Implications of the WHO Child Growth Standards in rural Honduras

Abstract

Objective: The present study analysed the impact of using the 2006 WHO Child Growth Standards ('the WHO standards') compared with the 1977 National Center for Health Statistics (NCHS) international growth reference ('the NCHS reference') on the calculated prevalence of chronic malnutrition in children aged 6?0-59?9 months. Design: Anthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland-Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories. Setting: The study was conducted in thirteen rural villages within Honduras's department of Intibucá. Subjects: Children aged 6?0-59?9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study. Results: The WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24?0-35?9 months and WHZ among males aged .24?0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender. Conclusions: The choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously.

Altered Gut Microbiota and Shift inBacteroidetesbetween Young Obese and Normal-Weight Korean Children: A Cross-Sectional Observational Study

“…Subjects completed questionnaires on lifestyle, bowel habits, and dietary intake and submitted them at the hospital visit. Anthropometric measurements, including height, weight, waist circumference, midarm circumference, hip circumference, thigh circumference, and blood pressure, were performed by professionally trained personnel [ 14 , 15 ]. Body composition analysis including skeletal muscle mass and total body fat content was measured using the inBody 770 analyzer (Biospace Co. Ltd., Seoul, Korea).…”

Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

“…Most studies in the literature used now obsolete child growth standards ( 6 , 20 , 21 ) or used a variety of incomparable cut-off points to define malnutrition ( 1 , 12 , 22 , 23 ) . The currently recommended WHO child growth standards ( 24 ) give higher estimates for both stunting and overweight compared with the earlier standards of the US National Center for Health Statistics ( 25 ) and the US Centers for Disease Control and Prevention ( 26 ) , and this poses serious problems concerning comparison of studies using the various standards. To enable valid comparisons across years, studies are needed that apply the new WHO growth standards to data that pre-date the new standards, as well as newer data.…”

Validation of growth standards and growth references: A review of literature

“…Only one study in the American Region presented children with lower growth outcomes in comparison to WHO growth standards (Martin et al, 2019). The evaluation in Honduras showed children who presented with lower height-for-age means but higher weight-forage and weight for height z scores in comparison to WHO growth standards (Nichols et al, 2012). Only one study in the Americas presented a curve that approximated the WHO growth standards (da Silva Vieira et al, 2015).…”

“…Research conducted in Brazil showed a growth trajectory similar to WHO growth standards for exclusively breastfed children compared to the NCHS 1977 growth reference (da Silva Vieira et al, 2015). A study done in Honduras showed that WHO standards were able to detect more children with stunting, overweight, and obesity but identified fewer underweight children compared to NCHS 1977 growth references (Nichols et al, 2012).…”