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

TLDR

Population estimates of malnutrition vary by age, growth indicator, and the nutritional status of index populations. The study compares growth patterns and malnutrition estimates derived from the WHO Child Growth Standards versus the NCHS/WHO international growth reference, and examines implications for child health programmes. Using secondary analyses of longitudinal birth‑to‑12‑month data and cross‑sectional surveys from Bangladesh, the Dominican Republic, and pooled North American/Northern European infants (4,787; 10,381; 226), the authors tracked healthy breast‑fed infants’ weight‑for‑age Z‑scores against both standards. Results show that underweight, stunting, wasting, and severe wasting rates are higher and overweight rates increase by 34% when assessed with WHO standards, indicating that WHO standards provide a more sensitive tool for monitoring early infancy growth and have important implications for lactation performance and infant feeding adequacy.

Abstract

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.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.Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe.Respectively 4787, 10 381 and 226 infants and children.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%.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.