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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

  • Mercedes de Onis (a1), Adelheid W Onyango (a1), Elaine Borghi (a1), Cutberto Garza (a2) and Hong Yang (a1)
  • DOI: http://dx.doi.org/10.1017/PHN20062005
  • Published online: 01 January 2007
Abstract
AbstractObjectives

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.

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*corresponding author: Email deonism@who.int
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3C Garza , M de Onis 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.

7M de Onis , TMA Wijnhoven , AW Onyango . Worldwide practices in child growth monitoring. Journal of Pediatrics 2004; 144: 461–5.

8M de Onis , C Garza , CG Victora , MK Bhan , KR Norum , eds. WHO Multicentre Growth Reference Study (MGRS): Rationale, Planning and Implementation. Food and Nutrition Bulletin 2004; 25(Suppl. 1): S189.

10E Borghi , M de Onis , C Garza , J Van den Broeck , EA Frongillo , L Grummer-Strawn , 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.

17American Academy of Pediatrics Policy Statement. Breastfeeding and the use of human milk. Pediatrics 2005; 115: 496506.

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