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

OBJECTIVE: 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. DESIGN: 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. SETTING: Youth HealthCare, providing periodical preventive health check-ups. PARTICIPANTS: 11 935 children aged 0–5 years. RESULTS: 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. CONCLUSIONS: 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.