|Year : 2015 | Volume
| Issue : 2 | Page : 78-81
Thinness among preschool children residing in rural area: A cross-sectional study
Rakesh K Nayak1, Padmaja R Walvekar2, Maheshwar D Mallapur3
1 Assistant Professor, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, Karnataka, India
2 Professor, Department of Community Medicine, KLE University's Jawaharlal, Nehru Medical College, Belgaum, Karnataka, India
3 Lecturer in Biostatistics, Department of Community Medicine, KLE University's Jawaharlal, Nehru Medical College, Belgaum, Karnataka, India
|Date of Web Publication||14-May-2015|
Rakesh K Nayak
Assistant Professor, Department of Community Medicine, SDM Medical College, Manjushree Nagar, Sattur, Dharwad - 580009, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: The legacy of malnutrition especially among preschool children is a huge obstacle to overall national development. India is home to more than one-third of the world's under-nourished children. While there is global acceptance that body mass index (BMI) should be used for assessment of obesity/adiposity in children, there has not been a similar consensus regarding use of BMI for assessment of under-nutrition in children. Materials and Methods: The present study was a community-based cross-sectional study carried out in a primary health center between January and December 2011. Study population comprised of 697 children aged between 2 and 5 years. Weight (kg) and height (cm) measurements were taken on each subject, and BMI was computed. Nutritional status was evaluated using the Cole's age- and sex-specific cut-off points of BMI. One-way ANOVA (F-test) was performed to test for age differences in means of weight, height, and BMI using SPSS statistical package. Results: A total of 339 boys and 358 females were studied. Result showed that age-combined prevalence of under-nutrition (Grades I, II, and III combined) among boys and girls was 63.4% and 58.6% respectively with an overall prevalence of 61.7%. There were significant mean differences between ages among boys in weight (F = 4.160; P < 0.001) and height (F = 6.502; P < 0.001). However, no significant mean differences between ages for BMI (F = 1.098; P = 0.295). Similar findings were seen among girls where in significant differences were observed in weight (F = 3.125, P < 0.001) and height (F = 6.895; P < 0.001) but not with BMI (F = 1.091; P = 0.311). Conclusion: Our study provided evidence that these children were under acute and chronic nutritional stress in the form of thinness.
Keywords: Body mass index, preschool children, thinness
|How to cite this article:|
Nayak RK, Walvekar PR, Mallapur MD. Thinness among preschool children residing in rural area: A cross-sectional study. J Sci Soc 2015;42:78-81
| Introduction|| |
Child growth is the universal means to assess adequate nutrition, health and development of individual children and to estimate the overall nutritional status and health of populations. Compared to other health assessment tools, measuring child growth is a relatively inexpensive, easy to perform and noninvasive process.  Worldwide, over 10 million children under the age of 5 years die every year from preventable and treatable illnesses despite effective health interventions. At least half of these deaths are caused by malnutrition.  India is home to more than one-third of the world's under-nourished children. In 2010, one in five children were estimated to be underweight in developing countries.  The WHO health statistics of 2012 for India show the proportion of stunting as 47.9% and that of underweight as 43.5%.  According to the National Family Health Survey-3, survey conducted in 2005-2006, 48% of children were stunted, 20% were wasted, and 43% were underweight.  Generally, three anthropometric indicators are often used to assess nutritional status during childhood: Underweight (low weight-for-age), stunting (low height-for-age), and wasting (low weight-for-height).  In India, weight for age has been the most widely used indicator for assessment of nutritional status, for detection of under-nutrition and for monitoring the improvement following interventions in children.  Body mass index (BMI), devised by Adolphe Quetelet describes the relation of weight to height and provides a way to translate weights at different heights into a common metric. In children, BMI varies not only with weight, but also with age and sex. Therefore, BMI values in children are compared with reference values that are generally age- and sex-specific.  While there is global acceptance that BMI should be used for assessment of obesity/adiposity in children, there has not been a similar consensus regarding the use of BMI for assessment of under-nutrition in children. Under-nutrition has been termed as thinness (as in adults) defined as low BMI for age and it has been graded as III, II, I (severe, moderate and mild respectively) by Cole et al.  Since there is lack of information on the prevalence of thinness among preschool children using these BMI cut-off points, the objective of the present study was to assess the prevalence of different grades of thinness using the Cole's age-and sex-specific international cut-off values of BMI.
| Materials and methods|| |
This study was a community-based cross-sectional study carried out in Handignur primary health center, which is one of the field practice areas of Jawaharlal Nehru Medical College (JNMC), Belgaum, Karnataka. The study was 1-year from January to December 2011. A list of all children aged between 2 and 5 years was procured from the anganwadi registers. All children who had completed 5 years on the date of survey were excluded from the study. A total of 724 children were enrolled in the 2-5 years age group. Totally, 27 children were not eligible and hence were dropped out of the study, thus making the final sample size of 697. Ethical clearance was obtained from the JNMC Institutional Ethics Committee prior to the commencement of the study. A written informed consent was obtained from the parents of these children. Information on age, sex and residence were collected using a pretested questionnaire from the anganwadi teacher followed by anthropometric measurements. A minimum of three visits were given to each anganwadi to ensure that all the children were covered. Weight (kg) and height (cm) measurements were taken on each subject following the standard techniques.  BMI was computed following internationally accepted standard equation as BMI = weight (kg)/height (m 2 ). Nutritional status was evaluated using the age- and sex-specific cut-off points of BMI [Table 1] as described by Cole et al.  Grades III, II, and I of thinness refer to severe, moderate, and mild under-nutrition.
|Table 1: BMI (kg/m2) cut-off points for thinness grades III, II and I by Cole et al.|
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One-way ANOVA (F-test) was performed to test for age differences in means of weight, height, and BMI. All statistical analysis was undertaken using the trial version of SPSS 18 statistical package (IBM Statistical Package for Social Sciences). Statistical significance was set at P < 0.05.
| Results|| |
The overall mean and standard deviation (indicated in parentheses) of weight (kg), height (cm), and (BMI in kg/m 2 ) of the 2-5 years children were 12.3 (1.9), 92.5 (7.4), and 14.4 (1.6) among boys and 12.1 (2.0), 92.3 (7.4), and 14.2 (1.4) among girls. [Table 2] presents the age- and sex-wise mean and standard deviation of weight (kg), height (cm), and (BMI in kg/m 2 ) of the 2-5 years children. There were significant mean differences between ages among boys in weight (F = 4.160; P < 0.001) and height (F = 6.502; P < 0.001). However, no significant mean differences between ages for BMI (F = 1.098; P = 0.295) was noted. Similarly, among girls, significant differences were observed in weight (F = 3.125, P < 0.001), height (F = 6.895; P < 0.001), but not with BMI (F = 1.091; P = 0.311). It was also clear from the [Table 2] that there was a gradual decrease in BMI with increasing age both among boys and among girls.
[Table 3] presents the prevalence of thinness among the 2-5 years children. Results revealed that the age-combined prevalence of under-nutrition (Grades I, II, and III combined) among boys and girls was 63.4% and 58.6% respectively. It was also observed that initial preschooler boys were more under-nourished (68% and 58.8%) at age 2 and 3 years respectively than their female counterparts (61.4% and 54.0%) of the same age. However, as age advanced, no much difference was seen between preschool boys (62.7%) and girls (60%). Grade I thinness was more prevalent among both boys and girls.
|Table 3: Prevalence (%) of thinness by age and sex among 2-5 years children|
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| Discussion|| |
The recent study of Cole et al.  has stated that under-nutrition is better assessed as thinness (low BMI for age) than as wasting (low weight for height). These cut-off points were derived from multicenter data from the United States, Great Britain, Hong Kong, and the Netherlands including data from Brazil (developing country). Thus, these cut-off points are valid for use among Indian children [Table 1].
In our study, the mean BMI among boys was 14.3 ± 1.6, and that among girls was 14.2 ± 1.4. The values were less compared to a study done in West Bengal where in the mean BMI among boys and girls was 14.8 ± 1.8 and 14.6 ± 1.7 respectively.  The mean BMI significantly decreased with advancement of age (F = 7.754 P < 0.01), which was in contrast to our study where no significant difference was seen between different age groups. The overall prevalence of thinness in our study was 61.7%. A Study carried out West Bengal among Bauri preschool children has reported the overall prevalence of 66.2%.  Other studies that have reported a higher prevalence include studies done in West Bengal among Kora-Mudi tribal children (67.2%)  and among Integrated Child Development Services children in Vadodara city (63%).  Studies which have shown a comparatively lower prevalence include studies carried out in rural Bengal (50.7%),  Urban Orissa (48%),  Bhopal (58%)  and Santhal preschool children (56.4%).  Results of our study showed that boys were more under-nourished (63.4%) than girls (58.6%). Similar results were seen among Santhal preschool children (boys vs. girls: 59.4% vs. 53.3%)  and among Kora-Mudi tribal children.  However, in contrast to our findings, a study done in Darjeeling showed a higher prevalence among girls (47.4%) than boys (43%).  Boys showed a consistent higher prevalence than girls in all the age groups in our study. This was in contrast to Santhal children  where girls showed a higher prevalence in the second and 3 rd year of life. However, no significant sex difference in thinness was noted in study done by Bisai and Manna  When the different grades of thinness were considered, maximum children belonged to Grade I, followed by Grades II and III that was similar to other studies.  Grade III thinness was seen more among girls than boys in our study (18.7% vs. 17.6%). Similar results were seen in a Urban slum of Calcutta (girls vs. boys: 7.4% vs. 5.4%)  and among Kora-Mudi tribal children.  Grade I thinness was more common in boys and Grade II thinness was more common among girls in our study that was similar to Calcutta study.  This was in contrast to West Bengal study  where Grade I thinness was more among girls and Grade II thinness was more among boys.
| Conclusion|| |
Our study provided evidence that these children were under acute and chronic nutritional stress in the form of thinness indicating the requirement for immediate appropriate public health nutritional intervention programs. The results of the present study will be useful for national and international comparisons of rates of thinness among preschool children.
| Acknowledgments|| |
The authors acknowledge the financial assistance provided by the Director General, ICMR under the financial assistance for MD/MS Thesis program.
All subjects who participated in the study are gratefully acknowledged.
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[Table 1], [Table 2], [Table 3]