Wang S, Mei Y, Yang Z Y, Zhang Q, Li R L, Wang Y Y, Zhao W H, Xu T
National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100081, China.
National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Er Ke Za Zhi. 2023 Aug 2;61(8):700-707. doi: 10.3760/cma.j.cn112140-20230505-00314.
To compare the application of China growth standard for children under 7 years of age (China standards) and World Health Organization child growth standards (WHO standards) in evaluating the prevalence of malnutrition in children aged 0-<6 years in China. The research data came from the national special program for science & technology basic resources investigation of China, named "2019-2021 survey and application of China's nutrition and health system for children aged 0-18 years". Multi-stage stratified random sampling was used to recruit 28 districts (regions) in 14 provinces, autonomous regions or municipalities across the country. Children (=38 848) were physically measured and questionnaires were conducted in the guardians of the children. The indicators of stunting, underweight, wasting, overweight and obesity were evaluated by China standards and WHO standards respectively. Chi-square test was used to comparing the prevalence of each nutritional status between the two standards, as well as the comparison between the two standards by gender and age. Among the 38 848 children, 19 650 were boys (50.6%) and 19 198 were girls (49.4%), 19 480 urban children (50.1%) and 19 368 rural children (49.9%). The stunting, underweight and wasting cases in the study population were 2 090 children (5.4%), 1 354 children (3.5%) and 1 276 children (3.3%) according to the China standards, and 1 474 children (3.8%), 701 children (1.8%) and 824 children (2.1%) according to the WHO standards, respectively; the above rates according to the China standards were slightly higher than those to the WHO standards (=111.59, 213.14, and 99.99, all 0.001). The overweight and obesity cases in the study population were 2 186 children (5.6%) and 1 153 children (3.0%) according to the China standards, and 2 210 children (5.7%) and 1 186 children (3.1%) according to the WHO standards, with no statistically significant differences (=0.14 and 0.48, 0.709 and 0.488, respectively). Compared to the results based on WHO standards, the China standards showed a lower prevalence of overweight and obesity in boys (=14.95 and 5.85, <0.001 and =0.016, respectively), and higher prevalence of overweight in girls (=12.60, 0.001); but there was no statistically significant differences in girls' obesity prevalence between the two standards (=2.62, =0.106). In general, the prevalence of malnutrition among children aged 0-<6 years based on China standards is slightly higher than that on WHO standards. To evaluate the nutritional status of children, it is advisable to select appropriate child growth standards based on work requirements, norms or research objectives.
比较7岁以下儿童生长标准（中国标准）和世界卫生组织儿童生长标准（WHO标准）在中国0至＜6岁儿童营养不良患病率评估中的应用。研究数据来自中国国家科技基础资源调查专项“2019 - 2021年中国0 - 18岁儿童营养与健康状况调查及应用”。采用多阶段分层随机抽样方法，在全国14个省、自治区或直辖市招募了28个区（县）。对儿童（n = 38848）进行体格测量，并对儿童监护人进行问卷调查。分别采用中国标准和WHO标准评估发育迟缓、体重不足、消瘦、超重和肥胖指标。采用卡方检验比较两种标准下各营养状况的患病率，以及按性别和年龄在两种标准间的比较。在38848名儿童中，男孩19650名（50.6%），女孩19198名（49.4%）；城市儿童19480名（50.1%），农村儿童19368名（49.9%）。根据中国标准，研究人群中发育迟缓、体重不足和消瘦病例分别为2090名儿童（5.4%）、1354名儿童（3.5%）和1276名儿童（3.3%）；根据WHO标准，分别为1474名儿童（3.8%）、701名儿童（1.8%）和824名儿童（2.1%）；上述中国标准下的患病率略高于WHO标准下的患病率（χ² = 111.59、213.14和99.99，均P < 0.001）。根据中国标准，研究人群中超重和肥胖病例分别为2186名儿童（5.6%）和1153名儿童（3.0%）；根据WHO标准，分别为2210名儿童（5.7%）和1186名儿童（3.1%），差异无统计学意义（χ² = 0.14和0.48，P分别为0.709和0.488）。与基于WHO标准的结果相比，中国标准显示男孩超重和肥胖患病率较低（χ² = 14.95和5.85，P分别<0.001和 = 0.016），女孩超重患病率较高（χ² = 12.60，P = 0.001）；但两种标准下女孩肥胖患病率差异无统计学意义（χ² = 2.62，P = 0.106）。总体而言，基于中国标准的0至＜6岁儿童营养不良患病率略高于基于WHO标准的患病率。为评估儿童营养状况，建议根据工作要求、规范或研究目的选择合适的儿童生长标准。
