LENGTH SCREENS BETTER THAN WEIGHT IN STUNTED POPULATIONS

Stunting (low length-for-age) is the most widespread manifestation of growth retardation worldwide. Yet, most nutrition programs use weight- forage for screening of at-risk children. This study tested whether we ight-for-age was an effective screening tool in a severely stunted rur al Guatemalan population, using data from the INCAP longitudinal suppl ementation trial (n = 400). Stunting was defined as length-for-age <-2 SD of the National Center for Health Statistics standards at 3 y of a ge. Sensitivity and specificity analyses and receiver operating charac teristics curves were used to compare weight indicators (weight for-ag e, weight velocity and weight-for-length) with length (length-for-age and length velocity) and arm and head circumferences measured during e arly infancy. Length indicators were clearly superior to weight in pre dicting stunting (Z(da) test), and velocities were consistently worse than attained growth. Length-for-age at 6 mo had the best performance, followed by length-for-age at 3 mo, and weight-for-age at 6 and at 3 mo. Velocities, weight-for-length and circumferences were all poor pre dictors of stunting. Using the cutoff of <-1 SD, length-for-age at 3 m o was the best screening indicator for the early detection of growth f altering. Thus, the current use of weight-for-age, which results in la rge proportions of at risk children being missed by screening, greatly limits the potential for impact of nutrition interventions.