Growth References for Indian Children and Adolescents

A new study aimed to develop anthropometric growth references for Indian children and adolescents using data from multiple national surveys on 'healthy' children. 

Here, data were extracted from four Indian surveys conducted over the past two decades—NFHS-3, 4, and 5, and the Comprehensive National Nutrition Survey (CNNS)—focusing on 'healthy' children as defined by the WHO's Multicentre Growth Reference Study (MGRS) criteria. Using GAMLSS with the Box-Cox Power Exponential (BCPE) family, reference distributions for height-for-age (up to 19 years), weight-for-age (up to 9 years), weight-for-height (for children under 5 years), and BMI-for-age (for children aged 5-19 years) were estimated. The national prevalence of growth faltering was also estimated using NFHS-5 and CNNS data.

The new proposed Indian growth references consistently showed lower distributions compared to the World Health Organization (WHO) global standard – except for the first six months of age. Based on these new references, the prevalence of growth faltering in Indian children and adolescents decreased by more than 50% compared to the WHO standard.

The findings suggest that the WHO's one-size-fits-all approach may overestimate undernutrition in India – potentially leading to misdirected policy and public health expenditures. These results emphasize the need for validation through prospective and focused studies to establish a more robust evidence base. The distribution of growth metrics among 'healthy' Indian children and adolescents significantly deviates from WHO standards. 

New growth references for Indian children and adolescents, developed from nationally representative 'healthy' participants, appear more suitable for routine clinical use and policy formulation. Using these references, estimates of growth faltering among Indian children and adolescents are approximately halved compared to the WHO standards.

Source: Majumder R, Kurpad AV, Sachdev HS, et al. Indian Pediatrics. 2024 May;61(5):425-34.