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  • Title: Differences in stunting prevalences calculated from two similar growth references may be large and inconsistent in undernourished children.
    Author: Eckhardt CL, Adair LS.
    Journal: Ann Hum Biol; 2002; 29(5):566-78. PubMed ID: 12396376.
    Abstract:
    BACKGROUND: In 2000, the US Centers for Disease Control and Prevention (CDC) released a set of growth references that address limitations of the internationally recommended 1977 National Center for Health Statistics (NCHS) references. AIM: This study compares length-for-age Z-scores (LA Z-scores), height-for-age Z-scores (HA Z-scores), and age-specific stunting prevalences of undernourished children using the 1977 NCHS versus the 2000 CDC references. SUBJECTS AND METHODS: Data come from > 2000 children from the Cebu Longitudinal Health and Nutrition Study in the Philippines. Anthropometric data were collected bimonthly from birth to 2 years, at 8.5 and 11.5 years, and at 15 years in girls and 16 years in boys. Z-scores and stunting prevalences are compared between references. RESULTS: LA Z-scores were generally lower using the 1977 references, and stunting prevalences were higher from 0 to 2 years, with some crossover. Differences in HA Z-scores after 8.5 years of age were inconsistent in both direction and magnitude by reference and sex, with additional crossover. CONCLUSIONS: When applied to an undernourished population, the two references in question perform differently, with inconsistencies in direction and magnitude of Z-scores and stunting prevalences. The 2000 CDC growth references are clearly an improved tool. However, there are challenges inherent in switching to a new reference that will require the attention of researchers and field workers.
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