Center for Childhood Obesity Research, The Pennsylvania State University, University Park; Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.
Center for Childhood Obesity Research, The Pennsylvania State University, University Park; Geisinger Obesity Institute, Epidemiology and Health Services Research Geisinger, Danville, PA; Evaluation Sciences Unit, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA.
J Acad Nutr Diet. 2021 Mar;121(3):493-500. doi: 10.1016/j.jand.2020.11.009. Epub 2020 Dec 16.
Infants from low-income backgrounds receive nutrition care from both community and clinical care settings. However, mothers accessing these services have reported receiving conflicting messages related to infant growth between settings, although this has not been examined quantitatively.
Describe the agreement in infant growth assessments between community (Special Supplemental Nutrition Program for Women, Infants, and Children) and clinical (primary care providers) care settings.
A cross-sectional, secondary data analysis of infant growth measures abstracted from electronic data management systems.
Participants included a convenience sample of infants (N = 129) from northeastern Pennsylvania randomized to the WEE Baby Care study from July 2016 to May 2018. Infants had complete anthropometric data from both community and clinical settings at age 6.2 ± 0.4 months. Average time between assessments was 2.7 ± 1.9 weeks.
Limits of agreement and bias in weight-for-age, length-for-age, weight-for-length, and body-mass-index-for-age z scores as well as cross-context equivalence in weight status between care settings.
Bland-Altman analyses were used to describe the limits of agreement and bias in z scores between care settings. Cross-context equivalence was examined by dichotomizing infants' growth indicators at the 85th and 95th percentile cut-points and cross-tabulating equivalent and discordant categorization between settings.
Strongest agreement was observed for weight-for-age z scores (95% limits of agreement -0.41 to 0.54). However, the limits of agreement intervals for growth indicators that included length were wider, suggesting weaker agreement. There was a high level of inconsistency for classification of overweight/obesity using weight-for-length z scores, with 15.5% (85th percentile cut-point) and 11.6% (95th percentile cut-point) discordant categorization between settings, respectively.
Infant growth indicators that factor in length could contribute to disagreement in the interpretation of infant growth between settings. Further investigation into the techniques, standards, and training protocols for obtaining infant growth measurements across care settings is required.
来自低收入背景的婴儿在社区和临床护理环境中都能获得营养护理。然而，接受这些服务的母亲报告说，在不同的环境中，婴儿的生长情况存在相互矛盾的信息，尽管这一点尚未进行定量研究。
描述社区（妇女、婴儿和儿童特别补充营养计划）和临床（初级保健提供者）护理环境中婴儿生长评估的一致性。
这是一项从电子数据管理系统中提取婴儿生长测量数据的横截面、二次数据分析。
参与者包括 2016 年 7 月至 2018 年 5 月期间随机分配到 WEE 婴儿护理研究的宾夕法尼亚州东北部的一个方便样本的婴儿（N=129）。129 名婴儿在 6.2±0.4 月龄时同时在社区和临床环境中完成了完整的人体测量数据。两次评估之间的平均时间间隔为 2.7±1.9 周。
体重与年龄、身长与年龄、体重与身长以及体重与年龄的体质指数 z 评分的一致性界限和偏差，以及两种环境下体重状况的跨环境等效性。
使用 Bland-Altman 分析描述两种环境下 z 评分的一致性界限和偏差。通过将婴儿的生长指标在 85%和 95%的百分位截点处进行二分法，并对设定值之间的等效和不一致分类进行交叉制表，来检查跨环境等效性。
体重与年龄 z 评分的一致性最强（95%一致性界限为-0.41 至 0.54）。然而，包括身长在内的生长指标的一致性界限区间较宽，表明一致性较弱。使用体重与身长 z 评分来分类超重/肥胖时，不一致性程度较高，设定值之间分别有 15.5%（85%百分位截点）和 11.6%（95%百分位截点）的不一致分类。
考虑到身长的婴儿生长指标可能导致两种环境下对婴儿生长的解释不一致。需要进一步研究跨护理环境获取婴儿生长测量的技术、标准和培训协议。
