Asia Pacific J Clin Nutr (1994) 3, 61-64
Asia Pacific J Clin Nutr (1994) 3, 61-64
Secular trend of growth in pre-school
children in Singapore
Mabel A Yap1 MSc (Public Health), Kwok Chan Lun2 PLD, Kenneth R Lyen3
FRACP (Paediatrics)
and Sian Lian Lam4 MSc
(Public Health)
1Food and Nutrition
Department, Ministry of Health, Singapore;
2Department of Community, Occupational and
Family Medicine, National University of Singapore;
3Consultant Paediatrician and Paediatric
Endocrinologist, Singapore;
4Primary Health Division, Ministry of Health,
Singapore.
An anthropometric study was conducted on more than
13 500 children aged 04 years in 1988. Percentile charts were plotted
for height for age, weight for age, weight for height and head circumference
for age. When compared to an earlier study done in 1972, it was
found that Singapore pre-school children had increased in height
by 4.4 %; weight by 10.9 %; and head circumference by 4.1 %. When
the median height for age, weight for age and head circumference
for age were plotted against those of the NCHS charts (1978), Singapore's
pre-school children were generally shorter, lighter and had smaller
head circumferences than their American counterparts of the same
age. But, the median weight-for-height for each age group was comparable
to the Americans. The results indicate the secular trend of growth
in Singapore children and a trend towards reaching their full genetic
potential for growth.
Study conducted by the National
University of Singapore and sponsored by Dumex Division, East Asiatic
Company (S) Pte Ltd.
Introduction
Anthropometric studies of pre-school children have
a short history in Singapore. The first study was conducted in 1954
by Millis1. The most recent in-depth study was carried
out from 1972 to 1975 by Wong et al.2,3. After a lapse
of about 15 years it was felt that there was a need for a revision
of the growth reference charts. A cross sectional anthropometric study
of 13 565 children aged 0-6 years was carried out between March 1987
and January 1988 to fulfil this need. The sample of children was obtained
from 10 government polyclinics, 21 nursery schools and 18 kindergartens
throughout Singapore. Detailed descriptions of the sampling method,
equipment and techniques used have been described elsewhere4.
In this large-scale study, trained personnel collected single measurements
of length or height, weight and head circumference of the children,
using standardized methods and well-calibrated equipment. Percentile
charts for boys and girls were drawn for the following parameters:
height for age; weight for age; head circumference for age; and we
1000 ight for height. In this paper, comparisons of these parameters
with Wong's study and the National Centre for Health Statistics/Communicable
Diseases Centre/World Health Organisation (NCHS/CDC/WHO) reference
curves5 were made to assess the secular trend of growth
of Singaporean children.
Methods
The 50th percentiles of height for age, weight for
age and head circumference for age from the anthropometric study of
pre-school children conducted in 1988 were plotted against those from
Wong's study and the NCHS's reference curves, respectively. The median
weight for height of the present study was also plotted against those
of the NCHS's.
Results and
discussion
Comparison
of parameters with previous local study
Figures 1-6 show the relationship between the 50th
percentile curves of the various parameters in the present study with
those of the previous local study by Wong et al. When comparing height,
weight and head circumference, children from the present study generally
had greater values for all parameters. On average there were increases
of 4.5 % in height, 11.5 % in weight and 4.3 % in head circumference
for boys, and increases of 4.3 %,10.3 % and 3.9 % respectively, for
girls (Table 1).
Table 1. Average increase (%) in growth parameters
over previous study.
| |
Boys (%) |
Girls (%) |
| Height |
4.5 |
4.3 |
| Weight |
11.5 |
10.3 |
| Head circumference |
4.3 |
3.9 |
Figure 1. Comparison of height between present
study and Wong's (boys).
Figure2. Comparison of head circumferences
between present study and Wong's (girls).
Figure 3. Comparison of weight between present
study and Wong's (boys).
Figure 4. Comparison of weight between present
study and Wong's (girls).
Figure 5. Comparison of head circumference
between present study and Wong's (boys)
.
Figure 6. Comparison of head circumference
between present study and Wong's (girls).
If the medians (50th percentiles) of the height and
weight of children in the present study were plotted on the percentile
charts developed by Wong, the medians of the present study would lie
between the 75th and 90th percentiles, except for girls' height, which
was between the 50th and 90th percentiles. For head circumference,
the medians for both girls and boys fell somewhere between the 75th
and 97th percentiles of the previous growth charts. This has been
referred to as 'the secular trend' in growth, where children are getting
larger and growing to maturity more rapidly. Factors such as improved
nutrition, control of infectious diseases through immunization and
better sanitation, more widespread health and medical care and population
mobility (both geographically to urban areas and socially upward)
appeared to be responsible. This phenomenon has been well documented
in many European countries, Canada, the United States, Jamaica, Chile,
Australia, New Zealand, Japan and Hong Kong6.
Comparison
with NCHS's curves
Figures 7-14 show comparisons between the present
study and the National Centre for Health Statistics (NCHS) standards
for median height for age, median weight for age, median head circumference
for age and median weight for height.
Figure 7. Comparison of height between present
study and NCHS (boys).
Figure 8. Comparison of height between present
study and NCHS (girls).
Figure 9. Comparison of weight between present
study and NCHS (boys).
Figure 10. Comparison of weight between present
study and NCHS (girls).
Figure 11. Comparison of head comparison between
present study and NCHS (boys).
Figure 12. Comparison of head circumference
between present study and NCHS (girls)
.
Figure 13. Comparison of weight for height
between present study and NCHS (boys).
Figure 14. Comparison of weight for height
between present study and NCHS (girls).
Compared with Americans, the standards for children
in the present study were consistently lower than those of the NCHS
for height, weight and head circumference by age 9.5 both sexes even
though the NCHS data were collected in 1978 (Figs 7-12). When plotted
on the percentile charts of the NCHS, the values for median height,
weight and head circumference of Singapore children fell generally
between the 25th and 50th percentiles of the American children. A
similar but more exaggerated trend was also observed for height and
weight by age more than 20 years ago by Chang et al.7. However, when
the 50th percentiles of weight for height for the two studies were
compared, it was found that the curves were almost similar, indicating
that for the same height, both Singaporean and American children were
likely to attain the same weight (Figs 13-14).
These facts reinforced the findings of Eveleth and
Tanner that Asiatics, even thos 1000 e who were growing up under the
best circumstances, were less tall at all ages than affluent people
of European and African descent. This could be due to differences
in gene pools and environment and their interaction6. It was likely
that Singaporean children were reaching their full growth potential
as inferred by the comparison of the median weight for height curves.
This finding clearly demonstrates that the use of Western growth charts
as growth standards in Asiatic populations may not be appropriate,
and local growth charts should be used whenever they are available.
Conclusion
In summary, the above study had demonstrated that
the preschool children in Singapore have grown taller, heavier and
have larger head circumference when compared to their counterparts
more than 15 years ago.
When compared to American children of the same age
using the NCHS's curves, it was discovered that the local parameters
were consistently lower than those of the NCHS. Our children, however,
had attained the same weight for similar height when compared with
American children.
Based on the above findings, the percentile charts
derived from the present study had been selected for use in place
of the NCHS/CDC/WHO's curves for growth monitoring and screening purposes
in Singapore.
Acknowledgments: We thank the Ministry of Health, Singapore, the National University
of Singapore, staff and children of the polyclinics, child care centres,
nurseries and kindergartens that participated in the study, and Dumex
Division, the East Asiatic Company (S) Pte Ltd.
References
- Millis J. A study of growth in the first year of
life of southern Indian infants born in Singapore. J Pediatr 1954;94:692
696.
- Wong HB, Tye CY, Quck KM. Anthropometric studies
on Singapore children. 1. Heights, weights and skull circumference
on pre-school children. J Singapore Paediatr Soc 1972; 14: 68-89.
- Wong HB, Tay ISH. Anthropometric studies in Singapore
children. 11. Heights, weights, sitting heights, biacromial diameter,
bi-ilio-cristal diameter, subscapular skinfold, triceps skinfold,
upper arm circumference. J Singapore Pacdiatr Soc 1975; 17:76-83
- Yap M. Anthropometric studies in pre-school children
in Singapore (1988) (dissertation). Singapore. National University
of Singapore, 1989.
- Hamill PVV, Drizd TA, Johnson CL, et al. Physical
growth: National Centre for Health Statistics percentiles. Am J
Clin Nutr 1979;32:607-629.
- Eveleth PB, Tanner JM. Worldwide variation in human
growth. Int Biol Prog London; Cambridge University press, 1976.
- Chang KSF, Lee MMC, Low WD, et al. Standards of
height and weight of southern Chinese children. Far East Med J 1965;
1: 101-109.
Copyright © 1994 [Asia Pacific Journal of Clinical Nutrition]. All
rights reserved.
Please note: this article has been scanned and reformatted.
Please contact lshirven@ozemail.com.au if any errors are suspected.
Revised:
July 08, 1999
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