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Anthropometric reference data for international use: recommendations from a World Health Organization Expert
1Nutrition Unit, World Health Organization, Geneva, Switzerland.
Insights
The World Health Organization (WHO) reevaluated anthropometric references for health and nutrition assessment. New references are recommended for infants, while existing ones are provisionally accepted for specific childhood and adolescent measures.
Area of Science:
- Public Health
- Human Growth and Development
- Nutritional Science
Background:
- The World Health Organization (WHO) convened an Expert Committee to address the need for updated anthropometric references.
- Existing references, such as the National Center for Health Statistics (NCHS)/WHO reference, have limitations, particularly for breast-fed infants.
Purpose of the Study:
- To reevaluate the use of anthropometry across different age groups for assessing health, nutrition, and social wellbeing.
- To identify appropriate reference data and provide guidelines for its application.
Main Methods:
- Expert committee review and recommendation process.
- Evaluation of existing anthropometric references for various age groups (fetal, infant, child, adolescent, adult, elderly).
Main Results:
- Recommended an existing sex-specific multiracial reference for fetal growth.
- Recommended development of a new weight and length/height reference for infants and children due to drawbacks of the current NCHS/WHO reference.
- Recommended age-specific data for mid-upper arm circumference in preschoolers.
- Provisionally recommended NCHS body mass index (BMI) data for obesity definition and NCHS skinfold data for reference, with noted limitations.
- Stated no need for adult BMI reference data, recommending pragmatic cutoffs.
- Highlighted the lack of normative data for the elderly.
Conclusions:
- Updated and new anthropometric references are crucial for accurate health and nutrition assessments across the lifespan.
- Specific age groups require tailored reference data and interpretation guidelines.
- Further research is needed to develop normative data for the elderly population.
Abstract:
The World Health Organization (WHO) convened an Expert Committee to reevaluate the use of anthropometry at different ages for assessing health, nutrition, and social wellbeing. The Committee's task included identifying reference data for anthropometric indexes when appropriate, and providing guidelines on how the data should be used. For fetal growth, the Committee recommended an existing sex-specific multiracial reference. In view of the significant technical drawbacks of the current National Center for Health Statistics (NCHS)/WHO reference and its inadequacy for assessing the growth of breast-fed infants, the Committee recommended the development of a new reference concerning weight and length/height for infants and children, which will be a complex and costly undertaking. Proper interpretation of midupper arm circumference for preschoolers requires age-specific reference data. To evaluate adolescent height-for-age, the Committee recommended the current NCHS/WHO reference. Use of the NCHS body mass index (BMI) data, with their upper percentile elevations and skewness, is undesirable for setting health goals; however, these data were provisionally recommended for defining obesity based on a combination of elevated BMI and high subcutaneous fat. The NCHS values were provisionally recommended as reference data for subscapular and triceps skinfold thicknesses. Guidelines were also provided for adjusting adolescent anthropometric comparisons for maturational status. Currently, there is no need for adult reference data for BMI; interpretation should be based on pragmatic BMI cutoffs. Finally, the Committee noted that few normative anthropometric data exist for the elderly, especially for those > 80 y of age. Proper definitions of health status, function, and biologic age remain to be developed for this group.