BMI-for-age in South Asian children of 0-20 years in the Netherlands: secular changes and misclassification by WHO growth references

• Published in: Annals of human biology Vol. 45; no. 2; pp. 116 - 122
• Main Authors: de Wilde, J A, Dekker, M, Middelkoop, B J C
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Group 01.03.2018
• Subjects: Adolescent; Age Factors; Asia, Western - ethnology; bmi (body mass index); Body Mass Index; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Netherlands; normal distribution; obesity; Reference Standards; south asia; World Health Organization; Young Adult; BMI (body mass index); normal distribution; Child; obesity; South Asia
• ISSN: 0301-4460; 1464-5033
• DOI: 10.1080/03014460.2018.1445288

South Asians are prone to cardiometabolic disease at lower BMI levels than most other ethnic groups, starting in childhood. The magnitude of BMI misclassifications is unknown. To compare the BMI distribution of contemporary South Asian 0-20 year olds in the Netherlands with: (1) The South Asian norm reference (secular trends); and (2) The WHO child growth standard and reference. The BMI-for-age distribution of 6677 routine measurements of 3322 South Asian children, aged 0-20 years, was described with the LMS method and BMI z-scores. The BMI distribution in South Asian 0-4 year olds was almost similar to the norm reference (mean BMI z-score = 0.11, skewness = 0.31, SD = 1.0), whereas in 5-19 year olds the distribution had shifted upwards (mean = 0.53) and widened (skewness = -0.12, SD = 1.08). Overweight (incl. obesity) and obesity peaked at 8-10 years, at 45-48% and 35-37%, respectively. Relative to the WHO references, the BMI distribution was left-shifted at ages 0-4 years (mean BMI z-score = -0.46, skewness = 0.23, SD = 0.98) and widened at ages 5-20 years (mean = 0.05; skewness = -0.02, SD = 1.40). At most ages, thinness rates were significantly higher and obesity rates lower than based on South Asian norms. A secular change of BMI-for-age in South Asian children mostly affected children >4 years. WHO references likely under-estimate overweight and obesity rates in South Asian children.