Length and height percentiles for children in the South-East Asian Nutrition Surveys (SEANUTS)

Abstract

Objective: Health and nutritional information for many countries in the South-East Asian region is either lacking or no longer up to date. The present study aimed to calculate length/height percentile values for the South-East Asian Nutrition Survey (SEANUTS) populations aged 0·5-12 years, examine the appropriateness of pooling SEANUTS data for calculating common length/height percentile values for all SEANUTS countries and whether these values differ from the WHO growth references. Design: Data on length/height-for-age percentile values were collected. The LMS method was used for calculating smoothened percentile values. Standardized site effects (SSE) were used for identifying large or unacceptable differences (i.e. j SSE j > 0·5) between the pooled SEANUTS sample (including all countries) and the remaining pooled SEANUTS samples (including three countries) after weighting sample sizes and excluding one single country each time, as well as with WHO growth references. Setting: Malaysia, Thailand, Vietnam and Indonesia. Subjects: Data from 14 202 eligible children were used. Results: From pair-wise comparisons of percentile values between the pooled SEANUTS sample and the remaining pooled SEANUTS samples, the vast majority of differences were acceptable (i.e. j SSE j ≤ 0·5). In contrast, pair-wise comparisons of percentile values between the pooled SEANUTS sample and WHO revealed large differences. Conclusions: The current study calculated length/height percentile values for South East Asian children aged 0·5-12 years and supported the appropriateness of using pooled SEANUTS length/height percentile values for assessing children's growth instead of country-specific ones. Pooled SEANUTS percentile values were found to differ from the WHO growth references and therefore this should be kept in mind when using WHO growth curves to assess length/height in these populations. KeywordsNutrition Survey Length/height Percentiles Children SEANUTSThe economic transition due to rapid industrialization observed over the last decades in South-East Asian countries has coincided with marked changes in dietary habits and lifestyle patterns that may have a significant impact on several health indices in these populations (1)(2)(3)(4) . Because of these lifestyle changes, growth and physical development in infants, children and adolescents can be influenced and this is reflected mainly in changes recorded over time in certain anthropometric indicators, namely body weight, stature (or recumbent length in infants) and BMI. In this context, according to data from the WHO (5,6) , the decreasing trend in the prevalence of stunting (by 43·4 million) and underweight (by 35·6 million) and the increasing prevalence of overweight and obesity (by 4·4 million) observed over the last two decades among children in South-East Asia (including Thailand, Indonesia and Malaysia) provide a strong indication of this impact.

Body weight and BMI percentiles for children in the South-East Asian Nutrition Surveys (SEANUTS)

“…To achieve comparability of the anthropometric data collected in SEANUTS with those collected in the WHO Multicentre Growth Reference Study (MGRS), the sampling in SEANUTS followed the same approach as WHO ( 14 ) to exclude socio-economically disadvantaged and/or unhealthy children. The exclusion criteria applied in SEANUTS are presented in detail elsewhere ( 18 ) . Detailed information on the exclusion criteria used in the present study to identify eligible children in all participating countries is also provided elsewhere ( 18 ) .…”

“…The exclusion criteria applied in SEANUTS are presented in detail elsewhere ( 18 ) . Detailed information on the exclusion criteria used in the present study to identify eligible children in all participating countries is also provided elsewhere ( 18 ) . The application of the exclusion criteria resulted in a final pooled SEANUTS sample of 14 202 children having full data on anthropometric indices, age and sex, as previously reported ( 18 ) .…”

“…Detailed information on the exclusion criteria used in the present study to identify eligible children in all participating countries is also provided elsewhere ( 18 ) . The application of the exclusion criteria resulted in a final pooled SEANUTS sample of 14 202 children having full data on anthropometric indices, age and sex, as previously reported ( 18 ) . Considering that the average body weight and BMI levels in the excluded children ( n 2364) were found to be significantly lower compared with the relevant average levels in the eligible children, this indicates that the exclusion criteria used in the current study were appropriate for excluding actual cases of infants and children with possible health and/or socio-economic constraints on their growth.…”

“…Prior to all calculations, the samples of Malaysia, Thailand and Vietnam were weighted using a weight factor of ‘2’ as a means of adjusting for the unequal sample sizes in the four study sites and avoiding the over-representation of Indonesia in the total sample. Additional information on the exact statistical procedures followed to extract the ‘smoothed’ percentile values can be found elsewhere ( 18 ) .…”

Disentangling basal and accrued height‐for‐age for cross‐population comparisons

“…Resting on a universal model of human growth, this approach assumes that after controlling for environmental inputs, population differences in height are sufficiently small that a single standard can be used to assess healthy growth across all populations. However, empirical studies across a wider range of countries have provided mixed support for this assumption (Christesen, Pedersen, Pournara, Petit, & Júlíusson, ; De Wilde, van Dommelen, Van Buuren, & Middelkoop, ; Graitcer & Gentry, ; Hui, Schooling, & Cowling, ; Karra, Subramanian, & Fink, ; Panagariya, ; Rojroongwasinkul et al, ; van Buuren & van Wouwe, ). Moreover, relatively stable, non‐environmental factors, including genetic variation, can also contribute to variation in height‐for‐age (Coffey, Deaton, Dreze, Dean, & Tarozzi, ; Davies, ; Goldstein & Tanner, ; RONA, ; Weedon, Lettre, Freathy, & Lindgren, ).…”