Background WHO documents characterize stunting as, "…impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation." The equation of stunting with malnutrition is common. This contrasts with historic and modern observations indicating that growth in height is largely independent of the extent and nature of the diet. Subjects We measured 1716 Indonesian children, aged 6.0-13.2 years, from urban Kupang/West-Timor and rural Soe/West-Timor, urban Ubud/Bali, and rural Marbau/North Sumatra. We clinically assessed signs of malnutrition and skin infections. Results There was no relevant correlation between nutritional status (indicated by skinfold thickness) and height SDS (hSDS). 53% of boys, and 46% girls in rural Soe were short and thin, with no meaningful association between mean of triceps and subscapular skinfolds (x ̅ SF) and height. Skinfold thickness was close to German values. Shortest and tallest children did not differ relevantly in skinfold thickness. The same applied for the association between hSDS and mid upper arm circumference (MUAC) using linear mixed effects models with both fixed and random effects. 35.6% boys and 29.2% girls in urban Ubud were overweight; 21.4% boys and 12.4% girls obese, but with hSDS =-0.3, still short. Relevant associations between hSDS and x ̅ SF and MUAC were only found among the overweight urban children confirming that growth is accelerated in overweight and obese children. There were no visible clinical signs of malnutrition in the stunted children. Conclusion The present data seriously question the concept of stunting as prima facie evidence of malnutrition and chronic infection.

Background Childhood obesity is one of the most serious public health challenges of the 21st century. Its prevalence has increased at an alarming rate. Overweight and obese children are prone to obesity in adulthood and to developing non-communicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age. Increased waist circumference has been shown to contribute to the risk of metabolic syndrome in obese adults. Objective To assess for a correlation between waist circumference and insulin level in obese children. Methods In this cross-sectional study, obese children aged 6-10 years were included by consecutive sampling. We excluded children with infectious disease, malignancy, dyslipidemia, type 2 diabetes mellitus, or those who had not fasted before the blood draw. Subjects underwent waist circumference and fasting blood glucose measurements. Serum insulin levels were examined by enzyme-labeled chemiluminescent immunometric assay, after subjects had fasted for 10-14 hours. Data were analyzed by correlation analysis. Results Subjects had a mean waist circumference of 80.2 (SD 7.2) cm and mean insulin level of 10.70 (SD 7.5) µIU/mL . Pearson's correlation test revealed a significant, moderately positive correlation between waist circumference and elevated insulin level (r=0.45; P=0.006). Conclusion Waist circumference and insulin level have a significant, moderate, positive correlation in obese children. As such, waist circumference may be a simple method for early detection of hyperinsulinemia, as a risk factor for metabolic syndrome. [Paediatr Indones. 2017;57:194-7 ; doi: http://dx.doi.

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Background Childhood obesity is one of the most serious public health challenges of the 21st century. Its prevalence has increased at an alarming rate. Overweight and obese children are prone to obesity in adulthood and to developing non-communicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age. Increased waist circumference has been shown to contribute to the risk of metabolic syndrome in obese adults. Objective To assess for a correlation between waist circumference and insulin level in obese children. Methods In this cross-sectional study, obese children aged 6-10 years were included by consecutive sampling. We excluded children with infectious disease, malignancy, dyslipidemia, type 2 diabetes mellitus, or those who had not fasted before the blood draw. Subjects underwent waist circumference and fasting blood glucose measurements. Serum insulin levels were examined by enzyme-labeled chemiluminescent immunometric assay, after subjects had fasted for 10-14 hours. Data were analyzed by correlation analysis. Results Subjects had a mean waist circumference of 80.2 (SD 7.2) cm and mean insulin level of 10.70 (SD 7.5) µIU/mL . Pearson's correlation test revealed a significant, moderately positive correlation between waist circumference and elevated insulin level (r=0.45; P=0.006). Conclusion Waist circumference and insulin level have a significant, moderate, positive correlation in obese children. As such, waist circumference may be a simple method for early detection of hyperinsulinemia, as a risk factor for metabolic syndrome. [Paediatr Indones. 2017;57:194-7 ; doi: http://dx.doi.