Physical growth and nutritional status of garhwali girls
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《美国医学杂志》
Department of Anthropology, Panjab University, Chandigarh, India
Abstract
OBJECTIVE: The present study was conducted to evaluate physical growth and nutritional status of 214 school-going girls ranging in age from 5 to 12 years of rural area in Pauri Garhwal district of Uttaranchal. METHODS: Physical growth was evaluated using eleven standard anthropometric measurements viz., height, body weight, sitting height, biepicondylar humerus, bicondylar femur, head circumference, chest circumference, upper arm circumference, biceps skinfold, triceps skinfold and subscapular skinfold. To assess the nutritional status, weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age have been calculated using NCHS standards. RESULTS: It has been observed that the well nourished Indian girls and American girls show better performance in physical growth parameters as compared to the Garhwali girls at all ages. The Garhwali girls were found to be comparable with rural Indian girls in their growth status. Grade-I and Grade-II malnutrition was prevalent among the Garhwali girls, however, Grade-III malnutrition was found to be present in only a few girls. CONCLUSION: This average to poor nutritional status of the present Garhwali girls may be attributed to low dietary intake, low-middle socio-economic background, uneducated or partially educated parents, large family size, gender discrimination etc.
Keywords: Physical growth; Nutritional status; Anthropometric measurements; Dietary intake
The school-going children are the most important segment of our society, their physical growth and nutritional status is of utmost significance and presents a general health status of a community and nation as a whole. Good nutrition is also a determinant of healthy growth of mind and body. Several studies have been conducted on physical growth and nutritional status of children in different parts of the country as malnutrition continues to be a common, social and undoubtedly the biggest public health problem in our country today. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11]
Our country consists of diverse agro-climatic regions and ethnic multiplicities. Socio-cultural practices, life-styles and eating habits vary not only between states but also between the districts within a state. Rural India needs more attention as 98% of the geographical area of India and 72.9% of India's population occupy rural area spreading over six lakh villages[12]. Updated profiles on physical growth and nutritional status of children especially rural girls is therefore, important for formulation and implementation of appropriate nutrition intervention strategies and policies not only at the state level but also at district and tehsil levels.[11] As per the report of National Nutrition Monitoring Bureau and National Institute of Nutrition[13] nearly 43.8% children suffer from moderate degrees of protein energy malnutrition, 8.7% suffer from extreme forms of malnutrition and only 9.9% of the children are normal. In India, malnutrition is the direct cause of death of 500,000 children every year.[14] An estimated 450 million adult women in developing countries are stunted as a result of childhood protein energy malnutrition.[15]
The young girls are very important section of our society as they are our potential mothers and future homemakers. In this period of rapid growth, of a child is not taken care of, this influences the state of his/her health not only as a child but throughout life.[16] Hence, assessment of physical growth and nutritional status is most essential especially in case of girls in each and every part of the country. The present study, therefore, is an attempt in this regard to evaluate the physical growth and nutritional status of school-going girls aged between 5-12 years in Uttaranchal as also to compare the results with few other studies conducted in other Indian regions and abroad.
Materials and methods
The present cross-sectional data are based on a sample of 214 school-going Garhwali girls ranging in age from 5 to 12 years. The subjects were randomly selected from four village schools from Motadakh area in Tehsil Kotdwara under the jurisdiction of district Pauri Garhwal in Uttaranchal. All the subjects were physically and mentally normal and did not suffer from any apparent illness at the time of data collection. Date of birth of each student was recorded not only from school registers but was verified from the students and their parents. General information regarding their socio-economic status, caste, religion, parent's education and occupation, family size, structure and income etc. was also recorded.
The data so collected were grouped into 8 decimal age groups of one year interval. A total of eleven anthropometric measurements i.e. height, body weight, sitting height, biepicondylar humerus, bicondylar femur, head circumference, chest circumference, upper arm circumference, biceps skinfold, triceps skinfold and subscapular skinfold were taken on left side of each subject. All the measurements were taken with standard anthropometric instruments according to the methods and techniques described by Weiner and Lourie.[17] The measurements were recorded on each subject wearing minimum possible clothing and without any footwear. All the absolute and circumferential measurements were recorded to the nearest 0.1 cm except for weight, which was recorded to the nearest 0.1 kg. however, skinfold measurements were recorded to the nearest 0.1mm with the help of Swiss made skinfold caliper. All the data were collected by one of the author (SD) and repeated measurements were undertaken to establish intra and inter-observer variability which did not differ significantly from zero.
For assessing nutritional status of the subjects, weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age have been calculated. The subjects were divided into three levels of malnutrition besides normal i.e. grade-I, grade-II and grade-III malnutrition. The classification for weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age were followed from Gomez,[18] Waterloo,[19] Jelliffe[20] and Frisancho[21] respectively table1.
The data collected were subjected to statistical tools like mean, standard deviation, standard error etc. to obtain the results.
Results
Means and standard deviations for the values of height, weight, sitting height, biepicondylar humerus and bicondylar femur, head circumference, chest circumference and upper arm circumference of Garhwali girls are presented in table2. All the absolute and circumferential body dimensions show a gradual increase in mean values as age advances. Total gain in head circumference, chest circumference and upper arm circumference over the growth period of 5 through 12 years is 6.80 cm, 14.33 cm and 4.18 cm respectively. Mean values and standard deviations of triceps, biceps and subscapular skinfolds are shown in table2. Log transformation of mean values of skinfold measurements has been calculated by applying the formula as suggested by Edwards.[22] The skinfold at triceps shows a varying pattern of rise and fall as the age advances from 5 through 12 years. It shows a slight increase of 0.78 log units from 5 to 6 years, then there is a fall of 5.14 log units in the eighth year; and after that there is a gradual rise in the triceps skinfold up to 12 years. Biceps skinfold shows increase in mean value up to the age of 7 years, there is steep fall from 133.89 to 118.68 log units at the age of 8 years and after that the measurement exhibited a similar trend to triceps skinfold. Subscapular skinfold does not depict any particular trend, however, it shows gradual increase up to the age of 7 years, where a sharp decline occurred between 7 to 8 years and thereafter the value rises sharply up to 12 years.
By using these four different parameters for the assessment of nutritional status, it is apparent that maximum number of girls are either normal or suffering from only mild (Grade-I) malnutrition, while Grade-II malnutrition is prevalent among comparatively less number of girls. The prevalence of severely malnourished girls was found to be very low. However, for assessing the malnutrition status on the basis of triceps skinfold for age, a large number of girls are found to be severely malnourished.
Discussion
Mean values of weight, height, sitting height, chest circumference, head circumference, upper arm circumference and triceps skinfold of Garhwali girls ranging in age from 5 to 12 years were compared with American girls,[23] well nourished Indian girls,[24] average Indian girls, urban Indian girls and rural Indian girls.[25]
When compared with average urban and rural Indian girls and U.P. girls[25] the Garhwali girls show superior and comparable performance in sitting height at 6, 9 & 12 years and lag behind at the age of 5 years.
The growth trends in chest circumference when compared with average Indian, rural Indian and U.P. girls, the Garhwali girls show better performance at all the ages.
As far as the physical growth in head circumference is concerned, the present study girls show superior performance than the average Indian, urban Indian and U.P. girls.
Mean values in upper arm circumference of Garhwali girls were compared with well-nourished Indians and WHO standards and the results reveal that the Garhwali girls show lower mean values than those of well nourished Indian girls and American girls at all ages.
When the mean values of triceps skinfold of the Garhwali girls were compared with well-nourished Indians, lower socio-economic groups[24] and WHO standards, the results indicate that the Garhwali girls were having less subcutaneous fat at triceps at all ages.
The overall comparative low performance of Garhwali girls than other Indian groups studied may be attributed to the low-middle socio-economic background of the population under study and the observed growth retardation in anthropometric parameters may be more of nutritional origin although racial or genetic factors may also contribute.[11]
In the present study, when the body weight was evaluated against age, it was found that only 9.34% girls were normal and a large number of Garhwali girls were suffering from mild to moderate malnutrition, however, only a very few girls suffered from severe malnutrition. The body weight when evaluated against age serves as a good indicator of physical growth and nutritional status of a community and its validity for the assessment of nutritional status had already been established.[26] Similarly, according to height deficit for age, majority of the present study girls showed mild to moderate malnutrition, however, it has been found that the %age of individuals showing normal height was considerably higher i.e., 35.51%. It is therefore, observed that the current status of nutrition of a large section of the population under study is not adequate i.e., poor.
The present state of malnutrition in the Garhwali girls may probably be attributed to their low-middle socio-economic background, poor dietary intake due to poverty and lack of knowledge of the simplest facts of nutrition. Other factors which may be responsible for their poor nutritional profile may be the low literacy status of head of the households and other members, large families with high dependency ratio, occupational status like small land-hold farmers or having jobs with low monthly income. It may be related to basic cultural factors at the national level which may defeat the best efforts of households to attain good nutrition for the female members. Native customs may insist that the foods of better nutritional value and quality are reserved for boys.[15] It is further emphasised that there is need to explore the role of other dependable factors such as availability of health care infrastructure, personal hygiene and environmental sanitation etc., which may be considered to have direct influence on the physical growth and nutritional status of the child in the area.
References
1. Begum G, Choudhury B. A nutritional surveillance among the Assamese Muslims of Kamrup district, Assam. Ind Anthropologist 1996; 26(1): 1-25.
2. Kumar R, Marwaha RK, Bhalla AK, Gulati M. Protein energy malnutrition and skeletal muscle wasting in childhood acute lymphoblastic leuckemia. Ind Ped 2000 , 37: 720-726.
3. Nigam AK, Vir SC. Nutritional status of women and children in Uttar Pradesh-Causal factors. Ind J Prev Soc Med 2001; 32 (1&2): 1-9.
4. Aggarwal A, Singh P. Nutritional status and dietary intake of preschool children in Delhi. Ind J Nutr Dietet 2002; 39: 668-670.
5. Amrithaveni M, Barikor CW. Nutritional status of the Meghalaya pre-school children. Ind J Nutr Dietet 2002; 39: 262-268.
6. Balgir RS, Kerketta AS, Murmu AS, Dash BP. Clinical assessment of health and nutritional status of Gond children in Kalahandi district of Orissa. Ind J Nutr Dietet 2002; 39: 31-37.
7. Gulati JK, Jaswal S, Grewal G, Vig D. Nutritional status of rural children (9 to 11 years) from different agro climatic zones of Punjab. Paper presented at 5th Punjab Science congress organized by Thapar Institute of Engineering and Technology (Deemed University ) , Patiala from 7-9 February, 2002.
8. Laxmaiah A, Rao KM, Brahmam GVN, Kumar S, Ravindranath M, Kashinath K, Radhaiah G, Rao DH, Vijayaraghavan K. Diet and nutritional status of rural preschool children in Punjab. Ind Ped 2002; 39: 331-338.
9. Ozturk M, Akkus S, Malas MA, Kisioglu AN. Growth status with cerebral Palsy. Ind Ped 2002; 39: 834-838.
10. Yankanchi GM, Naik RK, Gaonkar V. Nutritional status of rural pre-school children by anthropometry. Ind J Nutr Dietet 2002; 39: 404-409.
11. Vashisht RN, Krishan K, Kaur C. Growth and nutritional status of school-going Punjabi rural Ropar girls. Pb Univ Res Bull (Sci) 2003; 53: 35-48.
12. Eswaraiah G. Challenges of the rural ecosystems in India. Employment News , Dated 15-21 March, 2003: 1-3.
13. National Nutrition Monitoring Bureau (NNMB and NIN). National Institute of Nutrition, Hyderabad. (C.f. Parvathi, 2001), 1993.
14. Parvathi S. Malnutrition in Indian children. Soc Welf 2001 ; 48 (6): 28-34.
15. Sinha A. Girl child-Health and social status. Soc Welf 2001 ; 48 (4): 27-33.
16. Bogin B. Patterns of Human Growth. New York; Cambridge University Press, 1988: 126-159.
17. Weiner JS, Lourie JA Human Biology-A Guide to field methods. Oxford and Edinburgh; Blackwell Scientific publications, 1969: 147-200.
18. Gomez F, Gatvan RP, Frank S, Cravioto CR, Vosquez J. Mortality in second and third degree malnutrition. J Trop Ped 1956; 2: 77-83.
19. Waterloo JC, Buzina R, Keller W, Lane JM, Nichaman MZ, Tanner JM. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin WHO 1977; 55(4): 489-498.
20. Jelliffe DB. The assessment of nutritional status of a community. WHO Monog Series No. 53, 1966: 1-271.
21. Frisancho AR. New norms of upper limb fat and muscle for assessment of nutritional status. Am J Clin Nutr 1981; 27: 1052-1058.
22. Edwards DAW, Hammond WH, Healy MJR, Tanner JM, Whitehouse RH. Design and accuracy of caliper for measuring subcutaneous tissue thickness. Br J Nutr 1955; 9: 133-143.
23. National Centre for Health Statistics (NCHS). NCHS growth curves for children birth to 18 years. U S Vital and Health Stat , Series 11 No. 165, 1977.
24. Vijayaraghavan K, Singh D, Swaminathan MC. Height and weights in well nourished Indian school children. Ind J Med Res 1971; 59: 643-654.
25. Indian Council of Medical Research (ICMR) Growth and physical development of Indian infants and children. ICMR Tech Rep Series No. 18, 1989.
26. Rao KV, Reddy PJ, Narayanan TP, Subhadra DV. Discriminant function analysis: a case study for an evaluation of various forms of protein energy malnutrition. Ind J Med Res 1979; 69: 99-108.(Vashisht RN, Krishan Kewa)
Abstract
OBJECTIVE: The present study was conducted to evaluate physical growth and nutritional status of 214 school-going girls ranging in age from 5 to 12 years of rural area in Pauri Garhwal district of Uttaranchal. METHODS: Physical growth was evaluated using eleven standard anthropometric measurements viz., height, body weight, sitting height, biepicondylar humerus, bicondylar femur, head circumference, chest circumference, upper arm circumference, biceps skinfold, triceps skinfold and subscapular skinfold. To assess the nutritional status, weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age have been calculated using NCHS standards. RESULTS: It has been observed that the well nourished Indian girls and American girls show better performance in physical growth parameters as compared to the Garhwali girls at all ages. The Garhwali girls were found to be comparable with rural Indian girls in their growth status. Grade-I and Grade-II malnutrition was prevalent among the Garhwali girls, however, Grade-III malnutrition was found to be present in only a few girls. CONCLUSION: This average to poor nutritional status of the present Garhwali girls may be attributed to low dietary intake, low-middle socio-economic background, uneducated or partially educated parents, large family size, gender discrimination etc.
Keywords: Physical growth; Nutritional status; Anthropometric measurements; Dietary intake
The school-going children are the most important segment of our society, their physical growth and nutritional status is of utmost significance and presents a general health status of a community and nation as a whole. Good nutrition is also a determinant of healthy growth of mind and body. Several studies have been conducted on physical growth and nutritional status of children in different parts of the country as malnutrition continues to be a common, social and undoubtedly the biggest public health problem in our country today. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11]
Our country consists of diverse agro-climatic regions and ethnic multiplicities. Socio-cultural practices, life-styles and eating habits vary not only between states but also between the districts within a state. Rural India needs more attention as 98% of the geographical area of India and 72.9% of India's population occupy rural area spreading over six lakh villages[12]. Updated profiles on physical growth and nutritional status of children especially rural girls is therefore, important for formulation and implementation of appropriate nutrition intervention strategies and policies not only at the state level but also at district and tehsil levels.[11] As per the report of National Nutrition Monitoring Bureau and National Institute of Nutrition[13] nearly 43.8% children suffer from moderate degrees of protein energy malnutrition, 8.7% suffer from extreme forms of malnutrition and only 9.9% of the children are normal. In India, malnutrition is the direct cause of death of 500,000 children every year.[14] An estimated 450 million adult women in developing countries are stunted as a result of childhood protein energy malnutrition.[15]
The young girls are very important section of our society as they are our potential mothers and future homemakers. In this period of rapid growth, of a child is not taken care of, this influences the state of his/her health not only as a child but throughout life.[16] Hence, assessment of physical growth and nutritional status is most essential especially in case of girls in each and every part of the country. The present study, therefore, is an attempt in this regard to evaluate the physical growth and nutritional status of school-going girls aged between 5-12 years in Uttaranchal as also to compare the results with few other studies conducted in other Indian regions and abroad.
Materials and methods
The present cross-sectional data are based on a sample of 214 school-going Garhwali girls ranging in age from 5 to 12 years. The subjects were randomly selected from four village schools from Motadakh area in Tehsil Kotdwara under the jurisdiction of district Pauri Garhwal in Uttaranchal. All the subjects were physically and mentally normal and did not suffer from any apparent illness at the time of data collection. Date of birth of each student was recorded not only from school registers but was verified from the students and their parents. General information regarding their socio-economic status, caste, religion, parent's education and occupation, family size, structure and income etc. was also recorded.
The data so collected were grouped into 8 decimal age groups of one year interval. A total of eleven anthropometric measurements i.e. height, body weight, sitting height, biepicondylar humerus, bicondylar femur, head circumference, chest circumference, upper arm circumference, biceps skinfold, triceps skinfold and subscapular skinfold were taken on left side of each subject. All the measurements were taken with standard anthropometric instruments according to the methods and techniques described by Weiner and Lourie.[17] The measurements were recorded on each subject wearing minimum possible clothing and without any footwear. All the absolute and circumferential measurements were recorded to the nearest 0.1 cm except for weight, which was recorded to the nearest 0.1 kg. however, skinfold measurements were recorded to the nearest 0.1mm with the help of Swiss made skinfold caliper. All the data were collected by one of the author (SD) and repeated measurements were undertaken to establish intra and inter-observer variability which did not differ significantly from zero.
For assessing nutritional status of the subjects, weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age have been calculated. The subjects were divided into three levels of malnutrition besides normal i.e. grade-I, grade-II and grade-III malnutrition. The classification for weight deficit for age, height deficit for age, upper arm circumference deficit for age and triceps skinfold deficit for age were followed from Gomez,[18] Waterloo,[19] Jelliffe[20] and Frisancho[21] respectively table1.
The data collected were subjected to statistical tools like mean, standard deviation, standard error etc. to obtain the results.
Results
Means and standard deviations for the values of height, weight, sitting height, biepicondylar humerus and bicondylar femur, head circumference, chest circumference and upper arm circumference of Garhwali girls are presented in table2. All the absolute and circumferential body dimensions show a gradual increase in mean values as age advances. Total gain in head circumference, chest circumference and upper arm circumference over the growth period of 5 through 12 years is 6.80 cm, 14.33 cm and 4.18 cm respectively. Mean values and standard deviations of triceps, biceps and subscapular skinfolds are shown in table2. Log transformation of mean values of skinfold measurements has been calculated by applying the formula as suggested by Edwards.[22] The skinfold at triceps shows a varying pattern of rise and fall as the age advances from 5 through 12 years. It shows a slight increase of 0.78 log units from 5 to 6 years, then there is a fall of 5.14 log units in the eighth year; and after that there is a gradual rise in the triceps skinfold up to 12 years. Biceps skinfold shows increase in mean value up to the age of 7 years, there is steep fall from 133.89 to 118.68 log units at the age of 8 years and after that the measurement exhibited a similar trend to triceps skinfold. Subscapular skinfold does not depict any particular trend, however, it shows gradual increase up to the age of 7 years, where a sharp decline occurred between 7 to 8 years and thereafter the value rises sharply up to 12 years.
By using these four different parameters for the assessment of nutritional status, it is apparent that maximum number of girls are either normal or suffering from only mild (Grade-I) malnutrition, while Grade-II malnutrition is prevalent among comparatively less number of girls. The prevalence of severely malnourished girls was found to be very low. However, for assessing the malnutrition status on the basis of triceps skinfold for age, a large number of girls are found to be severely malnourished.
Discussion
Mean values of weight, height, sitting height, chest circumference, head circumference, upper arm circumference and triceps skinfold of Garhwali girls ranging in age from 5 to 12 years were compared with American girls,[23] well nourished Indian girls,[24] average Indian girls, urban Indian girls and rural Indian girls.[25]
When compared with average urban and rural Indian girls and U.P. girls[25] the Garhwali girls show superior and comparable performance in sitting height at 6, 9 & 12 years and lag behind at the age of 5 years.
The growth trends in chest circumference when compared with average Indian, rural Indian and U.P. girls, the Garhwali girls show better performance at all the ages.
As far as the physical growth in head circumference is concerned, the present study girls show superior performance than the average Indian, urban Indian and U.P. girls.
Mean values in upper arm circumference of Garhwali girls were compared with well-nourished Indians and WHO standards and the results reveal that the Garhwali girls show lower mean values than those of well nourished Indian girls and American girls at all ages.
When the mean values of triceps skinfold of the Garhwali girls were compared with well-nourished Indians, lower socio-economic groups[24] and WHO standards, the results indicate that the Garhwali girls were having less subcutaneous fat at triceps at all ages.
The overall comparative low performance of Garhwali girls than other Indian groups studied may be attributed to the low-middle socio-economic background of the population under study and the observed growth retardation in anthropometric parameters may be more of nutritional origin although racial or genetic factors may also contribute.[11]
In the present study, when the body weight was evaluated against age, it was found that only 9.34% girls were normal and a large number of Garhwali girls were suffering from mild to moderate malnutrition, however, only a very few girls suffered from severe malnutrition. The body weight when evaluated against age serves as a good indicator of physical growth and nutritional status of a community and its validity for the assessment of nutritional status had already been established.[26] Similarly, according to height deficit for age, majority of the present study girls showed mild to moderate malnutrition, however, it has been found that the %age of individuals showing normal height was considerably higher i.e., 35.51%. It is therefore, observed that the current status of nutrition of a large section of the population under study is not adequate i.e., poor.
The present state of malnutrition in the Garhwali girls may probably be attributed to their low-middle socio-economic background, poor dietary intake due to poverty and lack of knowledge of the simplest facts of nutrition. Other factors which may be responsible for their poor nutritional profile may be the low literacy status of head of the households and other members, large families with high dependency ratio, occupational status like small land-hold farmers or having jobs with low monthly income. It may be related to basic cultural factors at the national level which may defeat the best efforts of households to attain good nutrition for the female members. Native customs may insist that the foods of better nutritional value and quality are reserved for boys.[15] It is further emphasised that there is need to explore the role of other dependable factors such as availability of health care infrastructure, personal hygiene and environmental sanitation etc., which may be considered to have direct influence on the physical growth and nutritional status of the child in the area.
References
1. Begum G, Choudhury B. A nutritional surveillance among the Assamese Muslims of Kamrup district, Assam. Ind Anthropologist 1996; 26(1): 1-25.
2. Kumar R, Marwaha RK, Bhalla AK, Gulati M. Protein energy malnutrition and skeletal muscle wasting in childhood acute lymphoblastic leuckemia. Ind Ped 2000 , 37: 720-726.
3. Nigam AK, Vir SC. Nutritional status of women and children in Uttar Pradesh-Causal factors. Ind J Prev Soc Med 2001; 32 (1&2): 1-9.
4. Aggarwal A, Singh P. Nutritional status and dietary intake of preschool children in Delhi. Ind J Nutr Dietet 2002; 39: 668-670.
5. Amrithaveni M, Barikor CW. Nutritional status of the Meghalaya pre-school children. Ind J Nutr Dietet 2002; 39: 262-268.
6. Balgir RS, Kerketta AS, Murmu AS, Dash BP. Clinical assessment of health and nutritional status of Gond children in Kalahandi district of Orissa. Ind J Nutr Dietet 2002; 39: 31-37.
7. Gulati JK, Jaswal S, Grewal G, Vig D. Nutritional status of rural children (9 to 11 years) from different agro climatic zones of Punjab. Paper presented at 5th Punjab Science congress organized by Thapar Institute of Engineering and Technology (Deemed University ) , Patiala from 7-9 February, 2002.
8. Laxmaiah A, Rao KM, Brahmam GVN, Kumar S, Ravindranath M, Kashinath K, Radhaiah G, Rao DH, Vijayaraghavan K. Diet and nutritional status of rural preschool children in Punjab. Ind Ped 2002; 39: 331-338.
9. Ozturk M, Akkus S, Malas MA, Kisioglu AN. Growth status with cerebral Palsy. Ind Ped 2002; 39: 834-838.
10. Yankanchi GM, Naik RK, Gaonkar V. Nutritional status of rural pre-school children by anthropometry. Ind J Nutr Dietet 2002; 39: 404-409.
11. Vashisht RN, Krishan K, Kaur C. Growth and nutritional status of school-going Punjabi rural Ropar girls. Pb Univ Res Bull (Sci) 2003; 53: 35-48.
12. Eswaraiah G. Challenges of the rural ecosystems in India. Employment News , Dated 15-21 March, 2003: 1-3.
13. National Nutrition Monitoring Bureau (NNMB and NIN). National Institute of Nutrition, Hyderabad. (C.f. Parvathi, 2001), 1993.
14. Parvathi S. Malnutrition in Indian children. Soc Welf 2001 ; 48 (6): 28-34.
15. Sinha A. Girl child-Health and social status. Soc Welf 2001 ; 48 (4): 27-33.
16. Bogin B. Patterns of Human Growth. New York; Cambridge University Press, 1988: 126-159.
17. Weiner JS, Lourie JA Human Biology-A Guide to field methods. Oxford and Edinburgh; Blackwell Scientific publications, 1969: 147-200.
18. Gomez F, Gatvan RP, Frank S, Cravioto CR, Vosquez J. Mortality in second and third degree malnutrition. J Trop Ped 1956; 2: 77-83.
19. Waterloo JC, Buzina R, Keller W, Lane JM, Nichaman MZ, Tanner JM. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin WHO 1977; 55(4): 489-498.
20. Jelliffe DB. The assessment of nutritional status of a community. WHO Monog Series No. 53, 1966: 1-271.
21. Frisancho AR. New norms of upper limb fat and muscle for assessment of nutritional status. Am J Clin Nutr 1981; 27: 1052-1058.
22. Edwards DAW, Hammond WH, Healy MJR, Tanner JM, Whitehouse RH. Design and accuracy of caliper for measuring subcutaneous tissue thickness. Br J Nutr 1955; 9: 133-143.
23. National Centre for Health Statistics (NCHS). NCHS growth curves for children birth to 18 years. U S Vital and Health Stat , Series 11 No. 165, 1977.
24. Vijayaraghavan K, Singh D, Swaminathan MC. Height and weights in well nourished Indian school children. Ind J Med Res 1971; 59: 643-654.
25. Indian Council of Medical Research (ICMR) Growth and physical development of Indian infants and children. ICMR Tech Rep Series No. 18, 1989.
26. Rao KV, Reddy PJ, Narayanan TP, Subhadra DV. Discriminant function analysis: a case study for an evaluation of various forms of protein energy malnutrition. Ind J Med Res 1979; 69: 99-108.(Vashisht RN, Krishan Kewa)