Misclassification of stunting, underweight and wasting in children 0–5 years of South Asian and Dutch descent: ethnic-specific v. WHO criteria

• Published in: Public health nutrition Vol. 23; no. 12; pp. 2078 - 2087
• Main Authors: de Wilde, JA, Peters-Koning, M, Middelkoop, BJC
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.08.2020
• Subjects: Age; Asian people; Assessment and Methodology; Body Height; Breastfeeding & lactation; Child, Preschool; Children; Children & youth; Cross-Sectional Studies; Descent; Ethnicity; Families & family life; Female; Growth Disorders - epidemiology; Humans; India; Infant; Male; Minority & ethnic groups; Netherlands; Pakistan; Parents & parenting; Prevalence; Research Paper; Subpopulations; Thinness - epidemiology; Underweight; Wasting Syndrome - epidemiology; Weight; World Health Organization; Youth; Netherlands; Pakistan; India; Suriname; Hague Netherlands; South Asia; Public health/standards; Body height; Growth charts; Body weight; Preschool; Child; Reference values
• ISSN: 1368-9800; 1475-2727
• DOI: 10.1017/S1368980019004464

Several authors have questioned the suitability of WHO Child Growth Standards (WHO-CGS) for all ethnic groups. The aim of this study was to identify potential misclassification of stunting, underweight and wasting in children of Surinamese Asian Indian, South Asian (Pakistan/India) and Dutch descent. A series of routine cross-sectional measurements, collected 2012-2015. South Asian-specific normative growth references for weight-for-age and weight-for-length/height were constructed using the LMS method based on historic growth data of Surinamese Asian Indians born between 1974 and 1976. WHO-CGS and ethnic-specific references were applied to calculate z-scores and prevalence of stunting, underweight and wasting. Youth HealthCare, providing periodical preventive health check-ups. 11 935 children aged 0-5 years. Considerable deviations from WHO-CGS were found, with higher-than-expected stunting rates, especially in the first 6 months of life. Surinamese Asian Indian children showed stunting rates up to 16·0 % and high underweight and wasting over the whole age range (up to 7·2 and 6·7 %, respectively). Dutch children consistently had mean WHO-CGS z-scores 0·3-0·5 sd above the WHO baseline (>6 months). The application of ethnic-specific references showed low rates for all studied indicators, although South Asian children were taller and larger than their Surinamese Asian Indian counterparts. WHO-CGS misclassify a considerable proportion of children from all ethnic groups as stunted in the first 6 months of life. Underweight and wasting are considerably overestimated in Surinamese Asian Indian children. Ethnic-specific growth references are recommended for Surinamese Asian Indian and Dutch children. The considerable differences found between South Asian subpopulations requires further research.