Nutrition Foundation of India, New Delhi, India.
Indian J Med Res. 2009 Nov;130(5):579-83.
BACKGROUND & OBJECTIVE: It is well documented that in preschool children undernutrition is associated with immune depression and increased risk of infections; infections aggravate undernutrition. Underweight is the most widely used indicator for assessment of undernutrition for investigating undernutrition and infection interactions. In India, nearly half the children are stunted and underweight; but majority of children have appropriate weight for their height and less than a fifth are wasted. The present study was undertaken to explore which of the five anthropometric indices for assessment of undernutrition (weight for age, height for age, wasting, BMI for age, and wasting and stunting with low BMI) is associated with more consistent and higher risk of morbidity due to infection in preschool children. METHODS: The National Family Health Survey-3 (NFHS-3) database provided the following information in 56,438 preschool children: age, sex, weight, height, infant and young child feeding practices and morbidity due to infections in the last fortnight. Relative risk (RR) of morbidity due to infections was computed in infants and children with stunting, underweight, low BMI for age, wasting and stunting with low BMI (< mean-2SD of WHO 2006 standards). RESULTS: Comparison of the RR for infections in undernourished children showed that the relative risk of morbidity due to infections was higher and more consistently seen in children with low BMI and wasting as compared to stunting or underweight. The small group of children who had stunting with wasting had the highest relative risk of morbidity due to infection. INTERPRETATION & CONCLUSION: In Indian preschool children, RR for infection was more consistently associated with BMI for age and wasting as compared to weight for age and height for age. Low BMI for age and wasting indicate current energy deficit; early detection and correction of the current energy deficit might reduce the risk of infection and also enable the child to continue in his/her growth trajectory for weight and height.
背景与目的：有充分的文献记载表明，学龄前儿童的营养不良与免疫抑制和感染风险增加有关；感染会加重营养不良。体重不足是评估营养不良的最常用指标，用于调查营养不良和感染的相互作用。在印度，近一半的儿童发育迟缓，体重不足；但大多数儿童的身高体重比适当，不到五分之一的儿童消瘦。本研究旨在探讨评估营养不良的五种人体测量指标（年龄别体重、年龄别身高、消瘦、年龄别 BMI 以及消瘦和低 BMI 性发育迟缓）中，哪一种与学龄前儿童因感染而发病的风险更为一致且更高。
方法：国家家庭健康调查-3（NFHS-3）数据库为 56438 名学龄前儿童提供了以下信息：年龄、性别、体重、身高、婴幼儿喂养方式以及最近两周因感染导致的发病情况。使用相对风险（RR）评估了发育迟缓、体重不足、年龄别 BMI 低、消瘦和低 BMI 性发育迟缓（低于 2006 年世卫组织标准均值-2SD）儿童的感染发病风险。
结果：与营养不良儿童的感染 RR 比较显示，与发育迟缓或体重不足相比，BMI 低和消瘦儿童的感染发病风险更高且更为一致。同时患有消瘦和发育迟缓的儿童群体的感染发病风险最高。
解释与结论：在印度学龄前儿童中，RR 与年龄别 BMI 和消瘦更为一致，而不是年龄别体重和身高别体重。年龄别 BMI 低和消瘦表明当前存在能量不足；早期发现和纠正当前的能量不足可能会降低感染风险，并使儿童能够继续其体重和身高的生长轨迹。
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