Growth assessment in clinical practice: whose growth curve?

Area of Science:

• Pediatrics
• Nutrition Science
• Public Health

Background:

• Accurate growth assessment is crucial for diagnosing undernutrition and overnutrition.
• Interpreting adequate growth post-nutrition intervention relies on appropriate growth curves.
• Discrepancies exist between different growth charts, impacting clinical decisions.

Purpose of the Study:

• To compare the World Health Organization (WHO) 2006 Growth Standard and the Centers for Disease Control and Prevention (CDC) 2000 Growth Reference.
• To analyze the impact of these differences on diagnosing nutritional status in children up to 59 months.
• To evaluate the implications for interpreting growth following nutritional interventions.

Main Methods:

• Comparative analysis of the WHO 2006 Growth Standard and CDC 2000 Growth Reference methodologies.
• Examination of the conceptual approaches underpinning each growth assessment tool.
• Evaluation of diagnostic outcomes for undernutrition and overnutrition based on each standard.

Main Results:

• The WHO standard, based on ideal growth, differs conceptually from the CDC reference, which reflects observed growth.
• Fewer children are diagnosed with poor weight gain using the WHO standard compared to the CDC reference.
• More children are identified with excess adiposity using the WHO standard than the CDC reference.

Conclusions:

• The choice of growth standard significantly influences the diagnosis of nutritional status in infants and children.
• The WHO Growth Standard may help prevent inappropriate interventions and overfeeding by identifying excess adiposity more readily.
• Consistent application of appropriate growth curves is essential for accurate growth monitoring and intervention.