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Differences in stunting prevalences calculated from two similar growth references may be large and inconsistent in

C L Eckhardt1, L S Adair

  • 1Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, University Square, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516-3997, USA. cara_eckhardt@unc.edu

Annals of Human Biology
|October 25, 2002
PubMed

Insights

The 2000 CDC growth references offer improved accuracy for assessing child stunting compared to the 1977 NCHS references, particularly in undernourished populations. Researchers should be aware of potential challenges when transitioning to the new growth references.

Area of Science:

  • Pediatrics
  • Public Health
  • Nutrition Science

Background:

  • The 1977 National Center for Health Statistics (NCHS) references were internationally recommended for child growth assessment.
  • Limitations in the 1977 NCHS references led to the development of new growth references by the US Centers for Disease Control and Prevention (CDC) in 2000.

Purpose of the Study:

  • To compare length-for-age Z-scores (LA Z-scores) and height-for-age Z-scores (HA Z-scores) between the 1977 NCHS and 2000 CDC growth references.
  • To evaluate age-specific stunting prevalences in an undernourished population using both reference sets.
  • To identify differences in growth metric calculations and stunting rates between the two growth references.

Main Methods:

  • Utilized data from over 2000 children participating in the Cebu Longitudinal Health and Nutrition Study in the Philippines.
  • Collected anthropometric data bimonthly from birth to 2 years, and at ages 8.5, 11.5, 15 (girls), and 16 (boys) years.
  • Calculated Z-scores and stunting prevalences using both 1977 NCHS and 2000 CDC references for comparative analysis.

Main Results:

  • Length-for-age Z-scores were generally lower with the 1977 references, resulting in higher stunting prevalences from birth to 2 years.
  • Height-for-age Z-scores showed inconsistent differences between references after 8.5 years of age, varying by sex and magnitude.
  • Some crossover in Z-scores and stunting prevalences was observed between the two reference systems.

Conclusions:

  • The 1977 NCHS and 2000 CDC growth references yield different results when applied to undernourished children.
  • The 2000 CDC growth references represent an improvement for assessing child growth and stunting.
  • Transitioning to new growth references presents challenges for researchers and field workers that require careful consideration.
Abstract

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