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Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes

Published online by Cambridge University Press:  02 January 2007

Mercedes de Onis ,
Adelheid W Onyango ,
Elaine Borghi ,
Cutberto Garza  and
Hong Yang
Mercedes de Onis*
Affiliation:
Department of Nutrition, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
Adelheid W Onyango
Affiliation:
Department of Nutrition, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
Elaine Borghi
Affiliation:
Department of Nutrition, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
Cutberto Garza
Affiliation:
Boston College, Chestnut Hill, MA, USA
Hong Yang
Affiliation:
Department of Nutrition, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
*
*corresponding author: Email deonism@who.int
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Abstract

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Objectives

To compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards (‘the WHO standards’) and the National Center for Health Statistics (NCHS)/WHO international growth reference (‘the NCHS reference’), and discuss implications for child health programmes.

Design

Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives.

Settings

Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe.

Subjects

Respectively 4787, 10 381 and 226 infants and children.

Results

Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%.

Conclusions

The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.

Keywords

Growth standardsAnthropometryUnderweightStuntingWastingOverweight
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 7 , October 2006 , pp. 942 - 947
Copyright
Copyright © The Authors 2006

References

1WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, Weight-for-age, Weight-for-length, Weight-for-height and Body mass index-for-age: Methods and Development. Geneva: World Health Organization, 2006.Google Scholar
2de Onis, M, Garza, C, Onyango, AW, Martorell, R, eds. WHO Child Growth Standards. Acta Paediatrica. Supplementum. 2006; 450 : 1–101.Google Scholar
3Garza, C, de Onis, M for the WHO Multicentre Growth Reference Study Group. Rationale for developing a new international growth reference. Food and Nutrition Bulletin 2004; 25(Suppl. 1). S5–14.CrossRefGoogle ScholarPubMed
4Hamill, PVV, Drizd, TA, Johnson, CL, Reed, RB, Roche, AF, Moore, WM. Physical growth: National Center for Health Statistics percentiles. American Journal of Clinical Nutrition 1979; 32: 607–29.CrossRefGoogle ScholarPubMed
5Dibley, MJ, Goldsby, JB, Staehling, NW, Trowbridge, FL. Development of normalized curves for the international growth reference: historical and technical considerations. American Journal of Clinical Nutrition 1987; 46: 736–48.CrossRefGoogle ScholarPubMed
6de Onis, M, Yip, R. The WHO growth chart: historical considerations and current scientific issues. Bibliotheca Nutritio et Dieta 1996; 53: 74–89.Google Scholar
7de Onis, M, Wijnhoven, TMA, Onyango, AW. Worldwide practices in child growth monitoring. Journal of Pediatrics 2004; 144: 461–5.CrossRefGoogle ScholarPubMed
8de Onis, M, Garza, C, Victora, CG, Bhan, MK, Norum, KR, eds. WHO Multicentre Growth Reference Study (MGRS): Rationale, Planning and Implementation. Food and Nutrition Bulletin 2004; 25(Suppl. 1): S1–89.CrossRefGoogle Scholar
9WHO Multicentre Growth Reference Study Group Enrolment and baseline characteristics in the WHO Multicentre Growth Reference Study. Acta Paediatrica. Supplementum 2006; 450: 7–15.Google Scholar
10Borghi, E, de Onis, M, Garza, C, Van den Broeck, J, Frongillo, EA, Grummer-Strawn, L, et al. WHO Multicentre Growth Reference Study Group. Construction of the World Health Organization child growth standards: selection of methods for attained growth curves. Statistics in Medicine 2006; 25: 247–65.CrossRefGoogle ScholarPubMed
11National Institute for Population Research and Training. Bangladesh Demographic and Health Survey 1996–97. Demographic and Health Surveys. Dhaka: National Institute for Population Research and Training, 1997.Google Scholar
12Molina Achécar, M, Ramirez, N, José Polanco, J, Ochoa, LH, Lerebours, G, Garcia, B. Encuesta Demografica y de Salud, ENDESA 2002. Demographic and Health Surveys. Santo Domingo, Republica Dominicana: Centro de Estudios Sociales y Demograficos, 2003.Google Scholar
13WHO Working Group on Infant Growth. An Evaluation of Infant Growth. Geneva: World Health Organization, 1994.Google Scholar
14Dewey, KG, Peerson, JM, Brown, KH, Krebs, NF, Michaelsen, KF, Persson, LA. et al. Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian and European data sets. World Health Organization Working Group on Infant Growth. Pediatrics 1995; 96: 495–503.CrossRefGoogle Scholar
15World Health Organization (WHO). Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: WHO, 1999.Google Scholar
16WHO Multicentre Growth Reference Study Group. Breastfeeding in the WHO Multicentre Growth Reference Study. Acta Paediatrica. Supplementum 2006; 450: 16–26.Google Scholar
17American Academy of Pediatrics Policy Statement. Breastfeeding and the use of human milk. Pediatrics 2005; 115: 496–506.CrossRefGoogle Scholar
18Fifty-fourth World Health Assembly. Resolution WHA54.2, Infant and Young Child Nutrition. Geneva: World Health Organization, 2001.Google Scholar
19World Health Organization (WHO). The Optimal Duration of Exclusive Breastfeeding. Report of an Expert Consultation. Geneva: WHO, 2002.Google Scholar
20WHO Multicentre Growth Reference Study Group. Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study. Acta Paediatrica. Supplementum 2006; 450: 56–65.Google Scholar