WHO growth reference for children and adolescents
Summary of published research1
The need for a widely applicable growth reference for older children and adolescents has increasingly been recognised by countries attempting to assess the magnitude of the growing public health problem of childhood obesity. This need has been reaffirmed by the recent release of the new under-five growth standards by the World Health Organisation (WHO) (see Field Exchange issues 28 and 30).
A paper has just been published which reports on a reconstruction of the 1977 National Centre for Health Statistics (NCHS)/WHO growth reference for older children. It compares the resulting new curves (the 2007 WHO reference) with the 1977 NCHS/WHO charts, and describes the transition at 5 years of age from the WHO references for under-fives to these new curves for school-aged children and adolescents.
The approach used in constructing the 2007 WHO reference addressed the limitations of the 1977 NCHS curves, recognised by the 1993 expert committee that recommended their provisional use for older children. The height-for-age median curves of the 1977 and 2007 references overlap almost completely with only a slight difference in shape. This is probably due to the different modelling techniques used. When compared to the 1977 NCHS/WHO curves, the differences in the newly reconstructed weightfor- age curves are significant in all centiles apart from the median and the -1 standard deviation (SD) curves. This reflects the important difference in curve construction methodology. The fact that the median curves of the two references overlap almost completely is reassuring in that the two samples used for fitting the models are the same within the healthy range (i.e. middle range of the distribution).
The reference data for Body Mass Index (BMI)-for-age recommended by WHO are limited in that they begin only at 9 years of age and cover a restricted distribution range (5th-95th percentiles). The 2007 reconstruction permits the extension of the BMI reference to 5 years, where the curves match WHO under-five curves almost perfectly (see table 1 for reference values). Furthermore, at 19 years of age, the 2007 BMI values for both sexes at +1 SD (25.4 kg/m2 for boys and 25.0 kg/m2 for girls) are equivalent to the overweight cut-off used for adults (25.0 kg/m2). The +2 SD value (29.7 kg/m2 for both sexes) compares closely with the cut-off for obesity (30.0 kg/m2).
The 2007 height-for-age and BMI-for-age charts extend to 19 years, which is the upper age limit of adolescence as defined by WHO. The weight-for-age charts extend to 10 years for the benefit of countries that routinely measure only weight and would like to monitor growth throughout childhood. Weight-for-age is inadequate for monitoring growth beyond childhood due to its inability to distinguish between relative height and body mass. Hence, the provision of BMI-for-age complements height-for-age in the assessment of thinness (low BMI-for-age), overweight and obesity (high BMI-for-age) and stunting (low height-for-age) in school-aged children and adolescents.
Growth reference data for children and adolescents aged 5-19 years (or 61-228 months) is available on the WHO website, http://www.who.int/growthref/en/
|Table 1 Reference values for height-for-age, weight-for-age and body mass index-for-age at 5 years by sex for the 1977 and 2007 references, and the WHO Child Growth Standards|
|1977 reference||2007 reference||WHO standards*||1977 reference||2007 reference||WHO standards*|
|Body mass index-for-age (kg/m2)**|
*WHO Child Growth Standards for 0-5 years of age.
**For BMI, the 1991 reference data start at 9 years of age.
1Onis de M et al (2007). Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organisation, volume 85, No 9, pp 649- 732, September 2007. Available at http://www.who.int/bulletin/volumes/85/9/07-043497/en/print.html#R18#R18
More like this
en-net: BMI for age or WfH?
What is currently seen as best method to determine acute malnutrition for boys aged 15-19 years , BMI for age or WfH? You have any experiences which method works...
Dear fellow nutritionists, I have read the various previous questions regarding the question on how to assess adolescent malnutrition, including the literature (For example:...
FEX: A growth reference for MUAC-for-age among school age children and adolescents and validation for mortality
Summary of research1 Location: Kenya, Uganda and Zimbabwe What we know: An internationally accepted reference for mid-upper arm circumference (MUAC) does not exist for...
This new 2006 WHO Growth standards: What will they mean for emergency nutrition programmes? Dear Editor Whilst welcoming the principles which have driven the development of...
en-net: Using length/height to estimate Age of 6-59 month old children in high Stunting level countries
WHO recommended to use 60 cm as an estimate for 6 month old infants and 100 cm for the 59-60 month old children in countries with high stunting rates in 1995 Nutrition...
I have recently collected data on weight, height, age, muac and pregnancy status of women in RH age group [15 -49]. Besides the effort made to make correction during data...
We're currently looking to expand admission criteria in Somalia to include children 5 to 10 years of age. Some partners are already doing this and using a variety of admission...
Experiences of ACF in Kabul city Claudine Prudhon is the head of the nutrition department in ACF HQ. Claudine is interested in improving the nutritional management of the under...
en-net: WHO Growth Standards
Why does the WHO Growth Standards have median in their z-score tables instead of mean? If they already have mean, why don't they have the percentage of median? It is easy to...
Dear Colleagues To identify mlanutrition/thinness with BMI, etc: We know we use BMI-for-Age for girls below the age of 19 years old. We also know that we need to use...
by Beth Matthews, Maureen Billiet (Concern field staff Angola) Annalies Borrell (Concern chief nutritionist Dublin). In children the three most commonly used anthropometric...
New publications1,2 In July last year the ACC/Sub-committee on nutrition published two reports on the assessment of nutritional status in emergencies. One report deals with...
FEX: Effect of adding RUSF to ageneral food distribution on child nutritional status and morbidity: a cluster randomised controlled trial
Summary of research1 Child during appetite test at a health facility offering treatment in Monrovia, Liberia The authors of a recent study hypothesized that including a daily...
Summary of research1 This research contributes to the evidence base regarding which anthropometric indicators identify malnourished sick children most at risk of death. Low...
en-net: MUAC FOR AGE CALCULATOR
KINDLY RECOMMEND WHICH SOFTWARE OR RELATED THAT I CAN USE FOR MUAC Just an FYI ... The R langage functions to add z-scores using the WHO standard and WHO references (older...
View this article as a pdf Research snapshot1 This article investigates trends in child anthropometry in Senegal between1990 and 2015, associating them with potential causes;...
Summary of research 1 Location: India What we know: The WHO Multicentre Growth Reference Study (MGRS) growth curves provide a single international reference for...
Ernest and I have been working on the zscorer package for the R Language for Data Analysis and Graphics. v0.3.1 of the zscorer package calculates and adds nutritional...
News Determining BMI is a way for health workers to identify malnutrition in children over 5 years of age, adolescents, and non-pregnant, non-lactating adults. BMI is...
en-net: Sitting - Standing Height Ratio
Hey everybody, I am looking for reference tables for the sitting-standing height ratio. Are there general reference tables or country/region-specific ones? Could anyone kindly...
Reference this page
WHO growth reference for children and adolescents. Field Exchange 32, January 2008. p11. www.ennonline.net/fex/32/who