Local versus universal growth standards: the effect of using NCHS as universal reference

Area of Science:

• Pediatrics
• Public Health
• Anthropometry

Background:

• Developing countries often lack local growth references for assessing child nutritional status.
• Fieldworkers frequently use the National Center for Health Statistics (NCHS) or other Western standards, which may not be appropriate.
• This practice can lead to inaccurate assessments and ineffective nutritional interventions.

Purpose of the Study:

• To evaluate the suitability of using the NCHS reference standard versus local standards for assessing the nutritional status of children in diverse geographical areas.
• To highlight the heterogeneity in growth patterns across different regions in Africa and Asia.

Main Methods:

• Cross-sectional data were collected from 6631 children aged 0-6 years across four distinct geographical areas in Africa and Asia.
• Children assessed had no signs of protein-energy malnutrition.
• Local growth curves were generated for each area and compared against the NCHS reference standard.

Main Results:

• Significant heterogeneity was observed among the local growth curves from the four geographical areas.
• Growth values at different ages were not consistently proportional to the NCHS reference standard.
• The NCHS reference standard did not accurately reflect local growth patterns in these populations.

Conclusions:

• The findings strongly support the use of locally derived growth standards for nutritional screening of children in developing countries.
• Implementing local standards is essential for developing accurate and effective child nutrition programs.
• Reliance on non-local standards can lead to misclassification of nutritional status and suboptimal program design.