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Updated: Aug 8, 2026

Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Conclusions about differences in linear growth between Bangladeshi boys and girls depend on the growth reference used
Insights
Growth references significantly impact the assessment of sex differences in height-for-age z-scores and stunting in Bangladeshi children. Findings highlight the need for careful interpretation of anthropometric data, especially when examining gender inequality.
Area of Science:
- Pediatric Nutrition
- Growth Monitoring
- Anthropometry
Background:
- Accurate assessment of child growth is crucial for public health interventions.
- Previous studies have shown varying results in sex differences in child growth.
- The choice of growth reference can influence the interpretation of growth data.
Purpose of the Study:
- To investigate sex differences in height-for-age z-scores and stunting among Bangladeshi children.
- To compare the impact of three different growth references (NCHS, CDC, British) on these assessments.
Main Methods:
- Analysis of data from 504,358 Bangladeshi children aged 6-59 months (1990-1999).
- Estimation of height-for-age z-scores using the 1977 NCHS, 2000 CDC, and 1990 British growth references.
- Examination of sex differences and growth curve patterns across the references.
Main Results:
- Growth curve patterns and sex differences varied significantly depending on the reference used.
- At 6 months, NCHS and CDC references indicated girls had higher z-scores than boys, while the British reference showed no difference.
- All references indicated faster deterioration of girls' z-scores from 6 to 24 months, with varying magnitudes of sex differences.
Conclusions:
- The assessment of sex differences in linear growth is highly dependent on the chosen growth reference.
- Further research is needed to understand the reasons for these discrepancies and inform the development of international growth references.
- Anthropometric data used to study gender inequality should be interpreted with caution due to reference-dependent variations.
Objective:
To examine sex differences in height-for-age z-scores and the percentage stunting among Bangladeshi children estimated using three growth references.
Design, Setting And Subjects:
Data collected between 1990 and 1999 by Helen Keller International's nutritional surveillance system in rural Bangladesh were analyzed for 504 358 children aged 6-59 months. Height-for-age z-scores were estimated using the 1977 NCHS, 2000 CDC and 1990 British growth references.
Results:
The shape of the growth curves for Bangladeshi boys and girls, and their positions relative to one another, depend on which of the three growth references is used. At 6 months of age the British reference showed no sex difference whereas the NCHS and CDC showed girls to have higher average z-scores than boys by 0.14 and 0.28 s.d., respectively. While all references showed a faster deterioration of girls' z-scores from 6 to 24 months, the magnitude and direction of the sex differences, and how they changed with age, were different. There was greater disagreement about girls' z-scores than boys. Discontinuities at 24 months in the NCHS and CDC produced jagged curves whereas the British curves were smooth.
Conclusions:
The assessment of sex differences in linear growth depends on the growth reference used. Reasons for the different results need to be determined and may aid the final development of the new WHO international growth reference and the guidelines for its use. The findings suggest that anthropometry as a tool to explore the effects of societal gender inequality must be used with caution.
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