Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition.
Challenges in Use of Adolescent Anthropometry for Understanding the Burden of Malnutrition.
复制标题
使用青少年人体测量学来了解营养不良负担的挑战。
作者：
A. Tumilowicz;Ty Beal;L. Neufeld;E. Frongillo
改善青春期的营养状况是改善这一代人和下一代人生活的机会。估计人口一级的营养不良负担是有针对性的干预措施和衡量随时间推移的进展的基础，对于青少年来说，我们通常依靠调查数据和2007年世卫组织增长参考来做到这一点。然而，当没有充分考虑指标和参考的潜在方法限制时，关于青少年患病率估计的误导性结论的风险很大。我们使用2014年孟加拉国食品安全和营养状况报告中对10-22岁女孩和年轻女性的全国流行率估计作为例子，以证明确定营养不良、超重和肥胖的真实流行率是复杂的，因为不同人群在青少年生长突发期、生长潜力和体型方面的种族/民族差异。进一步挑战这项任务的是，身体质量指数作为苗条和肥胖指标的固有局限性，以及难以区分营养良好的人群和营养不良的人群的界限。我们为青少年营养政策和计划决策提供建议，强调1)在使用2007年世卫组织生长参考时，批判性地解释指标和年龄分布的重要性；2)检查青春期前后发生的事情，当对人体测量学的解释更直接时，以及随时间的趋势；以及3)用其他信息补充人体测量，特别是饮食摄入量。最后，我们主张营养研究人员优先探索更好的方法来预测身高峰值速度，开发标准化指标来衡量青少年的饮食质量，并进行研究，以阐明因果关系，以便我们能够有效地改善青少年的膳食摄入量和营养状况。
Improving nutritional status during adolescence is an opportunity to improve the lives of this generation and the next. Estimating the burden of malnutrition at a population level is fundamental to targeting interventions and measuring progress over time, and for adolescents, we usually depend on survey data and the 2007 WHO Growth Reference to do so. There is substantial risk of misguided conclusions regarding adolescent prevalence estimates, however, when underlying methodological limitations of the indicators and reference are not adequately considered. We use national prevalence estimates among girls and young women 10-22 y of age from the 2014 State of Food Security and Nutrition in Bangladesh report as an example to demonstrate that determining the true prevalence of undernutrition, overweight, and obesity is complicated by racial/ethnic variation across populations in timing of the adolescent growth spurt, growth potential, and body build. Further challenging the task are inherent limitations of the body mass index as an indicator of thinness and adiposity, and cutoffs that poorly distinguish a well-nourished population from a malnourished one. We provide recommendations for adolescent nutrition policy and program decision-making, emphasizing the importance of 1) critically interpreting indicators and distributions by age when using the 2007 WHO Growth Reference; 2) examining what is happening before and after adolescence, when interpretation of anthropometry is more straightforward, as well as trends over time; and 3) complementing anthropometry with other information, particularly dietary intake. Finally, we advocate that nutrition researchers prioritize exploration of better methods to predict peak height velocity, for development of standardized indicators to measure dietary quality among adolescents, and for studies that will illuminate causal paths so that we can effectively improve adolescent dietary intake and nutritional status.