Prevalence of Low Weight-for-recumbent Length, Recumbent Length-for-age, and Weight-for-age Among Infants and Toddlers From Birth to 24 Months of Age: United States, 1999–2000 Through 2017–2018

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by Cheryl D. Fryar, M.S.P.H., Margaret D. Carroll, M.S.P.H., and Joseph Afful, M.S., Division of Health and Nutrition Examination Surveys

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Undernutrition in children is defined using weight-for-recumbent length, recumbent length-for- age, and weight-for-age. The Centers for Disease Control and Prevention (CDC) recommends using the World Health Organization (WHO) growth standards to monitor growth in children under age 2 years in the United States (1). The recommended definition of low values in infants is –2 z scores (corresponding to less than the 2.3rd percentile) on the WHO sex-specific growth standards (2). Less than the 5th percentile on the corresponding CDC sex-specific growth charts (3) also has been used as a cut point. Consequently, this report presents estimates using both definitions.

Based on the WHO growth standards, results from the 2017–2018 National Health and Nutrition Examination Survey (NHANES), using measured recumbent lengths and weights, indicate that an estimated 0.2% of infants and children under age 24 months have low weight-for-recumbent length, 2.9% have low recumbent length-for-age, and 0.9% have low weight-for-age. Based on the CDC growth charts, 2.9% of infants and toddlers have low weight-for-recumbent length, 5.0% have low recumbent length-for-age, and 8.3% have low weight-for-age. Differences between the WHO and CDC growth charts are described in the references below.

Table 1 shows the unweighted sample sizes for infants and toddlers with measured recumbent length or weight for each survey cycle from 1999–2000 through 2017–2018. Table 2 shows  the prevalence of low weight-for-recumbent length, recumbent length-for-age, and weight-for- age among infants and toddlers from birth to 24 months for each survey cycle from 1999–2000 through 2017–2018. The variability of the 2-year estimates over time is consistent with what might be observed in the smaller sample size of infants and toddlers in NHANES. Estimates are not shown for individual age groups due to low prevalence for some measures.

NHANES uses a stratified, multistage probability sample of the civilian noninstitutionalized U.S. population. Since 1999, data have been collected on persons of all ages beginning from birth. A household interview and a physical examination are conducted for each survey participant. During the physical examination, conducted in a mobile examination center, recumbent length and weight are measured as part of a more comprehensive set of body measurements. These measurements are taken by trained health technicians, using standardized measuring procedures and equipment. Observations for persons missing a valid recumbent length or weight measurement are not included in the data analysis.

For additional information on NHANES methods, visit: https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx.

References

1. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC). Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep 59(RR–9):1–15. 2010.

2. World Health Organization. WHO child growth standards. Length/height-for-age, weight- for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. 2006.

3. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Stat 11(246). 2002.

This Health E-Stat supersedes the earlier version, “Prevalence of Low Weight-for-recumbent Length, Recumbent Length-for-age, and Weight-for-age Among Infants and Toddlers From Birth to 24 Months of Age: United States, 1999–2000 Through 2015–2016”.

Suggested citation

Fryar CD, Carroll MD, Afful J. Prevalence of low weight-for-recumbent length, recumbent length-for-age, and weight-for-age among infants and toddlers from birth to 24 months of age: United States, 1999–2000 through 2017–2018. NCHS Health E-Stats. 2020.

Tables

Table 1. Unweighted sample size for infants and children from birth to 24 months with measured recumbent length or weight, United States, 1999–2000 through 2017–2018
Survey period Measured weight and recumbent length Measured recumbent length Measured weight
1999–2000 671 672 679
2001–2002 667 839 671
2003–2004 766 767 774
2005–2006 822 822 831
2007–2008 719 719 723
2009–2010 703 703 704
2011–2012 584 584 587
2013–2014 609 610 613
2015–2016 630 630 633
2017–2018 535 536 537

SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Surveys, 1999–2018.

Table 2. Low weight-for-recumbent length, recumbent length-for-age, and weight-for-age among infants and children from birth to 24 months: United States, 1999–2000 through 2017–2018
Survey period
Low
weight-for-recumbent length1,2		 Low
recumbent length-for-age3,4		 Low
weight-for-age5,6
WHO
growth charts		 CDC
growth charts		 WHO
growth charts		 CDC
growth charts		 WHO
growth charts		 CDC
growth charts
                                                                                               Percent (standard error)
1999–2000 0.4 (0.3) 3.5 (0.6) 4.9 (1.1) 6.4 (1.2) 1.6 (0.8) 6.1 (1.5)
2001–2002 0.7 (0.5) 4.4 (0.9) 3.3 (0.7) 4.5 (1.0) 0.8 (0.3) 4.9 (0.9)
2003–2004 1.1 (0.6) *5.5 (1.6) 3.9 (1.1) 5.0 (1.3) 2.5 (0.8) 9.0 (1.6)
2005–2006 1.7 (0.6) 5.7 (1.2) 2.1 (0.8) 3.8 (0.8) 1.2 (0.5) 7.9 (1.4)
2007–2008 1.2 (0.5) 3.6 (1.0) 3.8 (0.7) 7.1 (1.2) 1.4 (0.5) 9.9 (1.7)
2009–2010 0.3 (0.2) 3.0 (0.8) 3.3 (0.7) 5.0 (0.9) 1.1 (0.3) 7.2 (1.0)
2011–2012 0.9 (0.4) 3.6 (0.6) *3.2 (1.1) *3.9 (1.1) 0.4 (0.2) 6.4 (1.6)
2013–2014 0.9 (0.6) 3.5 (0.7) 3.4 (0.7) 5.1 (1.1) 0.8 (0.5) 7.7 (1.3)
2015–2016 1.4 (0.6) 3.9 (1.1) 3.2 (0.9) 5.6 (1.0) 1.7 (0.7) 7.3 (1.1)
2017–2018 0.2 (0.1) 2.9 (0.8) 2.9 (0.7) 5.0 (1.1) 0.9 (0.4) 8.3 (1.6)

*Estimate has a confidence interval width between 5 and 30 and a relative confidence interval width greater than 130%, and does not meet National Center for Health Statistics standards of reliability; see Series Report 2, Number 175.
1Weight less than 2.3rd percentile of weight-for-recumbent length on the sex-specific World Health Organization (WHO) growth standards.
2Weight less than 5th percentile of weight-for-recumbent length on the sex-specific Centers for Disease Control and Prevention (CDC) growth charts.
3Recumbent length less than 2.3rd percentile of recumbent length-for-age on the sex-specific WHO growth standards.
4Recumbent length less than 5th percentile of recumbent length-for-age on the sex-specific CDC growth charts.
5Weight less than 2.3rd percentile of weight-for-age on the sex-specific WHO growth standards.
6Weight less than 5th percentile of weight-for-age on the sex-specific CDC growth charts.
SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Surveys, 1999–2018.