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Fit to WHO weight standard of European infants over time
Daniel Levin1, Louise Marryat1, Tim J Cole2
1School of Mathematics and Statistics, University of Glasgow, Glasgow, UK.
Insights
The World Health Organization (WHO) growth charts fit Northern European infants acceptably, but with variations. Infant weights increased over time, but showed no consistent pattern beyond birth, suggesting measurement or feeding practice differences.
Area of Science:
- Pediatric growth monitoring
- Public health standards
- Nutritional anthropometry
Background:
- The 2006 World Health Organization (WHO) growth charts provide an international standard for child growth.
- Concerns exist regarding the fit of these charts for Northern European populations.
- This study investigates infant weight trends in relation to the WHO standard over five decades.
Purpose of the Study:
- To assess the fit of the 2006 WHO growth charts for well-nourished Northern European children across different birth cohorts.
- To analyze infant weight trajectories from birth to two years.
- To discuss the implications of observed deviations from the WHO standard.
Main Methods:
- Utilized four UK and one Finnish longitudinal datasets (over 8000 children, born 1959-2003).
- Calculated age-sex-adjusted Z-scores using WHO standards for infant weights (birth to 2 years).
- Employed Generalized Additive Models for Location, Scale and Shape (GAMLSS) for data summarization.
Main Results:
- Infant weights demonstrated a variable fit to the WHO standard.
- Mean birth weights were above the WHO median, decreasing by 8 weeks, then increasing.
- By one year, cohorts were up to 0.75 SD above the WHO median, with no consistent temporal trend after the initial period.
Conclusions:
- The WHO standard provides an acceptable, though variable, fit for Northern European infants.
- Increased birth weights over time were observed, but without consistent cohort-specific variations post-infancy.
- Deviations may stem from measurement protocols and evolving infant feeding practices.
Objectives:
The 2006 WHO growth charts were created to provide an international standard for optimal growth, based on healthy, breastfed populations, but it has been suggested that Northern European children fit them poorly. This study uses infant weight data spanning 50 years to determine how well-nourished preschool children from different eras fit the WHO standard, and discuss the implications of deviations.
Design:
Four longitudinal datasets from the UK and one from Finland were used comprising over 8000 children born between 1959 and 2003. Weights from birth to 2 years were converted to age-sex-adjusted Z scores using the WHO standard and summarised using Generalized Additive Models for Location, Scale and Shape.
Results:
Weights showed a variable fit to the WHO standard. Mean weights for all cohorts were above the WHO median at birth, but dipped by up to 0.5 SD to a nadir at 8 weeks before rising again. Birth weights increased in successive cohorts and the initial dip became slightly shallower. By age 1 year, cohorts were up to 0.75 SD above the WHO median, but there was no consistent pattern by era.
Conclusions:
The WHO standard shows an acceptable, but variable fit for Northern European infants. While birth weights increased over time, there was, unexpectedly, no consistent variation by cohort beyond this initial period. Discrepancies in weight from the standard may reflect differences in measurement protocol and trends in infant feeding practice.
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