PEM

Nutrition can be assesses by different methods: Diet history, anthropometry etc Clinically assessment of nutrition is mainly done by Growth measurement. Observed level of growth is compared to a Standard. A growth standard is one that best represents normal growth. It reflects optimal health and nutritional status.

Methods of Obtaining Intake Data

Direct observation and nutrient analysis: can be used only in controlled settings; doesnt represent usual intake; calorie counts fall into this category Food record or diary: prospective tool; asks client to record or weigh food intake for a specific time period Food frequency questionnaire: retrospective; asks client to complete a survey about food intake over a specific time period 24-hour recall: retrospective tool; asks client about food intake during the previous 24 hours

 Normal growth is that level of growth where innate genetic potential for growth finds full expression without constraints of nutrition, environment or disease. Growth of a healthy child is considered normal growth standard.

GROWTH STANDARDS & REFERENCES

GROWTH STANDARD
HARVARD

SUPPORTING POINTS
Earlier

LIMITATIONS
No significant difference from NCHS up to 5 years age. Applicable internationally up to 10 years due to wide variation in onset of puberty. Describes only how children grow in a particular region and time.

NCHS reference (How growth is occurring in a reference population; simply the distribution used for comparison) WHO Standard (How growth should be)

Suggested by WHO. NO NUTRITIONAL, ENVIRONMENTAL CONSTRAINTS in the reference population

Evidence and guidance for the first time about how every child in the world should grow. Differences in children's growth to age five are more influenced by nutrition, feeding practices, environment, and healthcare than genetics or ethnicity

PERCENTILE

Z score or standard score

Z -score for a measure (e.g., height or BMI), indicates how far and in what direction (positive vs. negative) a measured value deviates from the population mean, expressed in units of the population SD

0.2nd 2.3rd 2.5th 5th 16th

-3 -2 -1.96 -1.64 -1

Reflect reference distribution Standardized measures Comparable across age, sex and measure (dimensionless quantity) Subject to summary statistics (mean, SD) Can be studied as a continuous variable

50th (median)
84th 95th

0
+1 +1.64

Can quantify the growth status of children outside of the percentile ranges
Not straightforward to explain to the public . May be of limited use in clinical settings.

97.5th
97.7th 99.8th

+1.96
+2 +3