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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Worldwide variation in human growth and the World Health Organization growth standards: a systematic review
Valerie Natale1, Anuradha Rajagopalan
1The Forgotten Diseases Research Foundation, Santa Clara, California, USA.
Insights
The World Health Organization (WHO) growth charts may not accurately assess all children. Head circumference measurements showed significant variation, suggesting a single international standard is not appropriate for all populations.
Area of Science:
- Pediatric Growth Standards
- Anthropometry
- International Child Health
Background:
- The World Health Organization (WHO) developed international growth curves for children up to age 5.
- The WHO posits that universally breastfed, economically advantaged children exhibit similar growth patterns.
- This implies a single set of growth charts can be applied globally across diverse populations.
Purpose of the Study:
- To critically evaluate the applicability of WHO growth standards across different populations.
- To compare mean height, weight, and head circumference data from various studies against WHO data.
- To assess the suitability of a single international growth standard for diverse ethnic and national groups.
Main Methods:
- A systematic comparison of data from the WHO Multicentre Growth Reference Study (MGRS) was conducted.
- Data from studies encompassing 55 countries or ethnic groups were analyzed.
- Inclusion criteria focused on large, recent studies (1988-2013) of economically advantaged populations, including breastfed cohorts.
Main Results:
- Height variations between national and ethnic groups were observed, generally within 0.5 standard deviations of MGRS means.
- Weight variability was more pronounced; MGRS means were noted to potentially endorse slenderness amidst an obesity epidemic.
- Mean head circumference varied widely, with many groups showing means 0.5-1 SD above MGRS. Head size in breastfed infants aligned more closely with local norms than MGRS data.
Conclusions:
- WHO height and weight growth curves may not be universally optimal for all populations.
- Significant differences in head circumference means across groups indicate a risk of misdiagnosis (macrocephaly/microcephaly) if WHO charts are used.
- The study concludes that a single international standard for head circumference is not scientifically justified.
Objective:
The World Health Organization (WHO) has established a set of growth curves for use as international standards in children up to age 5. The WHO's position is that all economically advantaged children who were breastfed as infants grow similarly. As a result, a single set of growth charts can be used to judge growth in any child, regardless of race or ethnicity. The goal of this study was to compare mean heights, weights and head circumferences from a variety of studies with the WHO's data.
Design:
We compared data from the WHO's Multicentre Growth Reference Study (MGRS) with data from studies performed in 55 countries or ethnic groups.
Data Sources:
PubMed, WHO Global Database on Child Growth and Malnutrition, SciELO, Google Scholar, Textbooks and Ministries of Statistics and Public Health.
Eligibility Criteria:
Large recent studies (1988-2013) of economically advantaged groups, including comparisons with cohorts of breastfed children wherever possible.
Results:
Height varied somewhat among different national and ethnic groups. Means were generally within 0.5 of an SD of the MGRS means. Weight varied more than height, but the low MGRS means were seen as endorsing slenderness in the midst of an obesity epidemic. The mean head circumference varied widely. In many groups, means were consistently 0.5-1 SD above the MGRS mean. Head size in breastfed children at any age examined was far closer to local norms than to the MGRS means.
Conclusions:
Height and weight curves may not be optimal fits in all cases. The differences between national or ethnic group head circumference means were large enough that using the WHO charts would put many children at risk for misdiagnosis of macrocephaly or microcephaly. Our findings indicate that the use of a single international standard for head circumference is not justified.
Systematic Review Registration:
PROSPERO (# CRD42013003675).
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