The Pediatric Nutrition Surveillance System (PNSS) was established by CDC in 1974 to monitor the nutritional status of children who are under 60 months of age and from high-risk, low-income families participating in certain programs designed to improve the health of young children. These programs include the Special Supplemental Food Program for Women, Infants, and Children (WIC); the Early Periodic Screening, Diagnosis, and Treatment Program (EPSDT): and publicly funded maternal- and child-health clinics. Participation in the PNSS has grown to include 33 states, the District of Columbia, and Puerto Rico.

Preliminary data show that over 800,000 children under 60 months of age visited one of these programs for the first time in 1986. of these, 49.6% were white; 34.1%, black; 13.3%, Hispanic; 1.5%, American Indian/Alaskan Native; and 1.0%, Asian/ Pacific Islander. Most data were collected through WIC (77.3%) and EPSDT (21.9%). The National Center for Health Statistics (NCHS), CDC, growth reference population was used to calculate the age- and ethnic-specific prevalence of short stature (defined as height-for-age {H/A} lower than the fifth percentile), underweight (defined as weight-for-height {W/H} lower than the fifth percentile), and overweight (defined as W/H above the 95th percentile) (1).

The prevalence of short stature was greater than the 5% expected for all age and ethnic groups as compared with the NCHS reference population (Figure 1). Asian/ Pacific Islander children had the highest prevalence of short stature, and the prevalence tended to increase with age, reaching 22.9% at 48-59 months. Blacks had the lowest prevalence of short stature, except during infancy.

The prevalence of underweight was generally less than the 5% expected and tended to decrease with age in all ethnic groups except Asians/Pacific Islanders (Figure 2). Hispanics had the highest rate (8.1%) in the 0- to 11-month age group, whereas, in the older age groups, rates were highest for Asians/Pacific Islanders. The lowest rates in all age groups occurred among American Indian/Alaskan Native children.

In most instances, the rate of overweight exceeded the 5% expected when compared with the reference population (Figure 3). Overall, the highest rates occurred before 24 months of age, and the lowest, during the ages 24-35 months. Hispanics had the highest prevalence of high W/H in all but the 0- to 11-month age group.

Reported by: Family Health Svcs, Alabama Dept of Public Health. Div of Nutrition Svcs, Arkansas Dept of Health. Office of Nutrition Svcs, Arizona Dept of Health Svcs. WIC Program, Colorado Dept of Health. Nutrition Section, Connecticut Dept of Health Svcs. WIC State Agency, District of Columbia Dept of Human Svcs. WIC and Nutrition Svcs, Florida Dept of Health and Rehabilitation Svcs. Office of Nutrition, Georgia Dept of Human Resources. Nutrition Br, State of Hawaii Dept of Health. WIC Program, Iowa State Dept of Health. WIC Program, Idaho Dept of Health and Welfare. Nutrition Svcs, Illinois Dept of Public Health. WIC Program, Indiana State Board of Health. WIC Program, Kansas Dept of Health and Environment. WIC Program, Kentucky Dept of Human Resources. Nutrition Section, Louisiana Dept of Health and Human Resources. WIC Dept, Maine Dept of Human Svcs. Nutrition Dept, Detroit Health Dept; Bur of Community Svcs, Michigan Dept of Public Health. WIC Program, Mississippi State Dept of Health. Nutrition and Child Health Bur, Montana State Dept of Health and Environmental Sciences. Nutrition and Dietary Svcs Br, North Carolina Div of Health Svcs. WIC Program, Nebraska Dept of Health. WIC Program, New Hampshire Dept of Health and Welfare. Maternal and Child Health, New Jersey Dept of Health. Nutrition Section, New Mexico Dept of Health and Environment. WIC Program, Nevada Dept of Health. Div of Nutrition, Ohio State Dept of Health. Nutrition Div, Oklahoma State Dept of Health. WIC Program, Oregon State Health Div. WIC Program, Commonwealth of Puerto Rico Dept of Health. Office of Nutrition Svcs, Rhode Island Dept of Health. Nutrition Svcs and WIC Program, Tennessee Dept of Health and Environment. WIC Program, Utah Dept of Health. Nutrition Svcs, Vermont Dept of Health. WIC Program, Wyoming Dept of Health and Social Svcs, Div of Nutrition, Center For Health Promotion and Education, CDC.

Editorial Note

Editorial Note: These results reflect nutritional status among children from low-income families enrolled in certain publicly supported health programs in 1986. The prevalence of both short stature and overweight among these children exceeded the 5% expected in each category. However, the prevalence of low W/H for most age and ethnic groups was lower than expected, suggesting that underweight is not generally a common health problem in the PNSS population. The Hispanic population of Puerto Rico represented about 38% of all Hispanics in the PNSS, and their inclusion tended to increase the overall rate of underweight among Hispanics, especially among 0- to 11-month-old children.

All ethnic groups showed a marked drop in the prevalence of both short stature and overweight at age 2. This observation is most likely an artifact resulting from the recognized discontinuity of the NCHS reference curves at age 24 months (2). Consequently, any comparison of the prevalence of short stature or overweight among children below 24 months with those above 24 months should be made with caution.

Asian/Pacific Islander children more than 1 year of age were consistently shorter than the children in other ethnic groups. More than one in five Asian/Pacific Islander children over 3 years of age were below the fifth percentile for H/A. This high prevalence of short stature may reflect nutritional deficits as well as genetic factors among Southeast Asian refugee children.

The prevalence of short stature was lowest among blacks, especially among those more than 23 months old; however, they had the highest prevalence before 1 year of age. The high prevalence among children below 12 months of age was most likely due to the higher rate of low birthweight in this group. The low prevalence after 12 months of age may reflect improved nutritional status as well as genetically based differences in the growth potential of black children (3). In all ethnic groups, the overall prevalence of short stature among children less than 1 year old was higher than reported in previous years (4). This difference occurred because a change in the criteria used to edit data for the PNSS caused a greater proportion of low birthweight infants to be included in 1986 than in previous years.

As previously observed, rates of overweight were generally highest among Hispanic children. Overweight was also relatively prevalent among American Indians/Alaskan Natives, although not to the extent observed previously (4). While the cause of high W/H in Hispanic children is not well explained, it may not reflect obesity (5). Differences in body proportions and other genetically based factors may play a role (5).

References

1. National Center for Health Statistics. NCHS growth curves for children: birth-18 years, United States vital and health statistics. Hyattsville, Maryland: US Department of Health, Education, and Welfare, Public Health Service, 1977; DHEW publication no. (PHS)78-1650. (Vital and health statistics; series 11; no. 165).

2. Dibley NJ, Staeling N, Nieburg P, Trowbridge FL. Interpretation of z-score anthropometric indicators derived from the international growth reference. Am J Clin Nutr (in press).

3. Garn SM, Clark DC, Trowbridge FL. Tendency toward greater stature in American black children. Am J Dis Child 1973;126:164-6.

4. CDC. Prevalence of growth stunting and obesity: Pediatric Nutrition Surveillance System, 1982. In: CDC Surveillance Summary, 1983;32(no.4551:23-6.

5. Trowbridge FL, Marks JS Lopez de Romana G, Madrid S, Boutton TW, Klein PD. Body composition of Peruvian children with short stature and high weight-for-height - II: implication for the interpretation for weight-for-height as an indicator of nutritional status. Am J Clin Nutr (in press).

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