使用新的世界卫生组织儿童生长标准来评估婴儿营养不良与母乳喂养和死亡率的关系。
Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality.
出版信息
Bull World Health Organ. 2010 Jan;88(1):39-48. doi: 10.2471/BLT.08.057901. Epub 2009 Oct 13.
OBJECTIVE
To compare the estimated prevalence of malnutrition using the World Health Organization's (WHO) child growth standards versus the National Center for Health Statistics' (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy.
METHODS
A secondary analysis of data on 9424 mother-infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants' weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards.
FINDINGS
The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6-12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6-12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%).
CONCLUSION
Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life.
目的
比较使用世界卫生组织（WHO）儿童生长标准和美国国家健康统计中心（NCHS）生长参考评估营养不良的估计患病率，研究纯母乳喂养与营养不良的关系，并确定营养状况指标预测婴儿期死亡的敏感性和特异性。
方法
对加纳、印度和秘鲁的 9424 对母婴进行了二次数据分析。在一项维生素 A 补充试验中招募了母亲和婴儿，在此期间定期评估婴儿的体重、长度和喂养方式。使用 WHO 和 NCHS 生长标准确定营养状况指标。
结果
6 个月以下婴儿的生长迟缓、消瘦和体重不足发生率用 WHO 标准高于 NCHS 标准。然而，6-12 个月婴儿的消瘦发生率用 WHO 标准则低得多。纯母乳喂养时间与 6 个月内的营养不良无关。在 6 个月以下的婴儿中，使用 WHO 标准，首次免疫接种时严重消瘦的敏感性（70.2%）和特异性（85.8%）最高，可预测印度的死亡率。在加纳或秘鲁，没有任何指标是良好的预测指标。在 6-12 个月的婴儿中，6 个月时消瘦对预测加纳（敏感性：37.0%；特异性：82.2%）和秘鲁（敏感性：33.3%；特异性：97.9%）的死亡率最高，而消瘦在印度是最好的预测指标（敏感性：54.6%；特异性：85.5%）。
结论
使用 WHO 标准确定的营养状况指标比使用 NCHS 标准预测死亡率的指标更好。母乳喂养时间与 6 个月时的营养不良之间没有关联。使用 WHO 儿童生长标准强调了生命最初 6 个月营养不良的重要性。
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