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Learning objectives
NUTN 401/613: ▪ Describe anthropometric reference data
Assessment of ▪ Distinguish between standard and reference
▪ Describe the growth charts
nutritional status I ▪ Discuss the development of the WHO/MGRS standards
ANTHROPOMETRY
LECTURE 8: ANTHROPOMETRIC REFERENCE & STANDARD

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Anthropometric reference data Growth reference vs. Growth standard

▪ References developed from measurements obtained on
◦ Statistically adequate number of individuals
◦ Well-nourished
◦ Representing cross-section of community
◦ Living in an environment free from constraints of any sort
◦ Have capacity to reach maximum growth potential at each age group and sex
▪ National
◦ Well-nourished, healthy children selected from a local elite group
▪ Dataset representing the distribution of a given
anthropometric measurement as it changes with age in
both sexes based on a specified reference sample of
children
▪ Growth standard
◦ It represents optimal growth; it represents how children should
grow

▪ International ▪ Growth reference

◦ NCHS, CDC, WHO/MGRS ◦ Provides an indication of how children do grow

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Scales of measurement Growth charts

▪ Growth standards/references are used to compare
individuals or groups relative to other children of the same
age and sex
▪ Growth monitoring relies on two simple principles:
◦ Normally growing children more likely to be found in the body
than the tails of the anthropometric distribution
◦ Tend to maintain their position in the distribution during follow-up
1. Percentile
2. Z-scores
3. Percentage of median
▪ A series of percentile/standard curves that illustrate the
distribution of selected body measurements in the study
population
1. Used to track the growth of children from infancy
through adolescence
2. Indicates the state of the child's health, nutrition and well
being
3. Growth charts are used as a screening tool for nutritional
and other diseases

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Uses for growth charts

Individual level National level
◦ Monitoring and documenting ◦ Identification of problem areas
growth ◦ National and international
◦ Comparison with references comparisons
standards
◦ To detect growth faltering
Community level Scientists
◦ Research tool
◦ Monitoring health status
◦ Performance of programmes 1 year 2 years 3 years 4 years 5 years

◦ Comparison over time

WHO Child Growth Standards

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Some concerns about the NCHS growth Rationale for the development of the
reference WHO child growth standards
▪ Infants were predominantly formula-fed ▪ The recommended NCHS/WHO international reference is
inappropriate for assessing nutritional status
▪ Infrequent measurements
Individual infants
▪ Lacks representativeness
▪ Interferes with sound nutritional management of breastfed
▪ Does not follow current recommendation regarding infants, increasing their risk of morbidity and mortality
infant feeding Populations
▪ Provides inaccurate estimates of undernutrition and
overweight

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New WHO growth standards Why should we adopt new charts?

The international growth standards established by the WHO
in April 2006 directly confront the notion that ethnicity is a
major factor in how children grow. The new standards
demonstrate that children born in different regions of the
world, when given an optimum start in life, have the
potential to grow and develop within the same range of
height and weight for age.
(ECHUI, 2006: Global Framework for Action)
▪ Unlike the old growth charts, the new standards
1.Describe how children "should grow"
2.Establish breastfeeding as the biological "norm"
3.Provide international standards for all healthy children, as
human milk supports not only healthy growth, but also
optimal cognitive development and long-term health

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Study sites
Selection criteria for sites
▪ Demonstrate the presence of a child sub-population with
unconstraint growth
▪ Low altitude (<1,500m)
▪ Stable population (low mobility)
▪ Willingness to follow feeding recommendations
▪ Existence of breastfeeding support systems
▪ Local presence of qualified institutions

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