Head growth of undernourished children in rural Nepal: association with demographics, health and diet

Figures & data

Table 1 Anthropometric Z-scores

Z-score	HAZ (3747)			WAZ (3753)			WHZ (2639)			MUACZ (1500)			HCZ (3652)
	All	Boys	Girls	All	Boys	Girls	All	Boys	Girls	All	Boys	Girls	All	Boys	Girls
Mean (SD)	−1.36 (1.14)	−1.35 (1.42)	−1.37 (1.40)	−1.87 (1.09)	−1.84 (1.89)	−1.90 (1.95)	−1.44 (1.22)	−1.42 (1.40)	−1.46 (1.53)	−1.54 (0.71)	−1.55 (0.69)	−1.54 (0.72)	−2.14 (1.00)	−1.99* (0.094)	−2.31 (1.03)
% <−1	63	63	62	80	81	78	63	62	63	79	80	78	88	86	90
% <−2	27	27	27	43	42	44	29	28	30	26	27	26	56	50*	61

Notes: Z-scores for height (HAZ), weight (WAZ), weight-for-height (WHZ), mid-upper arm circumference (MUACZ) and head circumference (HCZ) for all children, and by gender. Mean (SD), median and the % of children with scores <−1 and −2 are shown.

* P < 0.0001 for comparison between boys and girls.

Figure 1 Distribution of HC Z-scores (n = 3652). The pooled HCZ scores are plotted against the number of measurements obtained, demonstrating a normal distribution.

Figure 2 Anthropometric Z-scores by age group. Z-scores for height (dark grey), weight (light grey) and HC (black) are shown by age group and gender. The solid lines show results for boys and girls together; results for girls are shown in the dashed lines, for boys in the dotted lines. Results for each age group (indicated for HAZ by b, for HCZ by d, for WAZ by f and g) were compared with that of the youngest children (indicated for HAZ by a, for HCZ by c, for WAZ by e). For clarity, only the P-values for boys and girls together are shown. For both height-for-age Z-score (HAZ) and head circumference-for-age Z-score (HCZ), results for children in older age groups were significantly lower (P < 0.0001) than for the children in the youngest age group (6–12 months). For weight-for-age Z-score (WAZ), older children also had significantly lower measurements than younger children (6–12-month-olds compared with 13–24-month-olds and 25–36-month-olds, P < 0.0001; 6–12-month-olds compared with the older age groups, P < 0.001).

Table 2 HCZ related to gender, age and other anthropometric measurements

Term	Estimate	Std Error	t ratio	Prob >|t|	Lower 95%	Upper 95%
Intercept	−1.007155	0.041504	−24.27	<0.0001*	−1.088528	−0.925781
Male	0.1439669	0.014343	10.04	<0.0001*	0.1158464	0.1720874
HAZ	−0.006782	0.018143	−0.37	0.7086	−0.042354	0.0287901
WAZ	0.4288333	0.018949	22.63	<0.0001*	0.3916818	0.4659847
Age	−0.005468	0.000451	−12.12	<0.0001*	−0.006352	−0.004583

Note: r ² = 0.26

* P < 0.0001 regression analysis of gender, WAZ and age in relation to HCZ.

Table 3 HCZ related to ASF consumption by age group

Age group, mon.	HCZ score mean (SE)
	No. of ASFs consumed
	None or one	Two or more
6–12	−2.38 (0.34)	−1.71 (0.23)
13–24	−2.25 (0.19)	−1.79 (0.10)*
25–36	−1.92 (0.12)	−1.59 (0.06) ^†
37–60	−2.51 (0.08)	−2.37 (0.04)
>60	−2.15 (0.05)	−2.27 (0.03)
6–36	−2.08 (0.10)	−1.69 (0.05) ^‡
>36	−2.26 (0.04)	−2.30 (0.02)
All ages	−2.22 (0.04)	−2.20 (0.02)

Notes: ASF, animal-source foods. HCZ by age group (months) were compared in relation to consumption of ASFs (none or one vs two or more) during the previous 24 h.

^* p = 0.03;

^† p = 0.02;

^‡ p = 0.001.

Figure 3 Number of animal-source foods consumed and HCZ. In children aged <36 months, the number of animal-source foods consumed related to HCZ (P < 0.0001).

Table 4 ASF consumption and HCZ

Term	Estimate	Std Error	t ratio	Prob >|t|
Children <36 months of age r ^2= 0.43, p < 0.0001
Intercept	−0.896468	0.181257	−4.95	<0.0001*
Age	0.0046522	0.005038	0.92	0.3564
Male	−0.007792	0.040395	−0.19	0.8472
HAZ	−0.034848	0.051798	−0.67	0.5015
WAZ	0.5714095	0.046205	12.37	<0.0001*
Total ASF consumption	0.2635587	0.09447	2.79	0.0055*
Illness	−0.032928	0.093871	−0.35	0.7260
Residence (hills or Terai)	0.0153996	0.04507	0.34	0.7328
Children >36 months of age r ^2 0.23, p < 0.0001
Intercept	−1.692521	0.10153	−16.67	<0.0001*
Age	0.0020822	0.000828	2.51	0.0120*
Male	0.1620967	0.020021	8.10	<0.0001*
HAZ	−0.063779	0.028658	−2.23	0.0262*
WAZ	0.4751642	0.029933	15.87	<0.0001*
Total ASF consumption	0.0021638	0.049179	0.04	0.9649
Illness	0.0150043	0.066615	0.23	0.8218
Residence (Hills or Terai)	0.043404	0.022737	1.91	0.0564

Notes: ASF, animal-source foods. Regression analysis of determinants of HCZ for younger (<36 months of age) and older (>36 months of age) children. For younger children, predictors of HCZ were WAZ and total ASF consumption. For older children, HCZ was predicted by age, gender, HAZ and WAZ, but not by ASF consumption.

* P < 0.05.