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... Show moreObjective: 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. Show less
For South Asian adults lowered BMI cut-offs for overweight and obesity are recommended as these are more in agreement with their body composition (low muscle mass, high fat mass) and the... Show moreFor South Asian adults lowered BMI cut-offs for overweight and obesity are recommended as these are more in agreement with their body composition (low muscle mass, high fat mass) and the considerably higher risk of cardiovascuar and metabolic disease. For South Asian children living in a Western country lowered BMI norms have not been established, nor other ethnic specific growth standards. The aims of this thesis are 1. to gain more insight into the normal physical growth of South Asian children 2. to develop South Asian specific height-for-age (0-21 years) and BMI-for-age (2-18 years) references, including BMI cut-offs. The studies in this thesis show that South Asian children are generally lighter and shorter than other ethnic groups. The mean birth weight is at 3012 grams around 450 grams lower than of Dutch babies and has remained unchanged for the past 35 years. In children 3-15 years thinness is highly prevalent and overweight prevalence is relatively low. Application of the developed height-for-age charts and lowered BMI cut-offs will expectedly lead to a better assessment of height and nutritional status (thinness, overweight) in this group. Consequently, thinness rates will be lower while overweight will be detected earlier, leading to earlier preventive interventions. Show less
