Abstract
Background
Infants from low-income backgrounds receive nutrition care from both community and
clinical care settings. However, mothers accessing these services have reported receiving
conflicting messages related to infant growth between settings, although this has
not been examined quantitatively.
Objective
Describe the agreement in infant growth assessments between community (Special Supplemental
Nutrition Program for Women, Infants, and Children) and clinical (primary care providers)
care settings.
Design
A cross-sectional, secondary data analysis of infant growth measures abstracted from
electronic data management systems.
Participants and setting
Participants included a convenience sample of infants (N = 129) from northeastern
Pennsylvania randomized to the WEE Baby Care study from July 2016 to May 2018. Infants
had complete anthropometric data from both community and clinical settings at age
6.2 ± 0.4 months. Average time between assessments was 2.7 ± 1.9 weeks.
Main outcome measures
Limits of agreement and bias in weight-for-age, length-for-age, weight-for-length,
and body-mass-index-for-age z scores as well as cross-context equivalence in weight status between care settings.
Statistical analysis performed
Bland-Altman analyses were used to describe the limits of agreement and bias in z scores between care settings. Cross-context equivalence was examined by dichotomizing
infants’ growth indicators at the 85th and 95th percentile cut-points and cross-tabulating
equivalent and discordant categorization between settings.
Results
Strongest agreement was observed for weight-for-age z scores (95% limits of agreement –0.41 to 0.54). However, the limits of agreement
intervals for growth indicators that included length were wider, suggesting weaker
agreement. There was a high level of inconsistency for classification of overweight/obesity
using weight-for-length z scores, with 15.5% (85th percentile cut-point) and 11.6% (95th percentile cut-point)
discordant categorization between settings, respectively.
Conclusions
Infant growth indicators that factor in length could contribute to disagreement in
the interpretation of infant growth between settings. Further investigation into the
techniques, standards, and training protocols for obtaining infant growth measurements
across care settings is required.
Keywords
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Biography
H. A. Harris is a postdoctoral fellow, Center for Childhood Obesity Research, The Pennsylvania State University, University Park (former); and a postdoctoral fellow, Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands (current).
Biography
S. M. R. Kling is a postdoctoral fellow, Geisinger Obesity Institute, Epidemiology and Health Services Research Geisinger, Danville, PA (former); a research fellow and assistant research and teaching professor, Center for Childhood Obesity Research, Department of Nutritional Sciences, The Pennsylvania State University, University Park (former); and a quantitative research scientist, Evaluation Sciences Unit, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA (current).
Biography
M. Marini is a statistician, Center for Childhood Obesity Research, The Pennsylvania State University, University Park.
Biography
S. G. Hassink is medical director, American Academy of Pediatrics Institute for Healthy Childhood Weight, Wilmington, DE.
Biography
L. Bailey-Davis is an assistant professor, Geisinger Obesity Institute, Population Health Sciences, Geisinger, Danville, PA.
Biography
J. S. Savage is an associate professor and director of the Center for Childhood Obesity Research, The Pennsylvania State University, University Park.
Article info
Publication history
Published online: December 16, 2020
Accepted:
November 11,
2020
Received:
April 29,
2020
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This project was supported by the Health Resources and Services Administration of the US Department of Health and Human Services under grant no. R40MC28317, Maternal and Child Health Field-Initiated Innovative Research Studies Program. Funding for REDCap was provided by The Penn State Clinical & Translational Research Institute, Pennsylvania State University Clinical and Translational Science Awards, National Institutes of Health/National Center for Advancing Translational Sciences grant no. UL1 TR002014.
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