Nutritional status and risk factors for stunting in preschool children in Bhutan

Yunhee Kang, Victor Aguayo, Rebecca K. Campbell, Laigden Dzed, Vandana Joshi, Jillian L. Waid, Suvadra Datta Gupta, Nancy J. Haselow, Keith West

Research output: Contribution to journalArticle

Abstract

Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z-scores of height-for-age [HAZ], weight-for-height [WHZ], and weight-for-age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7%). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2%, 2.6%, 7.4%, and 2.6%, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3% at <6 months (reference), 16.8% at 6–23 months (OR = 3.06, 95% CI [0.63, 14.8]), and 25.0% at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6% vs. an expected 2.5% of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.

Original languageEnglish (US)
Article numbere12653
JournalMaternal and Child Nutrition
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Bhutan
Growth Disorders
Preschool Children
Nutritional Status
Thinness
Malnutrition
Edema
Mothers
Child Nutrition Disorders
Weights and Measures
Nutrition Surveys
Foot
Linear Models
Logistic Models
Regression Analysis
Education
Food
Growth

Keywords

  • Bhutan
  • childhood stunting
  • nutritional trend
  • risk factors
  • South Asia
  • wasting

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Nutrition and Dietetics
  • Public Health, Environmental and Occupational Health

Cite this

Nutritional status and risk factors for stunting in preschool children in Bhutan. / Kang, Yunhee; Aguayo, Victor; Campbell, Rebecca K.; Dzed, Laigden; Joshi, Vandana; Waid, Jillian L.; Gupta, Suvadra Datta; Haselow, Nancy J.; West, Keith.

In: Maternal and Child Nutrition, 01.01.2018.

Research output: Contribution to journalArticle

Kang, Yunhee ; Aguayo, Victor ; Campbell, Rebecca K. ; Dzed, Laigden ; Joshi, Vandana ; Waid, Jillian L. ; Gupta, Suvadra Datta ; Haselow, Nancy J. ; West, Keith. / Nutritional status and risk factors for stunting in preschool children in Bhutan. In: Maternal and Child Nutrition. 2018.
@article{a99a2243589048a89d4449bd71ce8453,
title = "Nutritional status and risk factors for stunting in preschool children in Bhutan",
abstract = "Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z-scores of height-for-age [HAZ], weight-for-height [WHZ], and weight-for-age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7{\%}). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2{\%}, 2.6{\%}, 7.4{\%}, and 2.6{\%}, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3{\%} at <6 months (reference), 16.8{\%} at 6–23 months (OR = 3.06, 95{\%} CI [0.63, 14.8]), and 25.0{\%} at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6{\%} vs. an expected 2.5{\%} of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.",
keywords = "Bhutan, childhood stunting, nutritional trend, risk factors, South Asia, wasting",
author = "Yunhee Kang and Victor Aguayo and Campbell, {Rebecca K.} and Laigden Dzed and Vandana Joshi and Waid, {Jillian L.} and Gupta, {Suvadra Datta} and Haselow, {Nancy J.} and Keith West",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/mcn.12653",
language = "English (US)",
journal = "Maternal and Child Nutrition",
issn = "1740-8695",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Nutritional status and risk factors for stunting in preschool children in Bhutan

AU - Kang, Yunhee

AU - Aguayo, Victor

AU - Campbell, Rebecca K.

AU - Dzed, Laigden

AU - Joshi, Vandana

AU - Waid, Jillian L.

AU - Gupta, Suvadra Datta

AU - Haselow, Nancy J.

AU - West, Keith

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z-scores of height-for-age [HAZ], weight-for-height [WHZ], and weight-for-age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7%). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2%, 2.6%, 7.4%, and 2.6%, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3% at <6 months (reference), 16.8% at 6–23 months (OR = 3.06, 95% CI [0.63, 14.8]), and 25.0% at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6% vs. an expected 2.5% of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.

AB - Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z-scores of height-for-age [HAZ], weight-for-height [WHZ], and weight-for-age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7%). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2%, 2.6%, 7.4%, and 2.6%, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3% at <6 months (reference), 16.8% at 6–23 months (OR = 3.06, 95% CI [0.63, 14.8]), and 25.0% at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6% vs. an expected 2.5% of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.

KW - Bhutan

KW - childhood stunting

KW - nutritional trend

KW - risk factors

KW - South Asia

KW - wasting

UR - http://www.scopus.com/inward/record.url?scp=85056334025&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056334025&partnerID=8YFLogxK

U2 - 10.1111/mcn.12653

DO - 10.1111/mcn.12653

M3 - Article

C2 - 30412341

AN - SCOPUS:85056334025

JO - Maternal and Child Nutrition

JF - Maternal and Child Nutrition

SN - 1740-8695

M1 - e12653

ER -