Assessment of Japanese healthy children’s nutritional status using Waterlow classification


Malnutrition is associated with an increased risk of morbidity and mortality, and may case an undesirable effect on the growth and development in children. There have been several reports about the prevalence of malnutrition in hospitalized children, but reports about malnutrition in a large number of healthy children are quite limited. The aim of this study was to evaluate the prevalence of likelihood of malnutrition in Japanese healthy children. We retrospectively reviewed data of height and weight at a regular health check in 7517 healthy children (age 3 - 17; 3747 boys, 3770 girls) during 2008 and 2010 in Nara city, Japan. The data were evaluated using Waterlow classification, i.e., weight-for-height (W/H) and height-for-age (H/A). The prevalence of under-nutrition, as estimated by the values of W/H less than 90% and H/A less than 95%, were 20.1% and 8.3%, respectively, and this prevalence of malnutrition risk tended to vary substantially with age. The peak levels of the prevalence were found to be at around 12 years old for both sexes in W/H, and at around 11 years old for boys and at around 10 years old for girls in H/A. We have clearly demonstrated the existence of certain percentages of the likelihood of malnutrition at different ages in healthy children. These findings suggest that when we want to evaluate the nutritional status using Waterlow classification in hospitalized children, we should be careful by taking such reference values into account.

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Higashiyama, Y. , Kubota, M. , Oshima, S. , Mibu, M. , Yasui, Y. and Nagai, A. (2012) Assessment of Japanese healthy children’s nutritional status using Waterlow classification. Health, 4, 1036-1040. doi: 10.4236/health.2012.411158.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hendricks, K.M., Duggan, C., Gallagher, L., Carlin, A.C., Richardson, D.S., Collier, S.B., Simpson, W. and Lo, C. (1995) Malnutrition in hospitalized patients. Current prevalence. Archives of Pediatrics & Adolescent Medicine, 149, 1118-1122. doi:10.1001/archpedi.1995.02170230072010
[2] Pawellek, I., Dokoupil, K. and Koletzko, B. (2008) Prevalence of malnutrition in paediatric hospital patients. Clinical Nutrition, 27, 72-76. doi:10.1016/j.clnu.2007.11.001
[3] Aurangzeb, B., Whitten, K.E., Harrison, B., Mitchell, M., Kepreotes, H., Sidler, M., Lemberg, D.A. and Day, A.S. (2012) Prevalence of malnutrition and risk of under-nutrition in hospitalized children. Clinical Nutrition, 31, 35- 40. doi:10.1016/j.clnu.2011.08.011
[4] Den Broeder, E., Lippens, R.J., Van’t Hot, M.A., Tol-boom, J.J., Van Starveren, W.A., Hofman, Z. and Sengers, R.C. (1998) Effects of naso-gastric tube feeding on the nutritional status of children with cancer. European Journal of Clinical Nutrition, 52, 494-500. doi:10.1038/sj.ejcn.1600589
[5] Hirche, T.O., Hirche, H., Jungblut, S., Stern, M., Wagner, T.O. and Wiedemann, B. (2009) Statistical limitations of percent ideal body weight as measure for nutritional failure in patients with cystic fibrosis. Journal of Cystic Fibrosis, 8, 238-244. doi:10.1016/j.jcf.2009.03.004
[6] Marcarenhas, M.R., Zemel, B. and Stallings, V.A. (1998) Nutritional assessment in pediatrics. Nutrition, 14, 105- 115. doi:10.1016/S0899-9007(97)00226-8
[7] McMahon, K. and Brown, J.K. (2000) Nutritional screening and assessment. Seminars in Oncology Nursing, 16, 106-112. doi:10.1053/on.2000.5549
[8] Pencharz, P.B. (2008) Assessment of protein nutritional status in children. Pediatric Blood Cancer, 50, 445-446. doi:10.1002/pbc.21415
[9] Gomez, F., Galvan, R.R., Frenk, S., Munoz, J.C., Chavez, R. and Vazquez, J. (1956) Mortality in second and third degree malnutrition. Journal of Tropical Pediatrics, 2, 1271-1274.
[10] Waterlow, J.C. (1972) Classification and definition of protein-calorie malnutrition. British Medical Journal, 3, 566-569. doi:10.1136/bmj.3.5826.566
[11] Waterlow, J.C., Buzina, R., Keller, W., Lane, J.M., Nichaman, M.Z. and Tannner, J.M. (1977) The presen- tation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin of the World Health Organization, 55, 489-498.
[12] Reilly, H.M., Martineau, J.K., Moran, A. and Kennedy, H. (1995) Nutritional screening: Evaluation and implementation of a simple nutritional risk score. Clinical Nutrition, 14, 269-273.doi:10.1016/S0261-5614(95)80063-8
[13] The Ministry of Education, Culture, Sports, Science and Technology, Japan (2001) Reports of health statistics in school children.
[14] The Ministry of Health, Labour and Welfare, Japan (2001) Reports of growth investigation in infants and toddlers.
[15] Ca-ballero, B. (2005) A nutrition paradox—Underweight and obe-sity in developing countries. New England Jour- nal of Medicine, 352, 1514-1516. doi:10.1056/NEJMp048310
[16] Poskitt, E.M. (2009) Coun-tries in transition: Underweight to obesity non-stop? Annals of Tropical Paediatrics, 29, 1-11. doi:10.1179/146532809X401971
[17] Ge, S., Kubota, M., Nagai, A., Mamemoto, K. and Kojima, C. (2011) Retrospective individual tracking of body mass index in obese and thin ado-lescents back to childhood. Asia Pacific Journal of Clinical Nutrition, 20, 432-437.
[18] WHO (2011) Child growth stand-ards and the identification of severe acute malnutrition in infants and children. /index.html
[19] Dibley, M.J., Goldsby, J.B., Staehling, N.W., Trowbridge, F.L. (1987) Development of normalized curves for thinternational growth reference: historical and technical considerations. American Journal of Clinical Nutrition, 46, 736-748.
[20] Isanaka, S., Villamor, E., Shepherd, S. and Grais, R.F. (2009) Assessing the impact of the introduction of the World Health Organization growth standards and weight- for-height z-score criterion on the response to treatment of severe acute malnutrition in children: Secondary data analysis. Pediatrics, 123, 54-59. doi:10.1542/peds.2008-1375
[21] Sen, J., Mondal, N. and Dey, S. (2011) Assessment of the nutritional status of children aged 5 - 12 years using upper arm composition. Annals of Human Biology, 38, 752- 759. doi:10.3109/03014460.2011.610358
[22] Taranger, J. and Hagg, U. (1990) The timing and duration of adolescent growth. Acta Odontologica Scandinavica, 38, 57-67. doi:10.3109/00016358008997719
[23] The Ministry of Eduction, Culture, Sports, Science and Technology, Japan. (2011) Reports of health statistics in school children.

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