Growth charts - WHO standards versus India crafted

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CategoryHealth

Last Updated29/12/2023

High levels of child undernutrition have been a persistent problem in India.
It is driven by multiple determinants such as food intake, health, sanitation, women’s status and poverty.

The most common measures of childhood undernutrition are based on anthropometric standards such as stunting and wasting.
India, like most other countries, uses the globally accepted World Health Organization (WHO) Growth Standards to measure malnutrition.

The WHO standards are based on the Multicentre Growth Reference Study (MGRS) conducted in six countries between 1997 and 2003.
This raises concerns about the applicability to India.
The sample for India in the MGRS was drawn from a set of privileged households living in South Delhi.
This may lead to potential overestimation of undernutrition in the Indian context.

Comparisons with other large datasets may be invalid due to difficulties in finding equivalent samples with a favourable growth environment, as defined by the MGRS.
An adequate number of equivalent samples are difficult to find in large-scale surveys in India because of inequality and underrepresentation of the rich in data sets.

Another issue is the difference in genetic growth potential of Indians and the influence of maternal heights on child growth.
Maternal height is considered a non-modifiable factor, but low average maternal heights reflect intergenerational poverty and women's poor status.
An appropriate indicator of a deficient environment, such as stunting, needs to capture this deprivation as well.

Concerns arise about the standards being too plastic considering the issues of maternal heights and genetic potential.
Inappropriately high standards leading to a misdiagnosis of the situation leading to potential overfeeding and a rise in overweight and obesity.
Despite concerns, dietary gaps in children persist, highlighting the need for improved quality in nutrition programs.
Multiple interventions such as better sanitation, access to health care, childcare services and so on are required for better nutritional outcomes.

Gaps in distal determinants of stunting include livelihoods, poverty, education, and women's empowerment.
Addressing these gaps requires comprehensive interventions for better nutritional outcomes.
These goals are inextricably linked to the overall development of the country, with equitable distribution of resources.
Using the appropriate standards is also important for international comparisons and intra-country trends.

The Indian Council of Medical Research (ICMR) has formed a committee to revise growth references for India.
The committee recommends a rigorous nationwide study to examine child growth for potential development of national growth charts.
Despite ongoing debates, it is argued to stick to the aspirationally high but achievable standards suggested by the WHO-MGRS.