A regional pattern of height and weight in children under age fifteen.

A regional pattern of height and weight in children under age fifteen.

149
Rev Biomed 1997; 8:149-154.
Original article
A regional pattern of height and
weight in children under age
fifteen.
Gilberto Balam-Pereira1, Francisco Gurri-García2, Ernesto Ochoa-Estrada1, Genny Sonda-Ortiz1.
1
Cinvestav, Unidad Mérida, Mérida, Yucatán, México, 2ACT Indiana University, Bloomington, Indiana,
U.S.A.
RESUMEN.
La Península de Yucatán ha sido
considerada como una región crítica desde el
punto de vista de su alta frecuencia de
desnutrición, particularmente en los niños
menores de cinco años.
Los niños yucatecos son más bajos de
estatura y más delgados en comparación con los
de otras poblaciones. A la fecha todos los estudios
comparativos se han hecho con patrones
internacionales. Este trabajo se desarrolló durante
1995 y presenta los promedios de pesos y tallas
de una muestra de 11,764 menores de 15 años
del estado de Yucatán, que puede ser útil para la
evaluación de los programas nutricionales y de
intervención comunitaria locales.
Palabras clave: patrón, peso, talla, nutrición,
somatometría.
SUMMARY.
Frequency of malnutrition in the Yucatan
Peninsula is considered to be one of the most
critical in southeast Mexico, especially amongst
children under five years of age. In addition,
Yucatecan children are short and thin in
comparison with other populations. To date,
however, all nutritional clasifications have been
made based on international height and weight
standards. This paper presents a local height
and weight standard for children under 15 based
on a sample of 11,764 children from the state
of Yucatan (1995), that should be usefull in
local nutritional evaluation and intervention
programs.
Key words: pattern, weight, height, nutrition,
anthropometry.
Correspondence: Dr. Gilberto Balam-Pereira. Depto. de Ecología Humana, CINVESTAV, Unidad Mérida, Km. 6 Antigua Carretera a Progreso. Mérida,
Yuc., Mex. Telephone: (99) 8l-29-20. Fax: (99) 81-29-19 and (99) 81-29-17. E mail: [email protected]
Received September 27th, 1995; Accepted July 9th, 1997.
Vol. 8/No. 3/Julio-Septiembre, 1997
150
G Balam-Pereira, F Gurri-García, E Ochoa-Estrada, G Sonda-Ortiz.
INTRODUCTION.
The use of international standards in the
evaluation of nutritional status has not been without
its critics. Although Martorell (1), Waterlow (2),
Eveleth and Tanner (3) claim that minimal genetic
differences in growth exist between birth and age
10, children of similar socio-economic status and
different ethnic groups have shown differences in
growth physique (4-6). In light of this, growth
standards have been developed that reflect racial,
geographic and socio-economic differences (7).
Unfortunately, where malnutrition is
common, it becomes difficult to include only well
nourished children in local growth standards, as
recommended by the World Health Organization
(2). Nevertheless, Cameron (8) insists that it is
inadecuate to judge the growth of an individual
based on the average of a population that may
follow a different growth trajectory. Thus, he
proposes that local standards should be developed
for growth evaluation even if the secular trend in
growth continues. Cameron proposes, that in these
populations, regional standards should be revised
periodically.
It is possible to judge the growth of a child
based on a pattern obtained from a population with
different genetic and environmental characteristics.
Growth rate and final adult size, however, are the
result of an interactive process between genes and
environment. This environment is not exclusively
nutritional. Deviations from a local pattern, will
better detect individuals that are at a dissadvantage
in relationship to the rest of their population.
Individuals, who are truly different from their
population and not just too small in comparison to
an international standard.
The purpose of this paper is to propose the
first regional growth standard for the nutritional
classification of children under the age of fifteen
in the State of Yucatan. Because the urban and rural children in this sample do not belong to a
population at the end of its secular trend in growth,
this standard can only be considered temporary.
Similar efforts should be carried out every five to
Revista Biomédica
ten years. It is hoped that the following tables will
be useful to workers in health sciences working in
the Yucatan Peninsula.
MATERIAL AND METHOD.
A sample of 11,764 children under 15 years
old, was obtained from nine child care centers,
19 rural medical units "Unidades Medicas Rurales", 4 schools in Merida and Progreso and from
independent rural censuses carried out by us in
the maize region of the state of Yucatan. In the
census, height was measured with a Martin-type
anthropometer in children who could stand on
their own, and on an infant meter table on those
who could not, according to international
recomendations (9). Weight was taken using a
bathroom scale with children who could stand on
their own, and a spring scale for infants. The data
obtained in clinics was done with standard medical
equipment. In day care centers, children were
measured on an infant meter table and weighed on
pediatric scales.
The values of height for age and weight for
age were estimated for boys and girls separately.
Average monthly values of height for age, and
weight for age were obtained for up to 12 months
of age. After that, average values were obtained
every six months, and from children five to fourteen
years old, every year. The table values presented
for height/age (H/A) and weight/age (W/A) are
estimated. They were graphed and then smoothed
using a freehand method (10).
RESULTS.
The total sample consisted of 5,933 boys and
5,839 girls. Table 1 shows their distribution by age
group. These data were obtained in 19 municipios
of the state of Yucatan: Cantamayec 241,
Chaksinkin 352, Chankom 112, Chichimila 279,
Chikindzonot 408, Chumayel 224, Espita 228,
Halacho 254, Izamal 191, Kaua 245, Maní 157,
Maxcanú 217, Mérida 2,939, Sotuta 488, Teabo
151
Height and weight in children.
Table1
Distr
ibition b
yg
ender and a
ge of 11,764
ri
by
gender
ag
childr
en under 15 y
ear
s
.
ren
ye
rs
group
months and years
n
boys
n
girls
0 < 1 month
1<4
4<6
6 - 11
1 - 1.5 years
1.6 - 1.11
2 - 2.5
2.6 - 2.11
3 - 3.5
3.6 - 3.11
4 - 4.5
4.6 - 4.11
5 - 5.11
6 - 6.11
7 - 7.11
8 - 8.11
9 - 9.11
10 - 10.11
11 - 11.11
12 - 12.11
13 - 13-11
14 - 14-11
59
130
125
338
359
403
448
459
387
382
386
391
176
264
230
280
234
241
196
130
174
141
55
113
125
354
382
411
464
460
403
401
375
408
123
257
278
255
207
218
147
115
161
119
total
114
243
250
692
741
814
912
919
790
783
761
799
299
521
508
535
441
459
343
245
335
260
Total
5933
5839
11,764
_______________________________________________________
262, Tixcacalcupul 608, Tizimin 913, Valladolid
747, Yaxcaba 953 and Progreso 1946.
Table 2 shows the mean and the value two
standard deviations below the mean of height for
age. Table 3 shows the mean weight for age, and
the value one standard deviation from the mean.
One instead of two standard deviations were
considered to be of greater value in the early
detection of acute and chronic malnutrition (11).
Table2
Lenght (cm) b
geinc
hildr
en y
oung
er than 15 y
ear
s
by
ag
ch
re
young
ounge
ye
rs
ya
Age
year month
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
0
1
2
3
4
5
6
7
8
9
10
11
0
1
2
3
4
5
6
7
8
9
10
11
0
1
2
3
4
5
6
7
8
9
10
11
boys
-2 sd
mean
cm
girls
-2 sd mean
cm
45.7
45.8
46.0
47.1
50.4
50.5
55.5
55.8
55.8
58.0
58.2
59.8
59.8
60.9
64.8
65.3
65.3
65.3
65.4
66.5
66.6
67.0
67.1
67.4
67.6
67.7
68.0
68.4
68.7
68.8
74.4
74.4
74.6
74.7
74.8
74.8
39.8
40.2
45.4
48.0
51.0
51.5
53.0
55.8
55.8
56.0
57.7
57.8
60.0
60.0
62.2
62.4
62.4
63.3
64.3
64.7
66.3
66.5
67.0
67.0
67.3
67.6
68.3
68.4
68.4
68.7
68.8
72.2
72.6
72.7
74.0
74.0
59.0
59.1
59.6
59.9
59.9
62.6
63.7
64.4
66.7
68.2
68.2
68.4
70.2
70.2
70.9
72.1
73.4
74.7
74.7
75.7
76.3
76.8
77.1
78.0
78.9
79.1
79.7
81.1
81.2
81.8
82.8
83.6
84.1
84.7
85.2
85.4
53.4
54.1
55.2
56.6
58.6
60.6
62.1
63.5
64.9
67.0
67.0
67.4
68.7
69.4
71.0
71.2
72.1
72.3
73.3
73.6
74.6
76.0
76.0
76.0
76.6
77.7
78.3
80.6
80.7
80.7
81.3
82.0
82.3
82.3
84.1
85.3
Chronic malnutrition = - 2 s.d.
Vol. 8/No. 3/Julio-Septiembre, 1997
152
G Balam-Pereira, F Gurri-García, E Ochoa-Estrada, G Sonda-Ortiz.
Table 2 (contin
ua
tion)
nua
uat
Table3
Lenght (cm) b
geinc
hildr
en y
oung
er than 15 y
ear
s
by
ag
ch
re
young
ounge
ye
rs
ya
W eight (kg) b
geinc
hildr
en y
oung
er than 15 y
ear
s
.
by
ag
ch
re
young
ounge
ye
rs
ya
Age
year month
age
year month
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
5678910 1112 13 14 -
0
1
2
3
4
5
6
7
8
9
10
11
0
1
2
3
4
5
6
7
8
9
10
11
5.11
6.11
7.11
8.11
9.11
10.11
11.11
12.11
13.11
14.11
boys
-2 sd
mean
cm
74.9
75.2
75.4
75.5
77.5
77.7
78.0
78.6
80.9
81.0
81.1
81.3
82.6
82.8
82.9
83.6
83.7
83.7
83.8
84.0
84.0
85.8
85.9
86.0
92.9
96.5
101.1
104.5
109.1
114.5
119.7
122.7
126.5
132.9
85.9
87.2
87.4
88.6
89.0
89.9
90.2
90.3
91.0
91.0
91.1
91.4
91.5
91.7
93.6
93.8
93.8
93.9
94.0
94.0
94.9
95.0
95.6
96.2
103.1
109.2
113.4
119.3
122.8
122.8
131.2
134.3
139.9
146.3
girls
-2 sd
mean
cm
75.2
75.4
75.5
75.8
75.8
77.3
78.2
78.4
79.9
80.0
80.0
80.2
81.0
81.1
81.3
82.4
83.2
83.5
83.7
84.0
84.7
85.3
85.4
85.6
91.3
97.4
192.9
106.1
108.7
108.7
118.1
123.7
127.5
132.1
Chronic malnutrition = - 2 s.d.
85.4
86.0
87.0
87.2
87.3
89.0
89.1
90.2
90.3
90.5
91.2
91.2
91.3
91.4
91.6
92.5
93.4
93.4
94.1
94.1
95.1
95.5
96.0
96.0
100.7
106.6
113.9
118.3
122.6
122.6
131.2
134.4
139.6
143.5
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
0
1
2
3
4
5
6
7
8
9
10
11
0
1
2
3
4
5
6
7
8
9
10
11
0
1
2
3
4
5
6
7
8
9
10
11
boys
-1 sd mean
kg
girls
-1 sd mean
kg
1.7
2.5
2.6
4.6
5.2
5.3
6.3
6.5
6.6
7.0
7.1
7.2
7.5
7.6
7.7
7.9
8.1
8.2
8.2
8.4
8.5
8.6
8.9
9.0
9.0
9.1
9.4
9.4
9.6
9.6
10.3
10.4
10.4
10.5
10.5
10.6
2.4
3.4
3.7
4.3
5.0
5.5
5.7
6.0
6.0
6.2
6.5
6.6
7.0
7.0
7.3
7.3
7.4
7.8
8.0
8.0
8.3
8.4
8.4
8.5
8.5
8.6
8.8
9.0
9.0
9.1
9.1
9.3
9.6
9.6
10.0
10.2
5.0
5.2
6.0
6.0
6.2
6.9
7.4
7.7
8.0
8.3
8.5
8.5
8.7
9.0
9.0
9.0
10.0
10.0
10.0
10.0
10.0
10.3
10.4
10.5
10.5
10.7
11.1
11.1
11.4
11.6
12.0
12.0
12.0
12.3
12.3
12.5
.
Acute malnutrition : - 1 s.d.
Revista Biomédica
4.4
4.6
5.0
5.4
6.0
6.6
6.9
7.1
7.2
8.0
8.0
8.0
8.1
8.4
8.5
8.7
9.0
9.1
9.2
9.7
10.0
10.0
10.0
10.0
10.2
10.4
10.5
11.0
11.0
11.0
11.4
11.4
11.4
11.6
11.8
12.0
153
Height and weight in children.
Table 3 (contin
ua
tion)
nua
uat
W eight (kg) b
geinc
hildr
en y
oung
er than 15 y
ear
s
.
by
ag
ch
re
young
ounge
ye
rs
ya
age
year month
3
0
3
1
3
2
3
3
3
4
3
5
3
6
3
7
3
8
3
9
3 10
3 11
4
0
4
1
4
2
4
3
4
4
4
5
4
6
4
7
4
8
4
9
4 10
4 11
5- 5.11
6- 6.11
7- 7.11
8- 8.11
9- 9.11
10 - 10.11
11 - 11.11
12 - 12.11
13 - 13.11
14 - 14.11
boys
-1 sd mean
kg
girls
-1 sd
mean
kg
10.8
10.8
11.1
11.2
12.0
12.0
12.0
12.0
12.2
12.2
12.3
12.4
12.5
12.5
13.0
13.0
13.1
13.1
13.2
13.3
13.3
14.0
14.0
14.3
14.5
15.2
16.5
18.9
20.3
22.0
23.6
26.7
30.6
37.0
10.2
10.3
10.5
10.6
10.8
11.0
11.1
11.3
11.6
11.6
11.8
11.8
11.9
11.9
12.1
12.3
12.4
12.4
12.4
12.4
12.7
13.0
13.2
13.4
14.1
15.5
16.9
18.3
20.3
22.4
24.6
26.3
30.6
36.0
12.6
12.8
12.9
13.2
13.3
13.6
13.7
13.7
14.0
14.1
14.2
14.2
14.2
14.2
14.4
14.5
14.6
14.7
14.7
14.8
14.8
15.1
15.3
15.4
16.2
18.1
20.1
21.6
23.1
25.3
27.8
29.8
31.6
38.0
.
Acute malnutrition : - 1 s.d.
12.3
12.4
12.6
12.7
12.8
13.0
13.2
13.4
13.4
13.4
13.5
13.5
13.6
13.6
13.7
13.9
14.0
14.1
14.3
14.4
14.5
14.7
14.9
14.9
15.5
18.2
19.3
21.3
25.0
28.0
29.7
31.9
34.4
38.0
DISCUSSION.
In the abscence of a local growth pattern for
the Yucatan Peninsula, Ramos Galvan’s (12) and
the National Center for Health Statistics (NCHS)
(13) standards have been used for growth and
nutritional monitoring. These patterns, however,
were developed amongst populations that differ
considerably from the Yucatan, especially the
Maya. These and Maya admixed children are well
represented in the present standard.
The Maya are extremely short and stocky.
Well fed, even fat children under the age of 1.5
years old, will appear as stunted using the
aformentioned standards. It is not the intention of
this paper to solve or even to contribute to the
"small but healthy" controversy. We simply
aknowledge that Maya, and Maya admixed children
at the present do grow at a different pace than well
off Mexico City dwellers, or Americans. Yucatan
children have distinctive proportions, and
recognizing this may lead us to a better diagnosis
of their living conditions.
It is also important to keep in mind that many
of the children measured in this survey are
malnourished according to Waterlow’s (2)
classification. They, however, belong to a
population where most children have been
classified as malnourished using these standards
(14) Within this population, the use of this standard will permit the identification of those who are
less adapted and at greater risk. It may be used to
make operational decisions, and to select the areas
in which resources are more urgently needed.
This reference is presented as a tool for use
in local clinics. It is extremely dissapointing for a
mother to be told that child should have a height
that he or she will never attain. The use of this
standard will present mothers a more realistic
choice in the monitoring of their child’s growth.
Nevertheless, we do not at any point propose that
the reference presented here should be considered
a final standard. Children in Yucatan have a long
way to go before they can achieve their genetic
potential (15).
Vol. 8/No. 3/Julio-Septiembre, 1997
154
G Balam-Pereira, F Gurri-García, E Ochoa-Estrada, G Sonda-Ortiz.
ACKNOWLEDGMENTS.
We want to acknowledge the Instituto Mexicano del Seguro Social, for their collaboration in providing
us with the data collected in their institutions We also want
to mention that some of the data from the maize region was
obtained with money from NSF grant. The authors take
full responsibility for the contents of this article.
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