两种儿童生长标准评价6岁以下儿童营养状况的比较

Comparison of two child growth standards in assessing the nutritional status of children under 6 years of age

目的比较中国2022年发布的7岁以下儿童生长标准(简称中国标准)与世界卫生组织儿童生长标准(简称WHO标准)评价我国0~<6岁儿童营养状况的差异。方法横断面研究数据来自国家“十三五”科技基础资源调查专项“中国0~18岁儿童营养与健康系统调查与应用”,采用多阶段分层随机整群抽样方法纳入全国14个省、自治区、直辖市的38848名0~<6岁儿童进行体格测量,对儿童家长进行问卷调查。分别应用中国标准和WHO标准评价生长迟缓、低体重、消瘦、超重和肥胖5项指标。采用χ^(2)检验比较两种标准间各指标检出率以及不同性别、不同月龄两种标准间各指标检出率差异。结果38848名儿童中男19650名(50.6%)、女19198名(49.4%),城市儿童19480名(50.1%)、农村儿童19368名(49.9%)。儿童的生长迟缓、低体重和消瘦按中国标准评价分别有2090名(5.4%)、1354名(3.5%)和1276名(3.3%),WHO标准评价分别有1474名(3.8%)、701名(1.8%)和824名(2.1%),中国标准检出率均高于WHO标准(χ^(2)=111.59、213.14、99.99,均P<0.001)。超重和肥胖按中国标准评价分别有2186名(5.6%)和1153名(3.0%),WHO标准评价分别有2210名(5.7%)和1186名(3.1%),差异均无统计学意义(χ^(2)=0.14、0.48,P=0.709、0.488)。男童的超重检出率中国标准低于WHO标准(χ^(2)=14.95,P<0.001),女童则是中国标准高于WHO标准(χ^(2)=12.60,P<0.001)。男童的肥胖检出率中国标准低于WHO标准(χ^(2)=5.85,P=0.016),女童则差异无统计学意义(χ^(2)=2.62,P=0.106)。结论中国标准对0~<6岁儿童的营养不良检出率总体略高于WHO标准,评价儿童营养状况宜根据实际工作要求或研究目标需求选择适合的儿童生长标准。

ObjectiveTo 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.MethodsThe 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(n=38848)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.ResultsAmong the 38848 children,19650 were boys(50.6%)and 19198 were girls(49.4%),19480 urban children(50.1%)and 19368 rural children(49.9%).The stunting,underweight and wasting cases in the study population were 2090 children(5.4%),1354 children(3.5%)and 1276 children(3.3%)according to the China standards,and 1474 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(χ^(2)=111.59,213.14,and 99.99,all P<0.001).The overweight and obesity cases in the study population were 2186 children(5.6%)and 1153 children(3.0%)according to the China standards,and 2210 children(5.7%)and 1186 children(3.1%)according to the WHO standards,with no statistically significant differences(χ^(2)=0.14 and 0.48,P=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(χ^(2)=14.95 and 5.85,P<0.001 and=0.016,respectively),and higher prevalence of overweight in girls(χ^(2)=12.60,P<0.001);but there was no statistically significant differences in girls′obesity prevalence between the two standards(χ^(2)=2.62,P=0.106).ConclusionsIn 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.