Relationships Between Anthropometrical Indices and Socio-Economic Differences for Children at 6 Years Old Living in Urban Areas of Ardebil, Iran
A. Naghizadeh Baghi,
The aim of this study was to explore association between
economic differences and nutritional status of children living in Ardebil
urban areas. In a descriptive cross-sectional study, 698 preschool children
(346 males, 352 females) at 6 years old from different regions of Ardebil
city (Iran) were selected by a multi stage sampling method. Variables
such as age and anthropometric factors (height, weight and BMI) were measured.
The results showed that the mean values for height, weight and BMI were
less than NCHS standards. There has been no severe malnutrition among
the subjects studied. However, mild (31.6%) and moderate underweight (7.9%)
were observed. Similarly, no severe stunting cases were observed; however,
17.2 and 1.4% of the cases were suffering from mild and moderate stunting,
respectively. Mild and moderate wasting rates were found to be 25.5 and
0.9%, respectively. Based on BMI for age, 2 and 4% of children were overweighed
and being at the risk of overweight, respectively. Significant associations
were observed between birth weight and BMI and weight. There was a significant
difference between height and family`s monthly income. Height of the children
was significantly higher in objects living in private homes compared to
rental homes (p<0.05). No significant association was observed between
anthropometric factors and birth ranking, mother education and employment
status. The lack of severe malnutrition implies that the growth status
is acceptable among children at 6 years old, although it was lower than
the NCHS standards. However, economic status may affect long term growth
of the children.
to cite this article:
A. Nemati, M Barak, A. Naghizadeh Baghi, N. Abbasgholizadeh, F. Homapour, S. Hazrati, V. Sepehram and B. Shakiba, 2008. Relationships Between Anthropometrical Indices and Socio-Economic Differences for Children at 6 Years Old Living in Urban Areas of Ardebil, Iran. Journal of Applied Sciences, 8: 3748-3752.
Nutrition is one of the most important factors influencing the children
health. It plays a vital role in prevention and control of various diseases.
Recent reports show that the world children suffer from protein energy
malnutrition (Robbins et al., 2007; Cornelio-Nieto, 2007; Agrahar-Murugkar,
2005). The influence of increasing affluence is likely to be seen both
in the form of increased obesity among older females and underweight among
children (Hakeem, 2001). There is considerable heterogeneity in poverty,
morbidity, mortality and nutritional status in urban areas, with often
enormous differentials between poor and the middle- to high-income parts
of a particular city. Major socio-economic differences in child health
and mortality have been reported within the urban sector of Ghana (Rikimaru
et al., 1988), Guatemala (Engle., 1993), Ethiopia (Getaneh et
al., 1998), Brazil (Gross and Monteiro, 1989), Nepal (Martorell et
al., 1984), Malawi (Quinn et al., 1995), Bangladesh (Ahmed
et al., 1991), Saudi Arabia (Serenius and Swailem, 1988), Pakistan
(Hakeem, 2001) and Iran (Ayatollahi et al., 2006). The possible
socio-economic reasons of trend in the BMI and prevalence of overweight
and obesity among preschool has been well of defined in a number of studies
(Jakimaviciene and Tutkuviene, 2007; York et al., 2004). The patterns
of within-urban differences vary between countries according to the overall
degree of national development and the particular history of urban development.
Excess weight appears first among the affluent and then among low-income
classes including young children and teenagers (Delpeuch and Maire, 1997).
Body mass index (BMI) is positively associated with income and education
in Asia but not in Latin America (Inclen, 1996). Pattern of association
between certain nutritional disorders and income level within a society
thus could be an indication of stage of nutrition transition. It appears
that, during the process of urbanization and associated nutrition transition,
societies pass through a span where both under- and over nutrition-related
problems occur simultaneously. The length of this stage is probably determined
by the society`s adaptation to a new lifestyle through behavioral change
and allocation of nutritional resources at the community and the household
level. Currently, in many developing countries, urban populations are
suffering from the worst of both worlds: the effect of under nutrition
with its greatest impact on infants, children and women of child-bearing
age and excessive nutrition creating a variety of chronic health conditions
in middle-aged and older adults (Posner et al., 1994; Popkin, 1994;
Popkin et al., 1996). The existing evidence suggests that the urban
society and the associated nutritional problems are too heterogeneous
to allow generalizations. In developing countries where the problem of
undernutrition is customarily given attention, the focus of attention
now needs to encompass overnutrition- related problems as well. Therefore
this study aims at exploring the association between income and nutritional
status in urban areas of Ardebil and focuses on the socio-economic differences
in anthropometrically assessed nutritional status of children living in
MATERIALS AND METHODS
Study design and population: Samples were selected using a multi
stage sampling method in 2007. A total number of 698 preschool children
(346 males, 352 females, at 6 years old) from different regions of Ardebil
city (Iran) were included in the study. Variables such as age and anthropometric
parameters (e.g., height, weight and BMI) were measured for all subjects.
A validated questionnaire was used to assess socio-economic differences
among subjects. Information about the family`s monthly income and possession
of household assets were obtained using a validated questionnaire. The
information was used to develop a Socio-Economic Status (SES) scale and
each family was assigned a SES score accordingly. Subjects having any
diseases were excluded from the study
Anthropometric measurements: Anthropometric parameters (height,
weight and BMI) were measured for all children meeting the study criteria.
Height and weight were obtained using a portable digital scale and portable
digital Stadiometer. Height and weight were measured without shoes and
in light summer school uniform in a private room by trained
research assistants. The subjects were asked to stand, without shoes
against the wall with heels, buttocks and shoulders touching the wall.
The head was kept in the plane and measurement was recorded to the nearest
0.5 cm. Weight was measured to the nearest 0.1 kg
using portable Soenle digital scales with a range of 0-200
kg. BMI was calculated using the data recorded for height and
weight. BMI values were compared with the reference values
-NHANES III- for corresponding ages (CDC, 2000). Children below the 5th
percentile were termed underweight and those having BMI above the 95th
percentile were termed overweight.
Statistical analysis: SPSS for windows, version 13 was used for
data entry and analysis. Results are expressed as mean±SD. The
data were analyzed using one sample t-test, Independent Samples t-test,
Pearson Correlation and Chi-square tests. Significance was assumed at
Percentile of height and weight for both sexes are shown in Fig.
1 and 2, respectively.
||The compared of height percentile of boys and girls
||The compared of weight percentile of boys and girls
||Mean values for height, weight and BMI in different
|All Values are mean±Standard deviation. *Different
is significant at the 0.05 level (2-tailed)
||The frequency of stunting between two different groups
based on Waterloo classification
Height and weight percentiles
for boys and girls were less than corresponding 10th, 25th, 50th, 75th,
90th and 95th NCHS percentile values (p<0.05). Table 1 shows the mean of the anthropometric parameters including
weight, height and BMI for all children based on living in rental/private houses
and gender. Height and weight of the children was significantly higher in objects
living in private homes compared to rental homes (p<0.05). The mean values
of height, weight and BMI of children in this study were less than the values
reported by NCHS. Comparing two other important variables, i.e., the situations
of weight (as the ratio of weight to standard weight for age) and height (as
the ratio of height to standard height for age), our data and NCHS values also
showed statistically significant differences (p<0.05). Based on Waterloo
classification, height for age values were within the normal range in majority
of cases (Table 2). As indicated in Table 3,
weight for height values were also in normal ranges. According to Gomez classification
for nutritional status of children by sex, it was found that the prevalence
of normal, mild and moderate underweight were, 60.5, 31.6 and 7.9%, respectively.
There has been no severe malnutrition among the subjects studied. Similarly,
no severe stunting cases were observed; however, 17.2 and 1.4% of the cases
indicated mild and moderate stunting, respectively. Mild and moderate wasting
were 26.5 and 0.9%, respectively. Based on BMI for age, only 2% of children
had overweighted and 4% being at the risk of overweight. Significant associations
were observed between birth weight and anthropometric parameters (i.e., BMI
and weight). There was a significant difference between height and family`s
monthly income; the children of family`s with high income were higher than lower
||The frequency of wasting between two different Groups
based on Waterloo classification
No significant associations were observed between anthropometric
factors and birth ranking, mother education and employment status. However,
the values for both weight and BMI showed significant difference when compared
to health care availability (p<0.05).
Present study indicates children have experienced mild and moderate under
nutrition. The higher prevalence of mild under nutrition along with less
moderate and no severe malnutrition may indicate appropriate health care
given by health workers leading to good information of parents on health
care as well as the better socio-economic status of household. Based on
BMI for age 2 and 4% of children had overweighed and being at the risk
of overweight, respectively. We found significant association between
birth weight and weight and BMI in children at six years old. The height-for-age,
on the basis of Waterloo classification, was normal for 81.4% with the
rest being stunted. Similarly, based on weight-for-age, we found 73.5
and 26.5% of children to be normal and wasting, respectively. According
to Gomez classification for nutritional status of children by sex, it
was found that the prevalence of normal and underweight were, 60.5%, 39.5,
respectively. Present data show significant relationship between total
family income and anthropometric parameters, which is similar to study
of Ayatollahi et al. (2006). A positive association between linear
growth of children and income level of families has been reported from
a number of studies (Quinn et al., 1995; Miller and Korenman, 1994;
Gross et al., 1996). Maximum height was related to high level income.
These positive relationships might be as a result of economic development
and improvement of social and health indicators in children at six years
old. Deficit in height has also been found to be more profoundly associated
with low income level than the differences in bodyweight in Bangladesh
(Bairagi and Chowdhury, 1994) and Brazil (Cedraz and Carvalho, 1990).
Present results supports Peña Reyes et al. (2002) report
on a clear reduction in the gap in height of children between well-off
and a lower socioeconomic status in different regions of Mexico. However,
there has been an increase in the prevalence of mild and moderate malnutrition.
Chronic undernutrition -as indicated by deficit in height- decreased with
increasing income level. Socio-economic status was related to height among
various sex groups. The influence of increasing affluence is likely to
be seen in the form of increased underweight among children. Differing
patterns of association between income and weight status among male and
female children need further research with more accurate birth records.
We observed no significant association between anthropometric parameters
and mother education; which is inconsistent with the study of Maddah et
al. (2007) in Rasht City of Iran. They reported that the relative
risk for under nutrition was higher in the children of both less and highly
educated mothers compared with children of mothers with an intermediate
level of education. The mean values of height, weight and BMI of children
in our study were less than the values reported by NCHS that is similar
to the repot of Nasirian and Tervij-Eslami (2006). Food assistance programs
have the potential to modify the effects of food insecurity on a child`s
weight and health status.
Severe malnutrition not observed in this study. The growth status in
children at 6 years old was marginally acceptable, although it was a little
bit lower than NCHS standard. As result we concluded that economic status
may affect the height growth of the children while possession of household
has impact on birth weight, height and weight.
Agrahar-Murugkar, D., 2005. Nutritional status of Khasi schoolgirls in Meghalaya. Nutrition, 21: 425-431.
Direct Link |
Ahmed, F., M.A. Bhuyan, N. Shaheen, S. Barua, B.M. Margetts and A.A. Jackson, 1991. Effect of socio-demographic conditions on growth of urban school children of Bangladesh. Eur. J. Clin. Nutr., 45: 327-330.
Ayatollahi, S.M., S. Pourahmad and Z. Shayan, 2006. Trend in physical growth among children in Southern Iran, 1988-2003. Ann. Hum. Biol., 33: 510-514.
Bairagi, R. and M.K. Chowdhury, 1994. Socioeconomic and anthropometric status and mortality of young children in rural Bangladesh. Int. J. Epidemiol., 23: 1179-1184.
CDC, (National Center for Chronic Disease Prevention and Health Promotion), 2000. Anhtro; Software for calculating pediatric anthropometry. V. 1.02, 1999. http://www.cdc.gov/nccdphp/ dnpa/anthro.htm.
Cedraz, L.M. and F.M. Carvalho, 1990. Family income and child malnutrition in the coast of Camacari Brazil. Arch. Latinoam. Nutr., 40: 323-332.
Cornelio-Nieto, J.O., 2007. The effects of protein-energy malnutrition on the central nervous system in children. Rev. Neurol., 2, 44: S71-74.
Delpeuch, F. and B. Maire , 1997. Obesity and developing countries of the South. Med. Trop. (Mars), 57: 380-388.
Engle, P.L., 1993. Influences of mothers and fathers income on children's nutritional status in Guatemala. Soc. Sci. Med., 37: 1303-1312.
Getaneh, T., A. Assefa and Z. Tadesse, 1998. Protein-energy malnutrition in urban children prevalence and determinants. Ethiop. Med. J., 36: 153-166.
Gross, R. and C.A. Monteiro, 1989. Urban nutrition in developing countries some lessons to learn. Food Nutr. Bull. WHO., 11, [http://www.unu.edu/ unupress/food/8F112e/8F112E03.htm#Urban nutrition in developing countries: Some lessons to learn].
Gross, R., W. Schultink and S. Sastroamidjojo, 1996. Stunting as an indicator for health and wealth: An Indonesian application. Nutr. Res., 16: 1829-1837.
Hakeem, R., 2001. Socio-economic differences in height and body mass index of children and adults living in urban areas of Karachi, Pakistan. Eur. J. Clin. Nutr., 55: 400-406.
Direct Link |
Inclen, 1996. Body mass index and cardiovascular disease risk factors in seven Asian and five Latin American centers data from the International Clinical Epidemiology Network (INCLEN). Obes. Res., 4: 221-228.
Jakimaviciene, E.M. and J. Tutkuviene, 2007. Trends in body mass index, prevalence of overweight and obesity in preschool Lithuanian children, 1986-2006. Coll. Antropol., 31: 79-88.
Maddah, M., Z. Mohtasham-Amiri, A. Rashidi and M. Karandish, 2007. Height and weight of urban preschool children in relation to their mothers educational levels and employment status in Rasht City, Northern Iran. Maternal Child Nutr., 3: 52-57.
Martorell, R., J. Leslie and P.R. Moock, 1984. Characteristics and determinants of child nutritional status in Nepal. Am. J. Clin. Nutr., 39: 74-86.
Miller, J.E. and S. Korenman, 1994. Poverty and children's nutritional status in the United States. Am. J. Epidemiol., 140: 233-243.
Direct Link |
Nasirian, H. and S. Tarvij-Eslami, 2006. Physical growth standards in six to twelve-year-old children in Mashhad, Iran. Arch. Iran Med., 9: 58-60.
Direct Link |
Peña Reyes, M.E., E.E. Cárdenas Barahona, M.B. Cahuich, A. Barragán and R.M. Malina, 2002. Growth status of children 6-12 years from two different geographic regions of Mexico. Ann. Hum. Biol., 29: 11-25.
Popkin, B.M., 1994. The nutrition transition in low-income countries an emerging crisis. Nutr. Rev., 52: 285-298.
Popkin, B.M., M.K. Richards and C.A. Montiero, 1996. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. J. Nutr., 126: 3009-3016.
Posner, B.M., M. Franz, P. Quatromoni and The Interhealth Steering Committee, 1994. Nutrition and the global risk for chronic diseases the Interhealth nutrition initiative. Nutr. Rev., 52: 201-207.
Quinn, V.J., M.O. Chiligo-Mpoma, K. Simler and J. Milner, 1995. The growth of Malawian preschool children from different socioeconomic groups. Eur. J. Clin. Nutr., 49: 66-72.
Rikimaru, T., J.E. Yartey, K. Taniguchi, D.O. Kennedy and F.K. Nkrumah, 1988. Risk factors for the prevalence of malnutrition among urban children in Ghana. J. Nutr. Sci. Vitaminol., 44: 391-407.
CrossRef | PubMed | Direct Link |
Robbins, J.M., K.S. Khan, L.M. Lisi, S.W. Robbins, S.H.Michel and B.R. Torcato, 2007. Overweight among young children in the Philadelphia health care centers: Incidence and prevalence. Arch. Pediatr. Adolesc. Med., 161: 17-20.
Direct Link |
Serenius, F. and A.R. Swailem, 1988. Growth and nutritional status of less privileged urban children in Saudi Arabia. Acta. Paediatr., 77: 93-103.
York, D.A., C.S. Rossner, C.I. Caterson, C.M. Chen, W.P.T. James, S. Kumanyika, R. Martorell and H.H. Vorster, 2004. Obesity, a worldwide epidemic related to heart disease and stroke: Group I: Worldwide demographics of obesity. Circulation, 110: e463-e470.