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
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 developmentpdf iconexternal icon. 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 developmentpdf icon. 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
| 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.
| 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 175pdf icon.
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.