Boston College School of Social Work, Chestnut Hill, Massachusetts, USA.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston Massachusetts, USA.
J Glob Health. 2020 Dec;10(2):020424. doi: 10.7189/jogh.10.020424.
Anthropometry is the most commonly used approach for assessing nutritional need among children. Anthropometry alone, however, cannot differentiate between the two immediate causes of undernutrition: inadequate diet vs disease. We present a typology of nutritional need by simultaneously considering dietary and anthropometric measures, dietary and anthropometric failures (DAF), and assess its distribution among children in India.
We used the 2015-16 National Family Health Survey, a nationally representative sample of children aged 6-23 months (n = 67 247), from India. Dietary failure was operationalized using World Health Organization (WHO) standards for minimum dietary diversity. Anthropometric failure was operationalized using WHO child growth reference standard z-score of <-2 for height-for-age (stunting), weight-for-age (underweight) and weight-for-height (wasting). We also created a combined anthropometric measure for children who had any one of these three anthropometric failures. We cross-tabulated dietary and anthropometric failures to produce four combinations: Dietary Failure Only (DFO), Anthropometric Failure Only (AFO), Both Failures (BF), and Neither Failure (NF). We estimated the prevalence and distribution of the four types, nationally, and across 640 administrative districts and 543 Parliamentary Constituencies (PCs) in India.
Nationally, 80.3% of children had dietary failure and 53.7% had at least one anthropometric failure. The prevalence for the four DAF types was: 44.0% (BF), 36.3% (DFO), 9.8% (AFO), and 9.9% (NF). Dietary and anthropometric measures were discordant for 46.1% of children; these children had nutritional needs identified by only one of the two measures. Nationally, this translates to 12 181 627 children with DFO and 3 281 913 children with AFO; the nutritional needs of these children would not be captured if using only dietary or anthropometric assessment. Substantial variation was observed across districts and PCs for all DAF types. The interquartile ranges for districts were largest for BF (29.8%-53.0%) and lowest for AFO (5.5%-13.4%).
The current emphasis on anthropometry for measuring nutritional need should be complemented with diet- and food-based measures. By differentiating inadequate food intake from other causes of undernutrition, the DAF typology brings precision in identifying nutritional needs among children. These insights may improve the development and targeting of nutrition interventions.
人体测量学是评估儿童营养需求最常用的方法。然而，人体测量学本身并不能区分营养不良的两个直接原因：饮食不足与疾病。我们提出了一种通过同时考虑饮食和人体测量学指标的营养需求分类法，即饮食和人体测量学失败（DAF），并评估其在印度儿童中的分布情况。
我们使用了来自印度的 2015-16 年全国家庭健康调查，这是一个具有全国代表性的 6-23 个月大儿童样本（n=67247）。饮食失败是通过世界卫生组织（WHO）最低饮食多样性标准来操作定义的。人体测量学失败是通过 WHO 儿童生长参考标准 z 分数为 <-2 的身高与年龄（发育迟缓）、体重与年龄（体重不足）和体重与身高（消瘦）来操作定义的。我们还为有这三种人体测量学失败之一的儿童创建了一个综合人体测量学指标。我们对饮食和人体测量学失败进行交叉制表，得出了四种组合：仅饮食失败（DFO）、仅人体测量学失败（AFO）、两者皆失败（BF）和两者皆无失败（NF）。我们在全国范围内估计了这四种类型的流行率和分布情况，并在印度的 640 个行政区和 543 个议会选区（PCs）进行了评估。
在全国范围内，80.3%的儿童存在饮食失败，53.7%的儿童至少有一种人体测量学失败。四种 DAF 类型的流行率分别为：44.0%（BF）、36.3%（DFO）、9.8%（AFO）和 9.9%（NF）。饮食和人体测量学措施在 46.1%的儿童中不一致；这些儿童的营养需求仅通过两种措施中的一种来识别。在全国范围内，这相当于有 1218.1627 名儿童有 DFO，有 328.1913 名儿童有 AFO；如果仅使用饮食或人体测量学评估，这些儿童的营养需求将无法被捕捉到。所有 DAF 类型在地区和议会选区之间都存在显著差异。地区的四分位间距最大的是 BF（29.8%-53.0%），最小的是 AFO（5.5%-13.4%）。
目前对人体测量学用于衡量营养需求的重视应辅以饮食和基于食物的措施。通过区分摄入不足的食物与营养不良的其他原因，DAF 分类法在识别儿童的营养需求方面具有更高的精准度。这些见解可能会改进营养干预措施的制定和目标制定。
