A call for development of a growth standard to measure malnutrition of school-age children

Bhor, Nilanjan (2017) A call for development of a growth standard to measure malnutrition of school-age children. Working Paper. Azim Premji University.

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There is no globally established standard for measuring malnutrition among children aged 5-18 years. Growth references are used as a standard but there are many limitations to using such references to assess nutritional status of Indian children. As per the World Health Organization, standards and references both serve as a basis for comparison, but each enables a different interpretation. A standard defines how children should grow; and deviations from the pattern it prescribes are evidence of abnormal growth. A reference, on the other hand, does not provide a basis for such value judgments, although in practice, references often are mistakenly used as standards. This paper has conducted a methodological review of prevalence of malnutrition from openly accessible literature pertaining to assessment of nutritional status of school-going children in India from the year 2000 to 2016. The methodological review reveals that a combination of different national and international references have been used in assessing nutritional status of Indian children. International references includes NCHS 1977, CDC 2000, WHO 2007, IOTF 2012 extended Body Mass Index (BMI) cutoffs, Gomez classification, Waterlow’s classification and national references such as - Agarwal standards, ICMR reference values, IAP reference and BMI cut-off for overweight & obesity of Indian children. A new national growth reference has been recently developed by Marwaha and others (2011) for BMI, but no assessment of nutritional status using this reference was found. Each of these methods was then applied to a database containing height, weight, age and sex of 5340 school-going children. Though there are three nutritional indicators for school-age children, majority of the study conducted used only BMI chart to assess nutritional status. Therefore BMI-for-age is considered for the analysis to i) understand the methodological application of the above growth references ii) compare the differences in nutritional status and iii) recommend an appropriate growth reference (from those available) to assess the nutritional status of Indian school-age children. The literature review also reveals that malnutrition among school-age children is prevalent in India. There is no national level data available to support this judgement across regions, gender and caste. Given a likely high prevalence of malnutrition, this paper calls for the development of a growth standard to measure malnutrition among school-age children in India. Though this paper is focused on malnutrition, it simultaneously provides similar importance to over growth. A growth Standard therefore fills up such gaps in measuring double burden of malnutrition i.e. under-nutrition and over-nutrition.

Item Type: Monograph (Working Paper)
Authors: Bhor, Nilanjan
Document Language:
Uncontrolled Keywords: Anthropometry, Growth charts, Malnutrition, School-age children
Subjects: Technology > Medicine & health
Divisions: Azim Premji University > University Publications > Working Paper
Full Text Status: Public
Note: The working paper series aims at reflecting the range of work done across the Azim Premji Foundation, including the Field Institutes and the University, and disseminating this work to a broader audience. University faculty, members of Field Institutes of the Foundation as well as students graduating from the University may contribute to the series. The findings, interpretations and conclusions expressed in these papers are entirely those of the authors and do not necessarily represent the views of Azim Premji University.
URI: http://publications.azimpremjiuniversity.edu.in/id/eprint/383
Publisher URL:

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