Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination
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Guidelines for evaluation of the nutritional status and growth in refugee children during the domestic medical screening examination

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    Much of our understanding of the nutritional and developmental status of newly arrived refugees in the United States is based on studies of specific ethnic cohorts during defined periods. For example, during the influx of Southeast Asian refugees in the late 1970s and early 1980s, significant growth and nutritional disorders were reported within these cohorts. In fact, the large number of U.S. entries from Southeast Asia during this period likely contributed to the increases observed in overall rates of stunting among the general U.S. Asian population.

    Since the 1980s, refugee populations arriving in the United States have become more diverse, with increasing numbers of refugees arriving from Africa, Europe, and the Middle East. For example, in 2005, populations originating from 10 countries constituted 86% of all newly arrived refugees: Cuban, Ethiopian, Iranian, Laotian, Liberian, Russian, Somali, Sudanese, Ukrainian, and Vietnamese. Undernutrition has been documented in many of these populations. Poor growth and nutrition have also been reported in refugee children arriving in the United States, although studies suggest that most refugee children experience catch-up growth and reach normal weight within 6-24 months of arrival in the United States.

    Although undernutrition is often associated with refugee status, concerns are increasing about overweight/obesity among refugees resettling to developed countries. Overweight and obesity are frequently assumed to be associated with assimilation to a U.S. lifestyle (increased availability of high-calorie foods, reduced physical activity), compounded by lack of nutritional education. However, one study identified a population of African children who had a high prevalence of overweight/obesity at the time of arrival, and other data have identified overweight/obesity and associated medical consequences in the newly arriving Iraqi population. This trend may reflect the overall rising global prevalence of overweight/obesity and/or the changing socioeconomic status of newly arriving refugees. Several studies have identified overweight/obesity to be a prevalent condition in both children and adult refugees after arrival in the United States; this condition is particularly evident among those from low-income countries in Latin America, the Caribbean, the Middle East, North Africa, certain nations of Sub-Saharan Africa, Central Eastern Europe, and the former Soviet Union. Several factors have been identified that increase the risk of obesity among refugees, including length of stay in the host country, level of acculturation to U.S. lifestyles, existing cultural beliefs and values, and poor quality of housing. Information on obesity in the United States is available at: and Therefore, these populations may increasingly be at risk for both undernutrition, a condition associated with development and cognitive delays, and overweight/obesity, a condition associated with chronic medical conditions, including hypertension, diabetes, and cardiovascular disease.


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