Duggan M B
Department of Paediatrics and Child Health, Mbarara, Uganda; College of Medicine, Blantyre, Malawi.
Ann Trop Paediatr. 2010;30(1):1-17. doi: 10.1179/146532810X12637745451834.
Anthropometry is a useful tool, both for monitoring growth and for nutritional assessment. The publication by WHO of internationally agreed growth standards in 1983 facilitated comparative nutritional assessment and the grading of childhood malnutrition. New growth standards for children under 5 years and growth reference for children aged 5-19 years have recently (2006 and 2007) been published by WHO. Growth of children <5 years was recorded in a multi-centre growth reference study involving children from six countries, selected for optimal child-rearing practices (breastfeeding, non-smoking mothers). They therefore constitute a growth standard. Growth data for older children were drawn from existing US studies, and upward skewing was avoided by excluding overweight subjects. These constitute a reference. More indicators are now included to describe optimal early childhood growth and development, e.g. BMI for age and MUAC for age. The growth reference for older children (2007) focuses on linear growth and BMI; weight-for-age data are age-limited and weight-for-height is omitted. Differences in the 2006 growth pattern from the previous reference for children <5 are attributed to differences in infant feeding. The 2006 'reference infant' is at first heavier and taller than his/her 1983 counterpart, but is then lighter until the age of 5. Being taller in the 2nd year, he/she is less bulky (lighter for height) than the 1983 reference toddler. The spread of values for height and weight for height is narrower in the 2006 dataset, such that the lower limit of the normal range for both indices is set higher than in the previous dataset. This means that a child will be identified as moderately or severely underweight for height (severe acute malnutrition) at a greater weight for height than previously. The implications for services for malnourished children have been recognised and strategies devised. The emphasis on BMI-for-age as the indicator for thinness and obesity in older children is discussed. The complexity of calculations for health cadres without mathematical backgrounds or access to calculation software is also an issue. It is possible that the required charts and tables may not be accessible to those working in traditional health/nutrition services which are often poorly equipped.
人体测量学是一种有用的工具，可用于监测生长发育和进行营养评估。1983年世界卫生组织发布国际公认的生长标准，促进了营养状况的比较评估以及儿童营养不良的分级。世界卫生组织最近（2006年和2007年）发布了5岁以下儿童的新生长标准以及5-19岁儿童的生长参考值。对5岁以下儿童的生长情况记录于一项多中心生长参考研究，该研究涉及来自六个国家的儿童，这些国家因育儿方式理想（母乳喂养、母亲不吸烟）而被选中。因此，这些数据构成了一个生长标准。大龄儿童的生长数据取自美国现有的研究，通过排除超重受试者避免了数据上偏。这些构成了一个参考值。现在纳入了更多指标来描述幼儿的最佳生长发育情况，例如年龄别BMI和年龄别上臂围。大龄儿童的生长参考值（2007年）侧重于线性生长和BMI；年龄别体重数据有年龄限制，身高别体重数据则被省略。2006年5岁以下儿童的生长模式与之前的参考值不同，这归因于婴儿喂养方式的差异。2006年的“参考婴儿”一开始比1983年的对应婴儿更重、更高，但到5岁时体重更轻。由于在第二年更高，其体型（身高别体重）比1983年的参考幼儿更小。2006年数据集中身高和身高别体重的数值范围更窄，因此这两个指标正常范围的下限设定得比之前的数据更高。这意味着，与之前相比，当身高别体重达到更高数值时，儿童才会被判定为身高别中度或重度体重不足（重度急性营养不良）。对营养不良儿童服务的影响已得到认识，并制定了相应策略。文中讨论了将年龄别BMI作为大龄儿童消瘦和肥胖指标的重要性。对于没有数学背景或无法使用计算软件的卫生保健人员来说，计算的复杂性也是一个问题。传统卫生/营养服务机构往往设备简陋，工作人员可能无法获取所需的图表和表格。
