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1997 Pediatric Nutrition Surveillance
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| WV | US | |
| Under 1 year | 40% | 32.2% |
| 1 year | 19% | 19.9% |
| 2 - 4 years | 41% | 40.0% |
Racial/Ethnic Distribution
West Virginia’s PedNSS population consists primarily of two ethnic groups, but is consistent with West Virginia’s general population demographics. The state and national ethnic distributions in 1997 PedNSS is as follows:
| WV | US | |
| White | 92.9% | 40.7% |
| Black | 5.8% | 22.0% |
| Hispanic | 0.3% | 29.3% |
| Asian | 0.2% | 3.1% |
All other racial and ethnic categories were of insufficient numbers in West Virginia PedNSS to generate reliable statistics (under 100) or were nonspecific.
Data Quality Summary - Progress in the Past Year
An area in which West Virginia’s PedNSS as a data system has improved is in increasing the number of records containing anthropometric values. In 1996, 22.1% of records had missing height or weight data. The cause of the missing data was found to be a programming error, and was corrected. In 1997, all records have height and weight data. This increase in the sample size causes the data to be more accurate, but when compared to previous years, this data does create the appearance of a change in overall prevalence of some risk indicators.
Fortunately, about eighty-five percent of the missing height /weight data was for infants under six months of age, not spread across all age groups. Since infants under six months of age most strongly reflect the effects of low birth weight and prematurity, and because they constitute about one quarter of the caseload, the increase in overall prevalence of short stature, underweight, and low weight-for-age may be attributed to the inclusion of these records. The other risk indicators tracked in PedNSS (anemia and low birth weight) were unaffected by missing data - therefore, it is accurate to compare 1997 rates with previous years.
PedNSS statistics for 1996 and 1997 are detailed below. Rather than creating trend lines which may be misleading, this format differs from the 1996 West Virginia PedNSS Summary to demonstrate the inclusion of the additional records, and how these records factor in the overall prevalence change. The number of records for children twelve months of age and over and the prevalence of risk factors in these age groups did not change significantly with the programming adjustment. About half of the infant measurements were missing in 1994. Height and weight measurements for infants were not compiled in 1995 and 1996. The trend estimates in the 1996 PedNSS report are accurate, but should not be compared with 1997.
To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:
Low height-for-age, also referred to as shortness or stunting, is defined as a height-for-age value below the 5th percentile of the NCHS/CDC height reference. It is expected that five percent of a normal population will fall in this low height-for-age category. Stunting reflects the long term health and nutrition history of a child. On an individual level, shortness can reflect the normal variation of growth within a population. In some children, short stature is related to factors such as lower birth weight or short parental stature. Other contributing factors to growth stunting can be frequent infections and long term poor nutrition.2 Short stature has been associated with low developmental and cognitive test scores, and stunting early in life may lead to reduced physical capacity and endurance in adulthood. 3
On a population level, the CDC finds a strong correlation between an increased prevalence of stunting and poor socio-economic conditions. Black, Hispanic and Asian children are more likely to be short than other children.4 The low income population reflected in PedNSS shows a persistent rate of low height-for-age in excess of five percent, but below the Healthy People 2000 goal of ten percent.
| Short Stature Low Height-for-Age | |||||||
| West Virginia - 1996 | West Virginia - 1997 | US Prevalence | |||||
| Age | Count | % | Age | Count | % | 1996 | 1997 |
| 0 - 2 months | 1,918 | 11.3 | 0 - 2 months | 23,704 | 10.2 | 12.0 | 11.8 |
| 3 -5 months | 2,342* | 8.4 | 3 -5 months* | 4,312 | 17.2 | 7.8 | 8.2 |
| 6- 11 months | 13,441 | 8.3 | 6- 11 months | 14,175 | 8.2 | 8.6 | 8.7 |
| All Ages | 81,737 | 6.8 | All Ages | 104,841 | 7.7 | 8.0 | 7.9 |
* In 1997, when infants under 6 months of age with low birth weight are excluded, the average overall prevalence of Low Height for Age is 6.0%, a decrease from 6.6% in 1996.
To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:
Low Weight-for-Age
Low weight-for-age (under the 5th percentile of the NCHS reference population) is regarded by the CDC PedNSS system as a less useful index in defining nutritional status. In populations with few children with low weight-for-height, weight-for-age provides the same information as height-for-age. Weight-for-age is a more useful tool in individual assessments, with serial follow-up, than as a population measure.5 The PedNSS system does not break out age categories for low weight-for-age, but a comparison of overall prevalence in West Virginia between 1996 and 1997 shows an increase of 0.4% (From 5.5% to 5.9%)
Underweight
Children with a weight-for-height value of less than the 5th percentile of NCHS/CDC reference population are considered to be underweight. Low weight-for-height, or thinness, is often associated with recent severe disease, but can also be the result of normal individual variation in a population. In developing countries, thinness indicates acute malnutrition (either the result of insufficient food, infectious or diarrheal disease, or both.) The prevalence of thinness in a population is usually low except during disaster conditions. 6 Low weight-for-height is generally not a problem in the United States, and no Healthy People 2000 goals have been established.
| Underweight - Low Weight-for-Height | |||||||
| West Virginia - 1996 | West Virginia - 1997 | US Prevalence | |||||
| Age | Count | % | Age | Count | % | 1996 | 1997 |
| 0-2 mos. | 1,615 | 5.8 | 0-2 mos. | 19,980 | 4.3 | 4.1 | 4.2 |
| 3-5 mos. | 2,341 | 1.4 | 3-5 mos. | 4,296 | 1.1 | 2.1 | 2.0 |
| 6-11 mos. | 13,441 | 2.4 | 6-11 mos. | 14,175 | 2.2 | 2.6 | 2.5 |
| All Ages | 81,427 | 2.4 | All Ages | 101,097 | 2.7 | 2.6 | 2.5 |
To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:
High weight-for-height is defined as those children in the 95th percentile and above of the NCHS/CDC reference. This index is used as a proxy for obesity, and in the pediatric population has become an important public health issue. One-third to one-half of those children above the 95th percentile will become obese adults. Obesity is associated with long term health consequences such as heart disease, hypertension and diabetes. 7 Nationwide, the percentage of children found above the 95th percentile of weight for height continues to climb, with a 1997 prevalence of 10.3% . West Virginia continues to be below the nation’s rate in 1997, having a prevalence of 7.9% high weight-for-height.
| Overweight - High Weight-for-Height | |||||||
| 1996 | 1997 | US Prevalence | |||||
| Age | Count | % | Age | Count | % | 1996 | 1997 |
| 0-2 mos. | 1,615 | 3.5 | 0-2 mos. | 19,980 | 4.1 | 6.2 | 6.1 |
| 3-5 mos. | 2,341 | 11.1 | 3-5 mos. | 4,296 | 9.8 | 14.7 | 14.9 |
| 6-11 mos. | 13,441 | 9.2 | 6-11 mos. | 14,175 | 9.3 | 11.3 | 11.7 |
| All Ages | 81,427 | 8.7 | All Ages | 101,097 | 7.9 | 10.1 | 10.3 |
An increase in high weight-for-height occurs for the age group 12-23 months - in 1996, this group was higher by an average of 3.0% of prevalence than both of the neighboring age categories, and in 1997, 3.8% higher.
To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:
Low birth weight infants and children continue to constitute a growing segment of the PedNSS population. Healthy People 2000, Objective 14.5 seeks to reduce low birth weight to no more than five percent of live births, and establishes a special population target for blacks at nine percent. Low birth weight is defined as a birth weight under 2500 grams (5 pounds, 8 ounces). Low birth weight occurs when an infant is born at less than 37 weeks of age, when there is intrauterine growth retardation, or as a result of both conditions. Low birth weight reflects maternal health status during pregnancy, and is a strong predictor of growth in early childhood. Premature low birth weight infants have a higher mortality rate, but full-term infants small for their gestational age exhibit slower physical growth, possibly slower mental development, and are more likely to have congenital abnormalities.8
Low birth weight data was unaffected by missing height and weight records, so that a comparison may be made between annual reporting periods. Trend data is shown here, back to 1992.
To view the Trend in Prevalence of Low Birth Weight for the United States and West Virginia, click here.
The reason for this increase in PedNSS will be the subject of more investigation. Certainly low birth weight is increasing in the general West Virginia population. West Virginia’s Vital Statistics report shows a steady annual increase from 7.2% in 1992 to 8.0% in 1996.9
To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:
The CDC has established criteria for anemia based on the Second National Health and Nutrition Examination Survey (NHANES II) data. For children under twenty-four months of age, the 5th percentile cutoff is hemoglobin measurement under 11.0 grams per deciliter, and for children aged two to five years, 11.2 grams per deciliter. PedNSS adjusts hematology values for altitude.10 All data presented here are for hemoglobin only, as 78% of national PedNSS measurements, and 99% of West Virginia PedNSS measurements are hemoglobin values. West Virginia continues to reflect the national trend of decreasing prevalence of anemia in 1997, down over a full percentage point from1996 levels.
To view the Trend in Prevalence of Low Hemoglobin in the United States and West Virginia, click here.
Anemia data was unaffected by missing height and weight data on infants. Therefore, the trend format used in 1996 PedNSS is employed again. West Virginia continues to reflect the national trend of decreasing prevalence of anemia in 1997, down over a full percentage point from 1996 levels.
While not all anemia is due to iron deficiency, it is the most common cause of anemia throughout the world. 11 Iron deficiency anemia impairs mental and psychomotor development in infants and children. Although iron deficiency can be reversed with treatment, the reversibility of impairments are not yet clearly understood. In addition, iron deficiency increases a child’s susceptibility to lead toxicity. Iron deficiency anemia is seen most commonly in children six months to three years of age. Those at highest risk are low birth weight infants after two months of age, breastfed infants who receive no supplemental iron after four months of age, and formula-fed infants who are not consuming iron-fortified formula. 12
Healthy People 2000, Objective 2.10, is to reduce iron deficiency anemia to less than three percent among children aged 1 through 4 years of age, and specifically targets two age groups among low-income children; those ages 1-2 years are targeted to reduce anemia rates to 10%, and children 3-4 years to 5%. Healthy People 2000 further defines iron deficiency as abnormal results from 2 or more of the following tests: mean corpuscular volume, erythrocyte protoporphyrin, or transferrin saturation.13 While WIC clinics do not perform these tests, the CDC continues to recommend hemoglobin screening for anemia in populations where the risk of anemia due to iron deficiency is high. 14
West Virginia has the lowest prevalence of anemia among all states and territories which participated in the 1997 PedNSS, and since 1993, has consistently been among the three lowest states reporting.
To view the occurrence of Low Hemoglobin by Age in the United States and West Virginia, click here.
Anemia is strongly associated with ethnicity - this year, nationwide, more than 25% of black children are anemic, as compared to about 14% of white children. This racial/ethnic association is present in West Virginia as well, but the lack of ethnic diversity in the West Virginia PedNSS population tends to mask this effect.
To view the occurrence of Low Hemoglobin by Race/Ethnicity in the United States and West Virginia, click here.
To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:
One of the major initiatives of the WIC program is to increase breastfeeding of infants and to prolong the duration of breastfeeding. Healthy People 2000, Objective 2.11, sets a goal to increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period (initiation), and to at least 50% the proportion who continue breastfeeding until their babies are 5 to 6 months old (duration). Special target populations are low income mothers, and black, Hispanic and American Indian/Alaskan natives.
To view 1997 Breastfeeding Duration Rates data for the United States and West Virginia, click here.
1997 PedNSS data on breastfeeding rates for infants six to eight months old shows that both the nation and West Virginia fall short of these goals, with West Virginia initiation rates almost three-quarters of the national rate, but falling behind in duration. Only about 30% of those initiating breastfeeding in West Virginia continue through 6 months of age, compared to 44% of those initiating breastfeeding nationally. Similar to the national statistics, West Virginia shows the greatest drop off in rates between one week and one month of age.
To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:
Endnotes
1.) CDC, Division of Nutrition. Enhanced Pediatric Nutrition
Surveillance System User Manual. US Department of Health and Human
Services, Public Health Service, 1994, pg. 1-6
2.) Ray Yip, et al., "Pediatric Nutrition Surveillance System - United States, 1980 - 1991", Morbidity and Mortality Weekly Report, Vol. 41, SS-7, November 27, 1992, pg. 9
3.) Institute of Medicine, WIC Nutrition Risk Criteria: A Scientific Assessment, National Academy Press, Washington, D.C., 1996. pg. 106-107
4.) CDC, Division of Nutrition. Enhanced Pediatric Nutrition Surveillance System User Manual. US Department of Health and Human Services, Public Health Service, 1994, pg. 1-7
5.) CDC, Division of Nutrition. Enhanced Pediatric Nutrition Surveillance System User Manual. US Department of Health and Human Services, Public Health Service, 1994, pg. 1-8
6.) I. Pravanta, "Nutrition" in L. Wilcox, J. Marks, eds. From Data to Action: CDC’s Public Health Surveillance for Women, Infants and Children, Centers for Disease Control and Prevention, U.S. Public Health Service, Atlanta, Ga., 1995. pg. 325
7.) CDC, Division of Nutrition. Enhanced Pediatric Nutrition Surveillance System User Manual. US Department of Health and Human Services, Public Health Service, 1994, pg. 1-7
8.) Institute of Medicine, WIC Nutrition Risk Criteria: A Scientific Assessment, National Academy Press, Washington, D.C., 1996. pg. 98-102
9.) WV Vital Statistics West Virginia Bureau for Public Health, Office of Epidemiology and Health Promotion. 1992 - 1995 and Provisional Statistics, 1996.
10.) CDC, Division of Nutrition. Enhanced Pediatric Nutrition Surveillance System User Manual. US Department of Health and Human Services, Public Health Service, 1994, pg. 1-10
11.) Ibid, pg. 1-9
12.) Ibid, Pg. 1-9
13.) U.S. Public Health Service. Healthy People 2000; National Health Promotion and Disease Prevention Objectives, Washington, D.C.: 1991; DHHS publication no. (PHS)91-50212. pg. 122
14.) Ray Yip, et al., Centers for Disease Control and Prevention. "Recommendations to Prevent and Control Iron Deficiency in the United States." Morbidity and Mortality Weekly Report, Vol. 41, SS-7, November 27, 1992, pg. 21