Misclassification of stunting, underweight and wasting in children 0-5 years of South Asian and Dutch descent: ethnic-specific v. WHO criteria

Wilde, J.A. de; Peters-Koning, M.; Middelkoop, B.J.C. (2020)

Article / Letter to editor

Objective: Several authors have questioned the suitability of WHO Child Growth Standards (WHO-CGS) for all ethnic groups. The aim of this study was to identify potential misclassification of stunting, underweight and wasting in children of Surinamese Asian Indian, South Asian (Pakistan/India) and Dutch descent. Design: A series of routine cross-sectional measurements, collected 2012-2015. South Asian-specific normative growth references for weight-for-age and weight-for-length/height were constructed using the LMS method based on historic growth data of Surinamese Asian Indians born between 1974 and 1976. WHO-CGS and ethnic-specific references were applied to calculate z-scores and prevalence of stunting, underweight and wasting. Setting: Youth HealthCare, providing periodical preventive health check-ups. Participants: 11 935 children aged 0-5 years. Results: Considerable deviations from WHO-CGS were found, with higher-than-expected stunting rates, especially in the first 6 months of life. Surinamese Asian Indian children showed stunting rates up to 16 center dot 0 % and high underweight and wasting over the whole age range (up to 7 center dot 2 and 6 center dot 7 %, respectively). Dutch children consistently had mean WHO-CGS z-scores 0 center dot 3-0 center dot 5sdabove the WHO baseline (>6 months). The application of ethnic-specific references showed low rates for all studied indicators, although South Asian children were taller and larger than their Surinamese Asian Indian counterparts. Conclusions: WHO-CGS misclassify a considerable proportion of children from all ethnic groups as stunted in the first 6 months of life. Underweight and wasting are considerably overestimated in Surinamese Asian Indian children. Ethnic-specific growth references are recommended for Surinamese Asian Indian and Dutch children. The considerable differences found between South Asian subpopulations requires further research.

• Child
• Preschool
• Growth charts
• Public health
• standards
• Reference values
• Body height
• Body weight

• All authors: Wilde, J.A. de; Peters-Koning, M.; Middelkoop, B.J.C.
• Date: 2020-08-01
• Journal: Public Health Nutrition
• Volume: 23
• Issue: 12
• Pages: 2078 - 2087
• DOI: doi:10.1017/S1368980019004464
• Link: https://www.cambridge.org/core/journals/public-health-nutrition/article/...