Anthropometric Growth Reference for Indian Children and Adolescents

Abstract

Background: The prevalence of faltered growth among under-5y children of India remains persistently high in the last three rounds of the Indian National Family Health Survey (NFHS). A potential cause for this sustained child undernutrition, despite substantial economic growth, is the use of an inappropriate, one-size-fits-all, WHO global standard for Indian children. We aimed to analyse if this was true, and if so to develop anthropometric growth references for Indian children and adolescents, based on available ‘healthy’ child data from multiple national surveys.

Methodology: Data on ‘healthy’ children, defined by stringent WHO selection criteria, were extracted from several Indian surveys over the last 2 decades (NFHS-3,4,5 and Comprehensive National Nutrition Survey, CNNS). Reference distributions of height-for-age for children up to 19 years, weight-for-age for children up to 9y, weight-for-height for children <5y and BMI for age for children up between 5-19y were estimated by conventional GAMLSS with Box-Cox Power Exponential (BCPE) family. The national prevalence of growth faltering was also estimated by the NFHS-5 and CNNS data.

Results: The distributions of the new proposed Indian growth references are consistently lower than the WHO global standard, except in the first 6 months of age. Based on these references, growth faltering (stunting, underweight and wasting) in Indian children and adolescents from the NFHS-5 and CNNS surveys, were >50% lower than when assessed using the WHO standard.

Conclusion: The WHO one-standard-fits-all approach for deriving population estimates of anthropometric growth faltering leads to inflated estimates of undernutrition in India, which are in contrast to India’s economic growth and supplementary feeding initiatives. It also leads to considerable clinical misclassification and is a driver of misdirected policy and public health expenditure in the Indian context.

Note:

Funding Information: The work has been executed without any fund.

Conflict of Interests: All authors declare that all authors have no competing interest.

Keywords: Growth standard; stunting;wasting; double burden; WHO