Office of Nutrition Services


1998 Pediatric Nutrition Surveillance
System Summary Report

For additional information or for any questions regarding this report, please contact: PNSS Coordinator at (304) 558-0030.

Overview

The Pediatric Nutrition Surveillance System (PedNSS) monitors the prevalence of specific health indicators of nutrition risk in low-income infants, children and adolescents. As surveillance is a continuous process, this allows for the evaluation of health indicators for this population over time. This data is used to supply information for planning health priorities and policies, and guiding, improving and supporting decisions regarding nutrition interventions at the state and local levels.

The Centers for Disease Control and Prevention (CDC) has been collecting PedNSS data since 1973. Currently, forty-six states, Indian Reservations, and Territories participate in contributing data to PedNSS. The information is collected nationwide from a variety of food assistance and public health and nutrition programs, such as Early Periodic Screening, Diagnosis and Treatment (EPSDT), Title V Maternal and Child Health Program (MCH) and the Head Start Program. The majority of the national data (three quarters) is generated by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

West Virginia has been participating in PedNSS since December, 1992, using  a WIC database that is now defunct. After 1994, data originated from WIC’s STORC (Storage, Transfer, Organization, and Retrieval of Casefiles) data system. All information in West Virginia PedNSS originates from measurements and information collected at WIC clinics. Since WIC is the sole contributor to PedNSS in West Virginia, data is limited to low income infants and children up to the age of five. Also, one eligibility path for WIC includes the presence of risk factors assessed in PedNSS. Data is summarized by visit, not by child. Therefore, PedNSS data may overstate the prevalence of risk factors, and should be interpreted with caution.

Data collected by PedNSS include population demographics and data that reflect health and growth problems in children. Nutrition risk indicators collected in PedNSS are short stature (low height-for-age), underweight (low weight-for-height), overweight (high weight-for-height), anemia (low hemoglobin) and low birth weight (<2500 grams). The measurements are interpreted by the computer software version of the National Center for Health Statistics (NCHS)/CDC growth reference.1 Additionally, infant feeding practices data is collected for children under two, to assess the prevalence and duration of breastfeeding. National PedNSS information, West Virginia statewide data, and county summary data are presented in this report. Healthy People 2000 objectives are presented as well.

Demographic Data

Demographic variables associated with risk for poor infant or child health include race/ethnicity and age. Socio-economic factors, which are often associated with poor health, are somewhat consistent throughout the PedNSS population in that the WIC Program limits participation to children with low family income or participation in certain means-tested programs such as Medicaid. The specific association these variables have with a given nutrition risk indicator will be discussed in the section regarding that indicator.

Additionally, Healthy People 2000 established special target populations for several health indicators reported in West Virginia PedNSS, based on age, ethnicity and economic status. Progress has been made towards meeting those objectives in West Virginia, and data will be reported where objectives have been established.

Age Distribution

The age distribution of the 78,975 records accepted in West Virginia PedNSS is compared to the national distribution in the following charts. While 7.6% of national data is data for children between five years of age and eighteen, that age group has not been included in the totals shown here to avoid inaccurate comparisons.  The proportion of infants-to-children in WV PedNSS has fluctuated only a few percentage points in the last five years.

1998 PedNSS Age Distribution

  WV US
Under 1 year 36.2% 41.3%
1 year 22.0% 19.2%
2 - 3 years 15.7% 15.3%
3 - 4 years 26.0% 24.3%

Racial/Ethnic Distribution

The PedNSS population in West Virginia is composed primarily of two racial or ethnic groups, but is consistent with West Virginia’s general population demographics. All other racial and ethnic categories were of insufficient numbers in West Virginia to generate reliable statistics (under 100), or were non-specific. The percentage each racial group contributes to PedNSS in West Virginia has not changed significantly in many years. The state and the national racial/ethnic distributions relative to West Virginia in 1998 PedNSS are reflected in the table below.

1998 PedNSS Race/Ethnicty

 

US

WV

White

40.4

92.8

Black

22.4

5.8

Hispanic

29.9

0.3

Asian/Pacific Islander

2.9

0.2

All other/unspecified*

4.5

0.9

*Numbers of other racial categories is <100 in WV PedNSS, not listed separately.

To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:

Short Stature

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 still meeting the Healthy People 2000 goal of less than ten percent.

In 1998, the national rate of short stature in PedNSS is virtually unchanged from 1997, at 7.8%. West Virginia PedNSS rates declined a tenth of a percentage point, from 7.7% in 1997 to 7.6% in 1998. When low birth weight infants less than six months old are excluded, the national rates fall by almost a percentage point, to 6.9% in 1998. West Virginia data shows a rate of reduction almost double that, at 5.9% in 1998. Ethnically, the major groups in West Virginia display the same characteristics as national populations. The following chart shows 1998 data. This data does include low birth weight children, and demonstrates how children born with a low birth weight tend to catch up with their peers.

1998 Short Stature:  Low Height-for-Weight
By Age and Ethnic Group

  US WV
< 1 Yr 1 Yr 2-4Yrs < 1 Yr 1 Yr 2-4Yrs

White

10.6 8.7 5.8 9.9 7.8 4.9

Black

15.4 10.4 4.6 13.3 7.6 3.8

Hispanic

7.1 7.7 4.8 * * 15.8

ALL**

10.5 8.9 5.3 10.1 7.8 4.9

*Indicates less than 100 records
**Groups having < 100 records in WV PedNSS not listed separately

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 followup, 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 1997 and 1998 shows a decrease from 5.9% to 5.7%. National PedNSS rates were 4.9% and 4.8%, respectively.

Low Weight-for-Height

Children with a weight-for-height value of less than the 5th percentile of NCHS/CDC reference population are considered to be underweight. According to CDC, 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 were established.

1998 Underweight:  Low Weight-for-Height
By Age Group

  US WV
< 1 Yr 2.9 3.0
1 Yr 2.8 3.6
>2-4Yrs 1.8 1.8
ALL >2.4 2.6

To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:

Overweight

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 1998 overall prevalence of 10.6% . West Virginia’s high weight-for-height rate is unchanged from 1997, and continues to be below the nation’s rate, having a prevalence of 7.9% high weight-for-height. There were no Healthy People 2000 objectives for this very young age group.

1998 Overweight:  High Weight-for-Height
By Age and Ethnic Group

 

US

WV

< 1 Yr

1 Yr >2-4Yrs

< 1 Yr

1 Yr

>2-4Yrs

White 7.7 12.0 7.5 6.5 11.2 7.6
Black 8.7 13.6 8.0 7.9 11.8 8.9
Hispanic 12.3 17.5 12.7 * * 8.9
ALL** 9.5 14.0 9.0 6.5 11.2 7.7

*Indicates less than 100 records.
**Groups having < 100 records in WV PedNSS not listed separately.

The noticeable increase in prevalence of overweight in the one year to two year age group parallels national PedNSS data. This phenomena is present in data representative of the general population as well. According to researchers, it is unclear whether this percentage is a reflection of an overweight problem, or an artifact of the NCHS growth charts, currently under revision. The same study found that between 1971 and 1994, the prevalence of overweight has not changed among children aged one through three years, but has increased in the four and five year age groups. 8

To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:

Low Birth Weight

Low birth weight infants and children continue to constitute a growing segment of the PedNSS population. Healthy People 2000, Objective 14.5 sought to reduce low birth weight to no more than five percent of live births, and established a special population target for African-Americans 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.9

The rate of low birth weight has been steadily rising in the West Virginia PedNSS population, with 1998 being the first year in many that no increase is noted. The West Virginia Vital Statistics reports for all state births, 1992 through1997, show increases each year, reaching 8.3% in 1997.10 The low-income PedNSS population shows a higher rate, below. Click here for trend data from West Virginia PedNSS, contrasted with national PedNSS data.

Similar to national statistics, West Virginia PedNSS demographic data reveals a higher rate of low birth weight among African Americans. Healthy People 2000 objectives have not been met among any category of the PedNSS population.

1998 Low Birth Weight by Race

 

US

WV

White

8.5

9.8

Black

13.7

13.8

Hispanic

6.9

3.9

Asian

7.9

5.8

ALL

9.4

10.0

To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:

Anemia

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.11 All data presented here are for hemoglobin only, as over 80% 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 1998, losing over a point and a half from 1997 levels.  Click here for trend data from West Virginia PedNSS, contrasted with national PedNSS data.

While not all anemia is due to iron deficiency, it is the most common cause of anemia throughout the world. 12 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. 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. 13

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 defined iron deficiency as abnormal results from two or more of the following tests: mean corpuscular volume, erythrocyte protoporphyrin, or transferrin saturation.14 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. 15 West Virginia has the lowest prevalence of low hemoglobin values among all states and territories which participated in the 1998 PedNSS, and since 1993, has consistently been among the three lowest in prevalence for states reporting hemoglobin.

1998 Low Hemoglobin By Age
Hgb <5th percentile

 

US

WV

< 12 months 19.6 6.8
  1- 2nd Year 19.0 7.2
  3 - 4th Year 15.9 5.1

Anemia is strongly associated with ethnicity - in 1998, nationally, more than 25% of black children in PedNSS are anemic, as compared to about 14% of white children. This racial/ethnic association is present in West Virginia PedNSS as well.

1998 Low Hemoglobin By Ethnic Group
Hgb <5th percentile

 

US

WV

   White 13.7 6.3
   Black 25.2 8.9
   Hispanic 16.3 6.0

To view data related to a specific PedNSS Health Indicator, click on the desired indicator listed below:

Breastfeeding

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, set 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.  Click here for trend data from West Virginia PedNSS, contrasted with national PedNSS data.

1998 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 about 80% 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 45% of those intiating 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:

WIC Local Agency Profiles

Because WIC is the sole contributor of PedNSS data in West Virginia, the administrative structure of that program is used to break data into regions. Each of the eight WIC Local Agencies in West Virginia have unique characteristics.  Some serve primarily rural and small town areas, and others are within a short drive of major American cities. As nutrition indicators can vary by age or ethnicity, so do PedNSS populations within local areas.

Not all records contain every indicator. Only those records with information on the specific indicator are accepted. Therefore, averages for the Local Agency may not agree with data for the individual counties included in the agency. Data is presented so local nutrition agencies may better address needs endemic to their own clients and personnel.

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 Contol 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.) Ogden CL, et al. Prevalence of overweight among preschool children in the United States, 1971 through 1994. Pediatrics, 1997;99:4

9.) Institute of Medicine, WIC Nutrition Risk Criteria: A Scientific Assessment, National Academy Press, Washington, D.C., 1996. pg. 98-102

10.) WV Vital Statistics West Virginia Bureau for Public Health, Office of Epidemiology and Health Promotion. 1992 - 1997

11.) 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

12.) Ibid, pg. 1-9

13.) Ibid, Pg. 1-9

14.) 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

15.) 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

 

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