.58, 95% confidence interval (CI): 0.10–3.30]. However, increased risk was associated with having a previous low‐birthweight birth (aOR = 6.53; 95% CI: 1.43–29.70) and a low intake of animal source foods (<25th percentile; aOR = 2.26; 95% CI: 1.01–5.04), and tended to be associated with being short (<150 cm; aOR = 2.05; 95% CI: 0.92–4.54). This study found no evidence to support the hypothesis that breastfeeding during late pregnancy increases the risk for SGA; however, studies with greater statistical power are needed to definitively examine this possible association and clarify whether there are other risks to the new baby, the toddler and the pregnant woman.     

Maternal selenium,copper and zinc concentrations in pregnancy associated with small‐for‐gestational‐age infants

Pregnancy during adolescence increases the risk of adverse pregnancy outcome, especially small‐for‐gestational‐age (SGA) birth, which has been linked to micronutrient deficiencies. Smoking has been shown to be related to lower micronutrient concentrations. Different ethnicities have not been examined. We used a subset from a prospective observational study, the About Teenage Eating study consisting of 126 pregnant adolescents (14–18‐year‐olds) between 28 and 32 weeks gestation. Micronutrient status was assessed by inductively coupled mass spectrometry. Smoking was assessed by self‐report and plasma cotinine, and SGA was defined as infants born <10th corrected birthweight centile. The main outcome measures were as follows: (1) maternal plasma selenium, copper and zinc concentrations in adolescent mothers giving birth to SGA vs. appropriate‐for‐gestational‐age (AGA) infants; and (2) comparison of micronutrient concentrations between women of different ethnicities and smoking habits. The plasma selenium {mean ± standard deviation (SD) [95% confidence interval (CI)]} concentration was lower in the SGA [n = 19: 49.4 ± 7.3 (CI: 45.9, 52.9) µg L^?1] compared with the AGA [n = 107: 65.1 ± 12.5 (CI: 62.7, 67.5) µg L^?1; P < 0.0001] group. Smoking mothers had a lower selenium concentration compared with non‐smokers (P = 0.01) and Afro‐Caribbean women had higher selenium concentrations compared with White Europeans (P = 0.02). Neither copper nor zinc concentrations varied between groups. Low plasma selenium concentration in adolescent mothers could contribute to the risk of delivering an SGA infant, possibly through lowering placental antioxidant defence, thus directly affecting fetal growth. Differences in plasma selenium between ethnicities may relate to variation in nutritional intake, requiring further investigation.     

Clinical comparison of weight‐ and age‐based strategy of dose administration in children receiving intravenous busulfan for hematopoietic stem cell transplantation

Bu, combined with TDM‐guided dosing, is associated with fewer graft failures/relapses and lower toxicity in pediatric HSCT. We aimed this retrospective study for comparison of weight‐ and age‐based dosing in terms of clinical outcomes such as time to engraftment, early complications, EFS, OS, and toxicity profiles in children receiving iv Bu. Sixty‐one children who underwent HSCT from April 2010 to February 2013 by means of a Bu‐based conditioning regimen and completed 100 days after transplantation at Ankara Children?s Hematology and Oncology Hospital Bone Marrow Transplantation Unit were enrolled in this study. SOS and neutropenic fever occurred more frequently in the weight‐based dosing group. We found a statistically significant correlation between Bu dose and the incidence of SOS (r = 0.26, p = 0.04). Multivariate analysis showed only weight‐based dosing of Bu was a significant predictor of SOS (HR = 9.46; p = 0.009). However, no relationship was found between two groups in terms of hemorrhagic cystitis, engraftment syndrome, acute or chronic GvHD, time to engraftment, chimerism, TRM, OS, and EFS rates. Weight‐based dosing of Bu may cause higher incidence of SOS and early infectious complications at the places where TDM of Bu cannot be performed.     

The validity and reliability of the Dietary Index for a Child's Eating in 2–8‐year old children living in New Zealand

This study aimed to examine the validity and reliability of the Dietary Index for a Child's Eating (DICE) in children living in New Zealand (NZ). Caregivers of healthy children aged 2–8 years completed a 4‐day estimated food record (4DFR) for their child and completed the DICE online on two separate occasions, 8 weeks apart. Relative validity was assessed by comparing the DICE and 4DFR total score and component subscores using the Wilcoxon test, Spearman rank correlation coefficients, cross‐classification, and weighted kappa (?) statistic. For evaluating construct validity, the DICE total score was compared with energy and nutrient intake from the 4DFR using linear contrast analysis. Intraclass correlation coefficients (Cronbach's α) and Bland–Altman plots were used to assess the reliability of DICE. From a possible score of 100, the mean ± standard deviation of DICE was 78.2 ± 11.5 and from the 4DFR, was 73.8 ± 10.8, with a positive correlation (r = 0.72; p < 0.001) and moderate agreement (? = 0.49). Cross‐classification showed 61.9% were correctly categorised into the same tertile group from DICE and the 4DFR. Participants in the highest tertile of DICE had higher intakes of fibre, vitamin C, vitamin A, vitamin D, folate, and calcium. Good agreement (α = 0.87) was found for reliability. DICE is a valid and reliable tool for the assessment of children's adherence to a healthy diet, as recommended by the NZ Ministry of Health Food and Nutrition guidelines.     

Weight, height and weight for height in 6–7-year-old children I. Relationship with demographic variables

Relationships between weight, height and weight for height at 6–7 years of age and a number of demographic variables have been studied in data from Infant Welfare Centre and school medical records. In both boys and girls height and weight were significantly related to birthweight. After allowing for birthweight and age no significant relationships were found in either boys or girls between height and any of the demographic variables. However, body mass index differed significantly according to birth order, the number of children in the family and the parents country of birth. No associations were observed between anthropometric measures at 6–7 years and paternal occupational status, maternal age and the number of younger siblings. Comparison of the study group with reference values from America and Australia provided no support for the view that one of these reference standards is more appropriate than the other for assessment of growth in Australian children.