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Comparison of anthropometric measures of nutritional status in preschool children in five developing countries
Insights
Nutritional status in children aged 1-5 years was assessed using weight, height, and arm circumference. Weight-for-age deficits often masked normal weight-for-height, indicating height limitations impact malnutrition diagnoses.
Area of Science:
- Pediatrics
- Nutrition Science
- Anthropometry
Background:
- Childhood malnutrition remains a significant global health concern, particularly in developing nations.
- Accurate assessment of nutritional status is crucial for timely intervention and effective public health strategies.
- Existing anthropometric indices may present limitations in accurately diagnosing malnutrition across different age groups.
Purpose of the Study:
- To evaluate the agreement between different anthropometric measures for assessing nutritional status in children aged 1-5 years.
- To compare the diagnostic accuracy of weight-for-age, height-for-age, weight-for-height, and arm circumference indices.
- To identify optimal cut-off points for these indices in identifying malnourished children.
Main Methods:
- A cross-sectional study involving 7304 children aged 1-5 years from diverse international settings (Columbia, Costa Rica, Dominican Republic, India, Pakistan).
- Measurements included weight, height, and mid-upper arm circumference.
- Application of previously validated anthropometric indices and comparison of diagnostic agreement.
Main Results:
- Weight-for-age and height-for-age deficits increased with age, while weight-for-height deficits decreased.
- Many children classified as mildly malnourished by weight-for-age had normal weight-for-height, suggesting height deficits contributed to the former diagnosis.
- High correlations were observed between weight and height, and between weight-for-age and height-for-age.
- A weight-for-height cut-off of 90% of standard showed good agreement with a weight-for-age cut-off of 75% of standard for malnutrition diagnosis.
- An arm circumference cut-off of 13.5 cm effectively identified children with severe or acute malnutrition.
Conclusions:
- Weight-for-age may overestimate malnutrition in children with stunting; weight-for-height provides a more accurate assessment of acute malnutrition.
- Mid-upper arm circumference is a sensitive indicator for identifying severe or acute childhood malnutrition.
- Combined use or careful selection of anthropometric indices is recommended for comprehensive nutritional status assessment in young children.
Abstract:
Weight, height, and arm circumference were measured in 7304 children 1 to 5 years old in Columbia, Costa Rica, the Dominican Republic, India, and Pakistan. Previously developed indices using these measures were applied to assess nutritional status, and the agreement between measures was compared. Weight for age and height for age deficits increased with age while weight for height deficits diminished. Many children diagnosed as mildly malnourished by weight for age were found to have normal weights for their actual heights. Deviations from weight for age norms were frequently due to height limitations. Highest positive correlation was found between weight and height, and between weight for age and height for age. Good agreement in malnutrition diagnoses was found between a weight for height limit of 90% of standard and a weight for age limit of 75% of standard. A cut-off point of 80% of standard weight for height was too low to detect most malnourished children. An age-constant arm circumference limit of 13.5 cm identified nearly all children with severe or acute malnutrition by weight for age or weight for height.