Anthropometric Growth Reference for Indian Children and Adolescents
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Updated: Jun 30, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Rajesh Majumder1, Anura V Kurpad2, Harshpal Singh Sachdev3
1Division of Epidemiology, Biostatistics and Population Health, St John's Research Institute, Bangalore, Karnataka, India.
Insights
New Indian growth references, based on national data, show lower growth metrics than global standards. This suggests over 50% reduction in growth faltering estimates for Indian children and adolescents, impacting public health policy.
Area of Science:
- Pediatric Nutrition
- Anthropometry
- Public Health
Background:
- Global growth references may not accurately reflect diverse populations like India.
- Developing country-specific anthropometric standards is crucial for precise health assessments.
Purpose of the Study:
- To establish novel anthropometric growth references for Indian children and adolescents.
- To compare these references with existing global standards (WHO).
Main Methods:
- Utilized data from four Indian national surveys (NFHS-3, 4, 5; CNNS) over 20 years.
- Applied Generalized Additive Models for Location, Scale and Shape (GAMLSS) with Box-Cox Power Exponential (BCPE) family.
- Estimated height-for-age, weight-for-age, weight-for-height, and BMI-for-age distributions.
Main Results:
- Proposed Indian growth references are consistently lower than WHO standards after the first six months of age.
- Using these new references, growth faltering prevalence in Indian children and adolescents decreased by over 50% compared to WHO standards.
- National prevalence of growth faltering was estimated using NFHS-5 and CNNS data.
Conclusions:
- The WHO's 'one-standard-fits-all' approach may overestimate undernutrition in India.
- Inflated undernutrition estimates can lead to misdirected public health policies and expenditure.
- Further prospective studies are recommended for validating these findings and strengthening the evidence base.
Objective:
We aimed to develop anthropometric growth references for Indian children and adolescents, based on available 'healthy' child data from multiple national surveys.
Methodology:
Data on 'healthy' children, defined by comparable WHO's Multicentre Growth Reference Study (MGRS) selection criteria, were extracted from four Indian surveys over the last 2 decades, viz, NFHS-3, 4, and 5 and Comprehensive National Nutrition Survey (CNNS). Reference distributions of height-for-age for children up to 19 years, weight-for-age for children up to 9y, weight-for-height for children less than 5 years and BMI for age for children between 5-19 y were estimated by GAMLSS with Box-Cox Power Exponential (BCPE) family. The national prevalence of growth faltering was also estimated by the NFHS-5 and CNNS data.
Results:
The distributions of the new proposed Indian growth references are consistently lower than the WHO global standard, except in the first 6 months of age. Based on these references, growth faltering in Indian children and adolescents reduced > 50% in comparison with the WHO standard.
Conclusion:
The study findings revealed that the WHO one-standard-fits-all approach may lead to inflated estimates of under nutrition in India and could be a driver of misdirected policy and public health expenditure in the Indian context. However, these findings need validation through prospective and focussed studies for more robust evidence base.
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