Use of National and International Standards in Assessing the Growth and Nutritional Status of Rural Indian Children

Abstract

This study compares anthropometry of rural Indian schoolchildren using national and international reference values, and explores association between demographic and socioeconomic variables and growth measures among rural children. A cross-sectional survey of height, weight, and BMI was conducted among schoolchildren (5-16 years) in Gujarat, where there were pre-established contacts who could facilitate access to schools and data collection for this study. Gender- and age-specific Z-scores were obtained for 519 children (234 girls, 285 boys) based on Indian reference values (Khadilkar et al., 2009) using an Excel® macro. Percentages of children stunted (height-for-age less than or equal to -2SD), underweight (weight-for-age less than or equal to -2SD), and wasted (BMI-for-age less than or equal to -2SD) were obtained (Khadilkar & Khadilkar, 2011). Children falling between adult Indian BMI levels 23 and 28 kg/m2 were considered overweight, and those above 28 kg/m2 were considered obese. Those stunted (height-for-age + 1SD), and obese (BMI > +2SD) were generated similarly using the WHO International Growth Standards (WHO, 2015). Regression analyses were conducted to model the relationship between growth measures, determined using national references, and predictor variables: age, gender, school, and caste. 21%, 23.1%, 8.9%, 2.7% and 0.2% of children were respectively stunted, underweight, wasted, overweight and obese based on Indian References and recommendations, and 27 %, 8.7%, 6.4% and 2.7 % respectively stunted, wasted, overweight and obese based on WHO Standards and recommendations. School was found to have significant interaction with all growth measures (P <.0001) and age had a significant interaction with height-for-age (P = 0.05). The current level of undernutrition, and emerging problems of overnutrition, in this study highlight a need to concentrate efforts to improve nutrition of Indian schoolchildren in rural areas.