Skip to main content Accessibility help
×
Home

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

  • Mercedes de Onis (a1), Adelheid W Onyango (a1), Elaine Borghi (a1), Cutberto Garza (a2), Hong Yang (a1) and WHO Multicentre Growth Reference Study Group...

Abstract

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      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
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      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
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      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
      Available formats
      ×

Copyright

Corresponding author

*corresponding author: Email deonism@who.int

References

Hide All
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.
2de Onis, M, Garza, C, Onyango, AW, Martorell, R, eds. WHO Child Growth Standards. Acta Paediatrica. Supplementum. 2006; 450 : 1101.
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.
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.
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.
6de Onis, M, Yip, R. The WHO growth chart: historical considerations and current scientific issues. Bibliotheca Nutritio et Dieta 1996; 53: 7489.
7de Onis, M, Wijnhoven, TMA, Onyango, AW. Worldwide practices in child growth monitoring. Journal of Pediatrics 2004; 144: 461–5.
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): S189.
9WHO Multicentre Growth Reference Study Group Enrolment and baseline characteristics in the WHO Multicentre Growth Reference Study. Acta Paediatrica. Supplementum 2006; 450: 715.
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.
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.
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.
13WHO Working Group on Infant Growth. An Evaluation of Infant Growth. Geneva: World Health Organization, 1994.
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: 495503.
15World Health Organization (WHO). Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: WHO, 1999.
16WHO Multicentre Growth Reference Study Group. Breastfeeding in the WHO Multicentre Growth Reference Study. Acta Paediatrica. Supplementum 2006; 450: 1626.
17American Academy of Pediatrics Policy Statement. Breastfeeding and the use of human milk. Pediatrics 2005; 115: 496506.
18Fifty-fourth World Health Assembly. Resolution WHA54.2, Infant and Young Child Nutrition. Geneva: World Health Organization, 2001.
19World Health Organization (WHO). The Optimal Duration of Exclusive Breastfeeding. Report of an Expert Consultation. Geneva: WHO, 2002.
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: 5665.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed