Department of Women's Health, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China.
Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
PLoS One. 2018 Sep 17;13(9):e0204142. doi: 10.1371/journal.pone.0204142. eCollection 2018.
The aim of this study was to investigate the nutritional status and its risk factors among children under 5 years, with special focus on the coexistence of under and over nutrition in population level.
We enrolled 6,570 children under 5 years among 26 counties in poor areas of China. Prevalences of malnutrition (stunting, underweight, wasting, overweight) were calculated. Overweight was evaluated using two indicators-weight for height Z score (WHZ) and body mass index for age Z score (BAZ), and results were compared.
The total prevalence of malnutrition was 19.2%. The prevalence of stunting and overweight were as high as 8.4% and 8.8%, respectively. The BAZ-estimated prevalence of overweight was 9.9%, which was higher than the WHZ-estimated prevalence (p<0.001). Children older than 12 months age, within a minority group, with a caregiver of illiteracy/primary education level were significantly associated with stunting in multilevel regression models (p<0.05). Children younger than 24 months age and boys were significantly associated with overweight (p<0.05).
Stunting and overweight were coexisted in surveyed areas. In conclusion, BAZ tended to overestimate the overweight prevalence compared with WHZ. While with the raising problem of childhood overweight, stunting should still be on the agenda for the poor areas in China. To improve children's nutritional status in poor areas of China, caregivers with children at high risk of malnutrition should be guided for healthy feeding practices.
本研究旨在调查 5 岁以下儿童的营养状况及其危险因素，特别关注人群中营养不足和营养过剩的共存情况。
我们在中国贫困地区的 26 个县招募了 6570 名 5 岁以下儿童。计算了营养不良（发育迟缓、体重不足、消瘦、超重）的患病率。超重采用身高体重 Z 评分（WHZ）和年龄体重 Z 评分（BAZ）两个指标进行评估，并进行了比较。
营养不良总患病率为 19.2%。发育迟缓率和超重率分别高达 8.4%和 8.8%。BAZ 估计的超重患病率为 9.9%，高于 WHZ 估计的患病率（p<0.001）。在多水平回归模型中，年龄大于 12 个月、少数民族、文化程度为文盲/小学的照顾者与发育迟缓显著相关（p<0.05）。年龄小于 24 个月和男孩与超重显著相关（p<0.05）。
研究地区存在发育迟缓与超重并存的情况。总之，与 WHZ 相比，BAZ 倾向于高估超重的患病率。随着儿童超重问题的出现，中国贫困地区仍应关注发育迟缓问题。为改善中国贫困地区儿童的营养状况，应对有营养不良高风险的儿童的照顾者进行健康喂养指导。
