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

Ja De Wilde,M Peters-Koning,Bjc Middelkoop

doi:10.1017/s1368980019004464

Ja De Wilde, M Peters-Koning + Show 1 more

Open Access

https://doi.org/10.1017/s1368980019004464

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Abstract

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. 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. Youth HealthCare, providing periodical preventive health check-ups. 11 935 children aged 0-5 years. 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. 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.

Highlights

Ethnic-specific growth references for weight-for-age and weight-for-length/height were constructed based on the growth of a cohort of 954 Surinamese Asian Indian children (51·3 % boys) born between 1974 and 1976
Parents of the children of Surinamese Asian Indian descent had the lowest education level compared with parents of the children of Dutch and South Asian descent
This study showed that in the first 6–12 months of life, the growth pattern of children of all three ethnic groups deviated from WHO Child Growth Standards (WHO-CGS), after which it plateaued at a relatively stable level

Summary

Methods

Population Most South Asians in the Netherlands are descendants of Asian Indians who migrated from India to Suriname, a former Dutch colony, between 1873 and 1916. When Suriname became independent from the Netherlands in 1975, many of these Surinamese Asian Indians migrated to the Netherlands, especially to larger cities. The total population of Asian Indians with Surinamese ancestry in the city of The Hague is estimated at around 35 000(20). Almost 5000 originate directly from India and Pakistan[21]. Data collection Youth HealthCare in the Netherlands routinely offers periodical health assessments to all children living in the Netherlands, of which at least ten are conducted from birth till the age of 5; the results are recorded. The current study was based on this routine data

Results

Discussion

Conclusion