Neck circumference (NC) is currently used as an embryonic marker of obesity and its associated risks. But its use in clinical evaluations and other epidemiological purposes requires sex and age-specific standardised cut-offs which are still scarce for the Pakistani paediatric population. We therefore developed sex and age-specific growth reference charts for NC for Pakistani children and adolescents aged 2–18 years.

Cross-sectional multi-ethnic anthropometric survey (MEAS) study.

Multan, Lahore, Rawalpindi and Islamabad.

The dataset of 10 668 healthy Pakistani children and adolescents aged 2–18 years collected in MEAS were used. Information related to age, sex and NC were taken as study variables. The lambda–mu–sigma (LMS) and quantile regression (QR) methods were applied to develop growth reference charts for NC.

The 5th, 10th, 25th, 50th, 75th, 90th and 95th smoothed percentile values of NC were presented. The centile values showed that neck size increased with age in both boys and girls. During 8 and 14 years of age, girls were found to have larger NC than boys. A comparison of NC median (50th) percentile values with references from Iranian and Turkish populations reveals substantially lower NC percentiles in Pakistani children and adolescents compared to their peers in the reference population.

The comparative results suggest that the uses of NC references of developed countries are inadequate for Pakistani children. A small variability between empirical centiles and centiles obtained by QR procedure recommends that growth charts should be constructed by QR as an alternative method.

Several authors have questioned the suitability of WHO Child Growth Standards (WHO-CGS) for all ethnic groups. The aim of this study was to identify potential misclassification of stunting, underweight and wasting in children of Surinamese Asian Indian, South Asian (Pakistan/India) and Dutch descent.

A series of routine cross-sectional measurements, collected 2012–2015. South Asian-specific normative growth references for weight-for-age and weight-for-length/height were constructed using the LMS method based on historic growth data of Surinamese Asian Indians born between 1974 and 1976. WHO-CGS and ethnic-specific references were applied to calculate z-scores and prevalence of stunting, underweight and wasting.

Youth HealthCare, providing periodical preventive health check-ups.

11 935 children aged 0–5 years.

Considerable deviations from WHO-CGS were found, with higher-than-expected stunting rates, especially in the first 6 months of life. Surinamese Asian Indian children showed stunting rates up to 16·0 % and high underweight and wasting over the whole age range (up to 7·2 and 6·7 %, respectively). Dutch children consistently had mean WHO-CGS z-scores 0·3–0·5 sd above the WHO baseline (>6 months). The application of ethnic-specific references showed low rates for all studied indicators, although South Asian children were taller and larger than their Surinamese Asian Indian counterparts.

WHO-CGS misclassify a considerable proportion of children from all ethnic groups as stunted in the first 6 months of life. Underweight and wasting are considerably overestimated in Surinamese Asian Indian children. Ethnic-specific growth references are recommended for Surinamese Asian Indian and Dutch children. The considerable differences found between South Asian subpopulations requires further research.

To compare estimates of underweight, stunting, wasting, overweight and obesity based on three growth charts.

Cross-sectional study to estimate weight-for-age, length/height-for-age and weight-for-height comparing the 2006 WHO Child Growth Standards (‘the WHO standards’), the 1977 National Center for Health Statistics (NCHS) international growth reference (‘the NCHS reference’) and the 1987 Argentine Pediatric Society Committee of Growth and Development reference (‘the APS reference’). Cut-off points were defined as mean values ±2 sd. Epi-Info software version 6·0 (Centers for Disease Control and Prevention) was used for statistical evaluations (χ2, P ≤ 0·05).

Greater La Plata conurbation, Buenos Aires, Argentina.

A total of 2644 healthy, full-term children from 0 to 5 years of age.

Prevalence of underweight was higher with the WHO standards than with the other references up to the first 6 months. For the rest of the ages, prevalence was lower with the WHO standards. Stunting prevalence was higher with the WHO standards at all ages. Prevalence of wasting was higher with the WHO standards compared with the NCHS reference up to the first 6 months and lower at 2–5 years of age. Overweight and obesity prevalences were higher with the WHO standards at all ages.

The new WHO standards appear to be a solid and reliable tool for diagnosis and treatment of nutritional diseases, also being the only one built with infants fed according to WHO recommendations. Therefore, our results support the decision of the National Ministry of Health about the utilization of the new WHO standards to monitor the nutritional status of Argentinean children aged less than 5 years.