Background: Under nutrition and overweight typically occur during nutritional transition periods in developing countries including Egypt. Short stature and anemia are public health concern due to its strong link with malnutrition which is a preventable risk factor. Objectives: to estimate the prevalence of overweight, obesity, underweight and short stature and its concurrence with anemia, also to determine the etiological profile of short stature among primary school children in Egypt. Methods: A cross-sectional study was carried out on 33,150 Egyptian children aged 6-11 years old from January 2018 to January 2020, allocated in 59 primary schools from diverse geographical districts in Egypt. Complete anthropometric measurements were conducted and applied according to WHO growth charts. Hemoglobin level was measured. Systematic approach to detect the etiology of short stature was applied randomly to a sample of 380 stunted children. Results: The prevalence of underweight was 8.2%, while obesity and overweight represented 21.8% (9.6 and 12.2% respectively). Overall short stature constituted 17%. The main etiologies of short stature were familial (40.8%) and constitutional (24.2%). Anemia was diagnosed in 26% of children; while concurrent anemia and stunting was reported in 9.9%. Regarding anemia and anemia with stunting were more common among girls (30.0% (OR = 1.50, CI95%: 1.43-1.58) and 11.4% (OR = 1.39, CI95%:1.29-1.49) respectively), who were living in rural areas (33.4% (OR = 1.96, CI 95%:1.87-2.06) &12.7% (OR = 1.72, CI 95%:1.60-1.85)) and those who had low socioeconomic status)34.6% (OR = 2.54, CI 95%:2.29-2.82) & 17.2% (OR = 3.32, CI 95%:2.85-3.88() respectively. Anemia with stunting was significantly higher among children aged ≥9 years old representing 12% (OR = 1.40, CI 95%:1.30-1.51).

ObjectiveTo define nomograms for blood pressure in Egyptian children and adolescents.Methods and study designA total of 60 025 Egyptian children from birth to 19 years were enrolled in this cross-sectional randomised study from December 2015 to March 2017. They were selected from diverse geographical districts in Egypt. Healthy children who fulfilled the inclusion criteria, which included good nutritional history, absence of fever or documented underlying disease at the time of examination, no evidence of haemodynamically significant illness, and no antihypertensive drugs or other chronic drug administration, were included in the study. Body weight, recumbent length (for less than 24 months) and height (from 2 years to 19 years), and blood pressure were measured using standard mercury sphygmomanometers.ResultsBlood pressure increases with age in both boys and girls. The 90th percentile of systolic and diastolic blood pressure among Egyptian children was different from other ethnic populations (American and Turkish children) in both sexes. Systolic and diastolic blood pressure showed a positive correlation with weight and height in both sexes (p<0.001).ConclusionWe assumed that normal blood pressure curves should be used cautiously during childhood, and it is recommended that every population have its own normal standard curve to define measured blood pressure levels in children. These centiles increased our knowledge and awareness of normal blood pressure among Egyptian children and adolescents. The percentiles will distinguish children and young adolescents with increased blood pressure and will be of value to both medical practice and scientific research.

Background: The Lambda-Mu-Sigma (LMS) and Z score methods are important for assessment of growth and nutritional status. In Egypt, there is a lack of this tool for monitoring growth in preschool children.Objective: To develop LMS and Z score growth references for assessment of growth and nutritional status for Egyptian children from birth up to 5 years.Methods: A total of 27,537 children [13,888 boys (50.4%) and 13,649 girls (49.6%)] from birth up to 5 years were included in a multistage cross sectional randomized study from different Egyptian geographic districts to create LMS and Z score references for weight, length/height, and body mass index corresponding to age in addition to weight for length/height. Healthy term infants and children, exclusive breast feeding for at least 4 months and not suffering from any chronic diseases were included in this study. Children with dysmorphic features, preterm infants, admitted in neonatal or pediatric intensive care units and having any chronic diseases (hematological, cardiac, hepatic, and renal) were excluded. In addition any health condition that affects child growth including nutritional disorders was also excluded. Un-paired t-test was calculated to compare the means of weight for age, length/height for age, weight for length/height, and BMI for-age z scores of the Egyptian and WHO reference values.Results: Through detailed tables and graphs, LMS and Z scores for weight for age, length/height for age, weight for length/height, and BMI for age of both sexes were represented. Our findings showed no statistically significant difference between reference charts of WHO and Egyptian Z score charts (P &gt; 0.05).Conclusion: This study provides the first reference for Egyptian children from birth up to 5 years based on Z score tool for assessment the growth and nutritional status in various clinical conditions and research, also allows comparison with references of other countries.

Background: Growth charts are an important method for evaluating a child's health, growth, and nutritional status. Objective: To establish Lambda-Mu-Sigma (LMS) and Z score references for assessment of growth and nutritional status in Egyptian school children and adolescents. Methods: A total of 34,822 Egyptian school children and adolescents from 5 to 19 years were enrolled in a cross sectional randomized study from December 2017 to November 2019 to create LMS and Z score references for weight, height and body mass index (BMI) corresponding to ages. They were selected from different districts in Egypt. Apparent Healthy children with good nutritional history and not suffering from any chronic diseases were included in the study. Results: Egyptian children of both sexes (54.3% boys and 45.7 % girls) from 5 to 19 years old were studied. Then LMS and Z scores for weight for age, height for age, BMI for age of both sexes were represented in detailed tables and graphs. There was no statistically significant difference between the Egyptian Z score charts and the reference values of WHO for weight, height and BMI corresponding to age (P > 0.05). Conclusion: This is the first national reference for growth and nutritional assessment using LMS and Z score charts in Egyptian school children and adolescents, this tool is essential for healthcare and research.

Background Cow’s Milk-related Symptom Score (CoMiSS) is an awareness tool to recognize cow’s milk allergy (CMA) symptoms in infants. We aimed to assess the best cut-off point of CoMiSS in our country and investigate other parameters suggested to raise the strength of CoMiSS in CMA diagnosis. Methods We enrolled 100 infants with CMA-suggestive symptoms with documentation of CoMiSS initially and 4 weeks after cow milk-free diet (CMFD) followed by an open food challenge (OFC) test. Infants with symptom recurrence upon challenge were diagnosed with confirmed CMA. Results Initial mean CoMiSS was 15.76 ± 5.29, being higher in the confirmed CMA group (84% of infants). Following CMFD, median CoMiSS significantly reduced to 1.5 in the confirmed CMA group compared to 6.5 in the negative group. Receiver operation characteristic (ROC) curve identified a CoMiSS score of ≥12 as the best cut-off value with 76.19% sensitivity, 62.50% specificity and overall accuracy of 74.00%. Mucoid stool, bloody stool and faltering growth were reported in 80, 41 and 52% of confirmed CMA infants, respectively, with considerable improvement following CMFD. Conclusions Our study revealed a CoMiSS score of ≥12 to be the best cut-off point. However, CoMiSS cannot be used alone for accurate diagnosis of CMA. Impact CoMiSS ≥12 can predict a positive response to CMFD; nevertheless, CoMiSS is a good awareness tool and cannot be regarded as a stand-alone CMA diagnostic test. CoMiSS reduction following CMFD was predictive of a reaction to OFC to diagnose CMA as well as for monitoring symptom improvement. Symptoms commonly associated with CMA as mucoid stool, bloody stool, marked abdominal distention not responding to medical treatment and faltering growth, in addition to their improvements in response to CMA are suggested parameters to be added to CoMiSS to improve its accuracy.