Date of Award

January 2021

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Mona Sharifi


Objective: To study the association between head circumference z-score (HCz) and nutritional status/adiposity.

Design/Methods: Using National Health and Nutrition Examination Survey (NHANES III) data collected between 1988 and 1994, we used linear regression models to examine the extent to which HCz is associated with measures of nutritional status/adiposity -- subscapular skinfold z-score (SSFz) and triceps skinfold z-score (TSFz) -- used to represent in children age 2 to 24 months. We accounting for the complex survey design and sequentially adjusted for weight-for-length z-score (WFLz), body mass index z-score (BMIz), and other covariates (age, sex, mother’s diabetes status, feeding method, maternal smoking status during pregnancy, mother’s BMI, household income, food insufficiency, and level of education).

Results: Of 3,051 individuals (representing an estimated 6.8 million individuals) included in the analysis, 51.2% were male, 54.5% were 12.1 to 24 months, and 81.1% had a birth weight between 2500 to 4000g. In unadjusted models, there was an inverse association between HCz (β: -0.072, 95% CI: -0.118, -0.026) and SSFz when adjusting for BMIz (β: 0.732, 95% CI: 0.669, 0.794). There was an inverse association between HCz (β: -0.099, 95% CI: -0.147, -0.053) and SSFz when adjusting for WFLz (β: 0.753, 95% CI: 0.689, 0.818). This relationship persisted in the fully adjusted models. We did not observe the same inverse or significant relationship between TSFz and HCz.

Conclusion: This study suggests that there is an inverse association between HCz and SSFz but this association may not exist between HCz and TSFz. Since HC is routinely-collected in pediatric primary care, this information can be used to potentially improve predictive models to assess nutritional status/adiposity in infants.


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