title: Differential estimates of underweight-for-age and growth related morbidity according to different growth standards in Indian children.
abstract: OBJECTIVE
  To compare the four different growth standards currently used in India [WHO (World Health Organization); NCHS (National Center for Health Statistics); ICDS (Integrated Child Development Scheme); IAP (Indian Academy of Pediatrics)] and determine which better predicts growth related morbidity in children after 3 mo of follow-up.
  
  
  METHODS
  The present cohort study was done at Indira Gandhi Government Medical College and Hospital, Nagpur, India. Eligible children were those who had; > 3 unformed stools in the prior 24 h, the duration of their diarrhea was up to 72 h; and they were able to accept oral fluids or feeds. Main outcome measures were classification of the malnutrition status as per each of the four growth standards by weight-for-age and weight-for-height z scores at three months follow-up.
  
  
  RESULTS
  A total of 724 children were included. Mean age was 17.8 mo; 40.6 % were ≤ 12 mo and 59.1 % were males. Estimates of malnourished varied by the four standards, (NCHS, 62.2 % to IAP, 7.4 %). When separated into 'malnourished' and 'severely malnourished' categories, differences were greater, (NCHS, 27.9 % vs. ICDS, 1.9 %). Overall agreement was 'fair' (0.2435, z = 22.21, p = 0.0000). After follow-up, children who were 'severely malnourished' gained more weight than the 'malnourished'group; however, mean weight differed by the four charts [e.g., IAP 767 g (SD ± 611 g), vs. ICDS 884.7 g (SD ± 778 g)].
  
  
  CONCLUSIONS
  Growth standards reported different rates of malnourished categories. The utility of the standards to detect children who are constitutionally vs. pathologically small is questionable. Monitoring the nutritional status of children at both the individual level and at population level has implications for clinical practice, policy development and resource allocation.
authors.affiliation: Lata Medical Research Foundation, Nagpur, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: Neetu
authors.initials: N
authors.lastname: Badhoniya
authors.forename: Michael
authors.initials: M
authors.lastname: Dibley
authors.forename: Camille H
authors.initials: CH
authors.lastname: Raynes-Greenow
mesh_terms: D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006130:Growth Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007228:Infant Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D012015:Reference Standards; D018570:Risk Assessment; D012720:Severity of Illness Index