The use of growth velocity z-scores to early detect growth faltering in Indonesian infants

Rizka Dinari; Vicka Oktaria; Margie Danchin

Rizka Dinari Melbourne School of Population and Global Health, The University of Melbourne, Australia
Vicka Oktaria Biostatistics, Epidemiology and Population Health Department (BEPH) and Centre for Child Health (CCH-PRO), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0002-3556-3028
Margie Danchin Melbourne School of Population and Global Health, The University of Melbourne, Australia, and Murdoch Children’s Research Institute and The Royal Children Hospital, Victoria, Australia https://orcid.org/0000-0002-7624-5691

Keywords: infant growth pattern; growth faltering; undernutrition

Abstract

Objective: This study aimed to describe infant growth patterns using attained growth z-scores and growth velocity z-scores in the first year of life in Indonesia.

Method: A cohort study of 359 newborns was conducted in 2015-2017 in Yogyakarta, Indonesia. Weight and length were routinely measured throughout the first year of life to calculate the attained growth z-scores (weight-for-age/WAZ, length-for-age/LAZ, and weight-for-length z-scores/WLZ) and growth velocity z-scores (weight velocity/WVZ and length velocity z-scores/LVZ). Undernutrition was categorized into underweight (WAZ<-2), stunting (LAZ<-2), and wasting (WLZ<-2). Growth faltering was categorized into weight faltering (WVZ<5^th centile) and length faltering (LVZ<5^th centile) using WHO child growth standards.

Results: The proportion of undernutrition and growth faltering varied throughout infancy. The highest proportion of undernutrition was the proportion of stunting at 12 months (15.3%) which was two times higher than at birth (7.3%). The highest proportion of weight and length faltering was in 4-6 months with 28.6% and 39.4%, respectively. Median WAZ was relatively stable at around -0.30 SD in the first six months before it slightly decreased to -0.64 SD at 12 months of age. Median LAZ increased from -0.62 SD at birth to -0.23 SD at four months before declining to -0.83 SD at 12 months. In comparison to attained growth z-scores, growth velocity z-scores depicted an opposing pattern. Median WVZ decreased from 0.33 SD at 0-2 months to -0.80 SD at 4-6 months, while median LAZ dropped from 1.33 SD at 0-2 months to -1.20 SD at 6-9 months.

Conclusion: The proportions of undernutrition and growth faltering were relatively high in the first year of life. Growth velocity z-scores showed an earlier downward pattern than attained growth z-scores. Therefore, routine monitoring, particularly in growth velocity z-scores, might allow earlier detection and treatment of child growth faltering.

Username
Password
Remember me