1. ¹Department of Health statistics, Faculty of Public Health, College of Medicine, Xi'an Jiaotong University, Xi'an, China
2. ²Applied Nutrition, Department of Nutrition, School of Medicine, The University of Tokushima, Tokushima, Japan
3. ³Department of Epidemiology, Faculty of Public Health, College of Medicine, Xi'an Jiaotong University, Xi'an, China

Correspondence: S Dang, Applied Nutrition, Department of Nutrition, School of Medicine, The University of Tokushima, 3 Kuramoto, Tokushima, Japan. E-mail: dangshaonong@yahoo.com.cn

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.

Received 29 March 2003; Revised 9 September 2003; Accepted 3 October 2003.

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).