Abstract
Background: The growth, development and nutrition of children in Tibet with high-altitude and unique traditional culture have recently gained attention. However, few researches are available on the nutritional status of younger children of Tibet.
Objective: The objective of the study was to evaluate the nutritional status of children below 36 months old in Tibet by means of anthropometry.
Design: The cross-sectional survey was conducted between August and September in 1999 and a sample of 1655 children below 36 months old was obtained using a stratified multistage cluster random sampling method from a total of seven districts of Tibet. Height, weight and hemoglobin concentration were measured and at the same time related sociodemographic and environmental information were collected. NCHS/CDC/WHO reference data were used to evaluate the nutritional status of the entire study children population and estimate the prevalence of stunting, underweight and wasting.
Results: Compared with the reference of NCHS/CDC/WHO, the distributions of HAZ and WAZ shifted to the left significantly and the means of HAZ and WAZ were −1.53 and −1.05, respectively, which were significantly lower than the reference value. The distribution of WHZ, however, was close to that of the reference. The reduction of Z-scores for height and weight occurred very early in life and was greatest in the second year after birth. The prevalence of malnutrition of children was 39.0% for stunting, 23.7% for underweight and 5.6% for wasting, respectively. Rural children had prevalence of stunting of 41.4% and underweight of 24.7%, as compared with prevalence of stunting of 25.3% and underweight of 18.1% for urban children. Stunting and underweight were associated with altitudes. The mean of hemoglobin (Hb) of children was 120.4 g/l and rural children had a significantly lower Hb concentration (119.9 g/l) than urban children (123.3 g/l). The prevalence of anemia seemed higher when using different altitude corrections for Hb to estimate the prevalence, but the consequences were uneven.
Conclusions: For Tibetan young children, the nutritional status of the entire population is poor and the prevalence of malnutrition is higher, especially for stunting. Malnutrition is related to high altitudes. Although the Hb concentration is higher induced by high altitude, there must be quite a lot of anemic children at high altitudes. The relationship between altitude and Hb for children on the Tibetan plateau requires further study in order to determine correctly the magnitude of anemia of children.
Sponsored and funding: The Ministry of Health, People's Republic China and United Nations Children's Fund (UNICEF).
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References
Beall CM (2000): Tibetan and Andean contrasts in adaptation to high-altitude hypoxia. Adv. Exp. Med. Biol. 475, 63–74.
Blood Hemoglobin Photometer Operating Manual (1999), Angelholm, Sweden: HemoCue AB.
CDC (1995): Altitude, Hemoglobin Curve and CDC Anemia Criteria which uses the altitude adjustment. Centers for Disease Control and Prevention.
Dallman PR, Siimes MA & Steckel A (1980): Iron deficiency in infancy and childhood. Am. J. Clin. Nutr. 33, 86–118.
Dang SN, Yan H, Zeng LX, Wang QL, Li Q & Li YF (2001): Analysis on nutritional status of children under three years old in the poor rural areas of Ningxia Hui autonomous region, China. J. China Children Health Care 9, 85–87.
De Meer K, Heymans HSA & Zijlstra WG (1995): Physical adaptation of children to life at high altitude. Eur. J. Pediatr. 154, 263–272.
De Onis M, Frongillo EA & Blossner M (2000): Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull. World Health Org. 78, 1222–1233.
Deng XP, PingCuo ZG & NiMa D (1991): Analysis on birth weight of 3939 newborn Tibetan and Han nationality children in Lhasa area, China. J. Tibetan Med. 12, 46–47.
Dibley MJ, Staehling N, Neiburg P & Towbridge FL (1987): Interpretation of Z-score anthropometric indicators derived from the international growth reference. Am. J. Clin. Nutr. 46, 749–762.
Dirren H, Logman MHGM, Barclay DV & Freire WB (1994): Altitude correction for hemoglobin. Eur. J. Clin. Nutr. 48(9), 625–632.
Graitcen PL & Gentry EM (1988): Measuring children: one reference for all. Lancet 2, 297–299.
Habicht JP, Martorell R, Yarbrough C, Malina RM & Klein RE (1974): Height and weight standards for preschool children: how relevant are ethnic difference in growth potential? Lancet 1, 611–615.
Harris NS, Crawford PB, Yangzom Y, Pinzo L, Gyaltsen P & Hudes M (2001): Nutritional and health status of Tibetan children living at high altitudes. N. Engl. J. Med. 344, 341–347.
He M, Mei J, Jiang Z, Chen Q, Ma J, Dai J, Li M, Su Y, Lui SSH, Yeung DL & Anderson GH (2001): Growth of infants during the first 18 months of life in urban and rural areas of southern China. J. Paediatr. Child Health 37, 456–464.
Liu R (1988): China Population, Section of Tibet. Beijing: Publishing House of Finance and Economy.
Liu RJ (1982): The survey on growth and development of 12077 students of primary and higher school living in Lhasa Municipal area in 1982. The collection of surveys on growth, development and health of students of primary and higher school in Tibet. Lhasa, China: The people's hospital of Lhasa Municipality.
Lohman TG, Roche AF & Martorell R (1991): Anthropometric Standardization Reference Manual (Abridged Edition). Champaign, IL: Human Kinetics Books.
National Bureau of Statistics of China (1999): China Statistics Yearbook. Beijing: China Statistical Publishing House.
National Working Committee on Children and Women (2001): Report of the People's of China on the Development of Children in the 1990s. p. 28.
Physical status (1995): The use and interpretation of anthropometry. Report of a WHO expert committee. WHO Tech Rep Ser 854.
Research Working Group on Growth and Development of Children in 9 Municipal Areas (1996): The Survey and Study on Development of Children, Ages 0–84 Months, Living in 9 Municipal Areas. Beijing: Publishing House of Beijing Medical University.
UNICEF/UNU/WHO (2001): Iron deficiency anaemia: assessment, prevention, and control. World Health Organization.
Weitz CA, Garruto RM, Chin CT, Liu JC, Liu RL & He X (2000): Growth of Qinghai Tibetans living at three different high altitudes. Am. J. Phys. Anthropol. 111, 69–88.
Yan H, Dang SN, Zeng LX, Li Q & Wang QL (1999): Report of surveys on basic health and maternal and child health care in 40 poor counties of western China and Tibet in 1999. Xi'an, China: Xi'an Jiaotong University.
Yip R, Nancy JB & Frederick LT (1988): Altitude and children growth. J. Pediatr. 113, 486–489.
Yip R (1987): Altitude and birth weight. J. Pediatr. 111, 869–876.
Zhao LY, Zhai FY, Hao HF, Du SF, He YN & Li Y (1999): The influential factors for the growth and development of preschool children in the poor areas of China. Acta Nutr. Sin. 21, 299–305.
Zhou AH, Hou SY, Qiang B, Bu Q & Wu ZM (1986): Survey and study on nutritional and growth status of children, ages 0–84 months, living in Lhasa Municipal area, Tibet. Lhasa, China: Maternal and Child Hospital of Lhasa Municipality.
Acknowledgements
We thank the Minister of Health, People's Republic of China, and United Nations Children's Fund for support and cooperation; Minister of Health, Tibet and the local health bureau and MCH stations such as Lhasa, Nyingchi, Xigaze, Lhokha, Chamdo, Nagchu and Ngari districts for cooperation and organization in the field data collection; and staff from MCH stations and Xi'an Jiaotong University for participation in the field data collection. We especially thank Dr Ray Yip and Dr Bin Liu, UNICEF, Beijng, Dr Zuguo Mei and Dr Parvanta Ibrahim, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Dr Tong Zhang, director of Project Office of MCH and Dr Gexin Wang, Minister of Health, People's Republic of China, Professor Zhonghui Feng, former director of Faculty of Public Health, Xi'an Jiaotong University and Yu Zhen, director of Department of MCH, Minister of Health, Tibet for their constructive suggestions in the preparation of research protocol and data collection and processing. We also thank Quangli Wang, Yuxue Bi, Hong Xie, Qiang Li, Shengbin Xiao for data arrangement and entry.
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Guarantor: HY.
Contributors: SD was involved in the preparation of the research protocol, field management, collection and analysis of data and manuscript writing. HY was responsible for the design of research and sampling, field management and preparation of protocol. SY provided significant advice, consultation and guidance on the data analysis and interpretation and manuscript writing. XW provided important advice on the design of research and collection of data. LZ was involved in the preparation of the survey and data of analysis.
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Dang, S., Yan, H., Yamamoto, S. et al. Poor nutritional status of younger Tibetan children living at high altitudes. Eur J Clin Nutr 58, 938–946 (2004). https://doi.org/10.1038/sj.ejcn.1601915
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DOI: https://doi.org/10.1038/sj.ejcn.1601915
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