title: Poor nutritional status of younger Tibetan children living at high altitudes.
abstract: BACKGROUND
  The growth, development and nutrition of children in Tibet with high-altitude and unique traditional culture have recently gained attention. However, few researches are available on the nutritional status of younger children of Tibet.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the nutritional status of children below 36 months old in Tibet by means of anthropometry.
  
  
  METHODS
  The cross-sectional survey was conducted between August and September in 1999 and a sample of 1655 children below 36 months old was obtained using a stratified multistage cluster random sampling method from a total of seven districts of Tibet. Height, weight and hemoglobin concentration were measured and at the same time related sociodemographic and environmental information were collected. NCHS/CDC/WHO reference data were used to evaluate the nutritional status of the entire study children population and estimate the prevalence of stunting, underweight and wasting.
  
  
  RESULTS
  Compared with the reference of NCHS/CDC/WHO, the distributions of HAZ and WAZ shifted to the left significantly and the means of HAZ and WAZ were -1.53 and -1.05, respectively, which were significantly lower than the reference value. The distribution of WHZ, however, was close to that of the reference. The reduction of Z-scores for height and weight occurred very early in life and was greatest in the second year after birth. The prevalence of malnutrition of children was 39.0% for stunting, 23.7% for underweight and 5.6% for wasting, respectively. Rural children had prevalence of stunting of 41.4% and underweight of 24.7%, as compared with prevalence of stunting of 25.3% and underweight of 18.1% for urban children. Stunting and underweight were associated with altitudes. The mean of hemoglobin (Hb) of children was 120.4 g/l and rural children had a significantly lower Hb concentration (119.9 g/l) than urban children (123.3 g/l). The prevalence of anemia seemed higher when using different altitude corrections for Hb to estimate the prevalence, but the consequences were uneven.
  
  
  CONCLUSIONS
  For Tibetan young children, the nutritional status of the entire population is poor and the prevalence of malnutrition is higher, especially for stunting. Malnutrition is related to high altitudes. Although the Hb concentration is higher induced by high altitude, there must be quite a lot of anemic children at high altitudes. The relationship between altitude and Hb for children on the Tibetan plateau requires further study in order to determine correctly the magnitude of anemia of children.
authors.affiliation: Department of Health statistics, Faculty of Public Health, College of Medicine, Xi'an Jiaotong University, Xi'an, China. dangshaonong@yahoo.com.cn
authors.forename: S
authors.initials: S
authors.lastname: Dang
authors.forename: H
authors.initials: H
authors.lastname: Yan
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: L
authors.initials: L
authors.lastname: Zeng
mesh_terms: D000531:Altitude; D001827:Body Height; D001835:Body Weight; D015362:Child Nutrition Disorders / Q000097:blood / Q000453:epidemiology*; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000097:blood / Q000453:epidemiology*; D007231:Infant, Newborn; D008297:Male; D009752:Nutritional Status; D015995:Prevalence; D012423:Rural Health; D018609:Tibet; D014504:Urban Health
chemical_list: D006454:Hemoglobins