Differences in stunting prevalences calculated from two similar growth references may be large and inconsistent in undernourished children.
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.


OBJECTIVE
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.


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.
Eckhardt
C L
CL
Department of Nutrition, Carolina Population Center, University of North Carolina at Chapel Hill, University Square, CB #8120, 123 West Franklin Street, Chapel Hill, NC 27516-3997, USA. cara_eckhardt@unc.edu
Adair
L S
LS
D000293:Adolescent; D000886:Anthropometry; D001699:Biometry; D002648:Child; D002657:Child Development; D015362:Child Nutrition Disorders / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012016:Reference Values; D014481:United States