Accuracy of international growth charts to assess nutritional status in children and adolescents: a systematic review

Oliveira, Mariane Helen de; Pereira, Débora dos Santos; Melo, Daiane Sousa; Silva, Jessica Cumpian; Conde, Wolney Lisboa

doi:10.1590/1984-0462/2022/40/2021016

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Revista Paulista de Pediatria

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Review Article • Rev. paul. pediatr. 40 • 2022 • https://doi.org/10.1590/1984-0462/2022/40/2021016 copy

Accuracy of international growth charts to assess nutritional status in children and adolescents: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012).

Data source:

We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: “Child”, “Adolescent”, “Nutritional Assessment”, “Growth Chart”, “Ethnic Groups”, “Stature by age”, “Body Mass Index”, “Comparison”, “CDC”, “WHO”, and “IOTF”. The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH.

Data synthesis:

Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations.

Conclusions:

There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.

Keywords:
Child; Adolescent; Nutrition assessment; Growth charts; Stature by age; Body mass index

Indicator	Age group	Nutritional status	WHO*(♂/♀)	CDC** (♂/♀)	IOTF**
Indicator	Age group	Nutritional status	WHO*(♂/♀)	CDC** (♂/♀)	♂	♀
Length/height-for-age	0<20 years	Stunting	p<3.00	p<5.00	--	--
Length/height-for-age	0<20 years	Normal height	p≥3.00	p≥5.00	--	--
BMI-for-age	0<5 years	Severe thinness	p<0.10	--	--	--
		Thinness	p≥0.10; p<3.00	p<5.00	p<15.50	p<6.50
		Normal weight	p≥3.00; p≤85.00	p≥5.00; p<85.00	p≥15.50; p<90.50	p≥16.50; p<89.30
		Risk of overweight	p>85.00; p≤97.00	--	--	--
		Overweight	p>97.00; p≤99.90	p≥85.00; p<95.00	p≥90.50; p<98.90	p≥89.30; p<98.60
		Obesity	p>99.90	p≥95.00	p≥98.90; p<99.83	p≥98.60; p<99.76
		Morbid obesity	--	--	p≥99.83	p≥99.76
	5<20 years	Severe thinness	p<0.10	--	--	--
		Thinness	p≥0.10; p<3.00	p<5.00	p<15.50	p<16.50
		Normal weight	p≥3.00; p≤85.00	p≥5.00; p<85.00	p≥15.50; p<90.50	p≥16.50; p<89.30
		Overweight	p>85.00; p≤97.00	p≥85.00; p<95.00	p≥90.50; p<98.90	p≥89.30; p<98.60
		Obesity	p>97.00; p≤99.90	p≥95.00	p≥98.90; p<99.83	p≥98.60; p<99.76
		Morbid obesity	p>99.90	--	p≥99.83	p≥99.76

Authors and year of publication	Study design and population	Main results
		Length/height-for-age			BMI-for-age
		NAT	CDC	WHO	NAT	CDC	WHO	IOTF
Alfaro et al., 2008¹⁹19. Alfaro EL, Vázquez ME, Bejarano IF, Dipierri JE. The LMS method and weight and height centiles in Jujuy (Argentina) children. Homo. 2008;59:223-34. https://doi.org/10.1016/j.jchb.2007.12.005 https://doi.org/10.1016/j.jchb.2007.12.0...	Cross-sectional — Argentina (Jujuy): 4,678 girls and 4,414 boys aged between 0 and 5 years	Ө	X	✓	--	--	--	--
Silveira et al., 2011²⁰20. Silveira CR, Beghetto MG, Carvalho PR, Mello ED. Comparison of NCHS, CDC and WHO growth charts in the nutritional assessment of hospitalized children up to five years old. Nutr Hosp. 2011;26:465-71. https://doi.org/10.1590/S0212-16112011000300006 https://doi.org/10.1590/S0212-1611201100...	Cross-sectional — Brazil (Porto Alegre): 203 hospitalized boys and 134 hospitalized girls aged between 0 and 5 years	--	X	✓	--	--	--	--
Bagni et al., 2012²¹21. Bagni UV, Luiz RR, Veiga GV. Distortions in child nutritional diagnosis related to the use of multiple growth charts in a developing country. Rev Paul Pediatr. 2012;30:544-52. https://doi.org/10.1590/S0103-05822012000400013 https://doi.org/10.1590/S0103-0582201200...	Cross-sectional — Brazil: (Rio de Janeiro): Height-for-age: 299 girls and 339 boys; BMI-for-age: 254 girls and 286 boys aged between 1 and 5 years	--	X	✓	--	X	✓	--
Pereira et al., 2010²²22. Pereira AS, Vieira CB, Barbosa RM, Soares EA, Lanzillotti HS. Comparative analysis of nutritional status of preschool children. Rev Paul Pediatr. 2010;28:176-80. https://doi.org/10.1590/S0103-05822010000200008 https://doi.org/10.1590/S0103-0582201000...	Cross-sectional — Brazil: (Rio de Janeiro): 157 girls and 155 boys aged 2-3 years	--	X	✓	--	--	--	--
Mei et al., 2008²³23. Mei Z, Ogden CL, Flegal KM, Grummer-Strawn LM. Comparison of the prevalence of shortness, underweight, and overweight among US children aged 0 to 59 months by using the CDC 2000 and the WHO 2006 growth charts. J Pediatr. 2008;153:622-8. https://doi.org/10.1016/j.jpeds.2008.05.048 https://doi.org/10.1016/j.jpeds.2008.05....	Cross-sectional — United States: 3,920 children aged 0-5 years	--	Ө	✓	--	X	✓	--
Bosman et al., 2011²⁴24. Bosman L, Herselman MG, Kruger HS, Labadarios D. Secondary analysis of anthropometric data from a South African national food consumption survey, using different growth reference standards. Matern Child Health J. 2011;8:1372-80. https://doi.org/10.1007/s10995-010-0685-5 https://doi.org/10.1007/s10995-010-0685-...	Cross-sectional — South Africa: 714 girls and 798 boys aged 1-5 years	--	X	✓	--	X	✓	--
Schwarz et al., 2008²⁵25. Schwarz NG, Grobusch MP, Decker ML, Goesch J, Poetschke M, Oyakhirome S, et al. WHO 2006 child growth standards: implications for the prevalence of stunting and underweight-for-age in a birth cohort of Gabonese children in comparison to the Centers for Disease Control and Prevention 2000 growth charts and the National Center for Health Statistics 1978 growth references. Public Health Nutr. 2008;11:714-9. https://doi.org/10.1017/s1368980007001449 https://doi.org/10.1017/s136898000700144...	Longitudinal — Gabon (Lambaréné): 150 girls and 139 boys evaluated at birth, at 3, 9 and 15 months of age	--	X	✓	--	--	--	--
Soliman et al., 2011²⁶26. Soliman A, Eldabbagh M, Khalafallah H, Alali M, Elalaily RK. Longitudinal growth of infants in Qatar: comparison with WHO and CDC growth standards. Indian Pediatr. 2011;48:791-6. https://doi.org/10.1007/s13312-011-0123-9 https://doi.org/10.1007/s13312-011-0123-...	Longitudinal — Qatar: 150 girls and 150 boys evaluated at birth, at 2, 4, 6, 12 and 18 months.	Ө	X	✓	--	--	--	--
Perera et al., 2014²⁷27. Perera PJ, Fernanado MP, Ranathunga N, Sampath W, Samaranayake R, Meththananda S. Growth parameters of Sri Lankan children during infancy: a comparison with World Health Organization multicentre growth reference study. Rev Bras Crescimento Desenvolv Hum. 2014;24:11-5. https://doi.org/10.7322/jhgd.71331 https://doi.org/10.7322/jhgd.71331...	Longitudinal — Sri Lanka: 241 girls and 244 boys evaluated at 2, 4, 6, 9, and 12 months.	✓	X	X	--	--	--	--
Nuruddin et al., 2009²⁸28. Nuruddin R, Lim MK, Hadden WC, Azam I. Comparison of estimates of under-nutrition for pre-school rural Pakistani children based on the WHO standard and the National Center for Health Statistics (NCHS) reference. Public Health Nutr. 2009;12:716-22. https://doi.org/10.1017/s1368980008002383 https://doi.org/10.1017/s136898000800238...	Cross-sectional — Pakistan: 2,584 Children aged 0 to 35 months National Survey: 721 girls and 812 boys Thatta survey: 494 girls and 557 boys	Ө	--	✓	--	--	--	--
Onis et al., 2007²⁹29. Onis M, Garza C, Onyango AW, Borghi E. Comparison of the WHO Child Growth Standards and the CDC 2000 Growth Charts. J Nutr. 2007;137:144-8. https://doi.org/10.1093/jn/137.1.144 https://doi.org/10.1093/jn/137.1.144...	Longitudinal — Canada, United States and European countries: children aged 0-12 months	--	Ө*	✓*	--	Ө*	✓*	--

Authors and year of publication	Study design and population	Main results
		Length/height-for-age			BMI-for-age
		NAT	CDC	WHO	NAT	CDC	WHO	IOTF
Mohammadi et al., 2020³⁰30. Mohammadi MR, Mostafavi SA, Hooshyari Z, Khaleghi A, Ahmadi N, Kamali K, et al. National Growth Charts for BMI among Iranian children and adolescents in comparison with the WHO and CDC curves. Child Obes. 2020;16:34-43. https://doi.org/10.1089/chi.2019.0107 https://doi.org/10.1089/chi.2019.0107...	Cross-sectional — Iran: 11,797 girls and 10,921 boys aged between 6 and 18 years	--	--	--	✓	X	--	--
Esmaili et al., 2019³¹31. Esmaili H, Hajiahmadi M, Fathi M, Ghadimi R. Northern Iranian growth charts for children aged 7-11 years: comparison with international reference curves. East Mediterr Health J. 2019;24:1146-54. https://doi.org/10.26719/emhj.18.040 https://doi.org/10.26719/emhj.18.040...	Cross-sectional — Northern Iran (Babol): 2,090 girls and 1,993 boys aged between 7 and 11 years	--	--	--	✓	X	X	--
Ma et al., 2010³²32. Ma J, Wang Z, Song Y, Hu P, Zhang B. BMI percentile curves for Chinese children aged 7-18 years, in comparison with the WHO and the US Centers for Disease Control and Prevention references. Public Health Nutr. 2010;13:1990-6. https://doi.org/10.1017/s1368980010000492 https://doi.org/10.1017/s136898001000049...	Cross-sectional — China: 115,374 girls and 116,766 boys aged between 7 and 18 years	--	--	--	✓	X	X	--
Cavazzotto et al., 2014¹⁶16. Cavazzotto TG, Brasil MR, Oliveira VM, Silva SR, Ronque VE, Queiroga MR, et al. Nutritional status of children and adolescents based on body mass index: agreement between World Health Organization and International Obesity Task Force. Rev Paul Pediatr. 2014;32:44-9. https://doi.org/10.1590/s0103-05822014000100008 https://doi.org/10.1590/s0103-0582201400...	Cross-sectional — Brazil (Maringá, Rio Claro, Guarapuava and Londrina): 778 girls and 863 boys aged between 6 and 13 years	--	--	--	--	--	Ө	Ө
Silva et al., 2018³³33. Silva DA, Martins PC, Gonçalves EC. Comparison of three criteria for overweight and obesity classification among adolescents from southern Brazil. Motriz Rev Educ Fis. 2018;23:1-8. https://doi.org/10.1590/s1980-6574201700040007 https://doi.org/10.1590/s1980-6574201700...	Cross-sectional — Brazil (São José/SC): 613 girls and 519 girls aged between 14 and 19 years	--	--	--	✓	--	✓	X
Roman et al., 2015³⁴34. Roman EP, Ribeiro RR, Guerra-Junior G, Barros-Filho AA. A comparison of the nutritional status of girls according to different body mass index references. Rev Bras Saude Mater Infant. 2015;15:121-9. https://doi.org/10.1590/S1519-38292015000100010 https://doi.org/10.1590/S1519-3829201500...	Cross-sectional — Brazil (Cascavel): 2,729 girls aged between 9 and 17 years	--	--	--	✓	X	✓	--
Romagna et al., 2010³⁵35. Romagna ES, Silva MC, Ballardin AZ. Prevalência de sobrepeso e obesidade em crianças e adolescentes de uma unidade básica de saúde em Canoas, Rio Grande do Sul, e comparação do diagnóstico nutricional entre os gráficos do CDC 2000 e da OMS 2006. Sci Med. 2010;20:228-31. https://doi.org/10.11606/d.108.2018.tde-17052018-144820 https://doi.org/10.11606/d.108.2018.tde-...	Cross-sectional — Brazil (Canoas, Porto Alegre): 155 girls and 117 boys aged between 5 and 18 years	--	--		--	X	✓	--
Silva et al., 2010³⁶36. Silva DA, Pelegrini A, Petroski EL, Gaya AC. Comparison between the growth of Brazilian children and adolescents and the reference growth charts: data from a Brazilian project. J Pediatr (Rio J). 2010;86:115-20. https://doi.org/10.2223/jped.1975 https://doi.org/10.2223/jped.1975...	Cross-sectional — Brazil (North, Northeast, Midwest, Southeast and South): 18,326 girls and 23,328 boys aged between 7 and 17 years	Ө	Ө	Ө	Ө	X	✓	--
Cossio-Bolaños et al., 2015³⁷37. Cossio-Bolaños MA, Viveros-Flores A, Hespanhol JE, Camargo C, Campos RG. Applicability of BMI in adolescent students living at moderate altitude of Peru. Nutr Hosp. 2015;31:922-7. https://doi.org/10.3305/nh.2015.31.2.7733 https://doi.org/10.3305/nh.2015.31.2.773...	Cross-sectional — Peru (Arequipa): 138 girls and 181 boys aged between 12 and 18 years	✓	X	--	✓	X	--	--
Valerio et al., 2017³⁸38. Valerio G, Balsamo A, Baroni MG, Brufani C, Forziato C, Grugni G, et al. Childhood obesity classification systems and cardiometabolic risk factors: a comparison of the Italian, World Health Organization and International Obesity Task Force references. Ital J Pediatr. 2017;43:19. https://doi.org/10.1186/s13052-017-0338-z https://doi.org/10.1186/s13052-017-0338-...	Cross-sectional — Italy: 3,061 girls and 3,009 boys aged between 5 and 17 years	--	--	--	✓	--	Ө	✓
Minghelli et al., 2014³⁹39. Minghelli B, Nunes C, Oliveira R. Body mass index and waist circumference to define thinness, overweight and obesity in Portuguese adolescents: Comparison between CDC, IOTF, WHO references. Pediatr Endocrinol Rev. 2014;12:35-41. PMID: 25345083	Cross-sectional — Portugal (Algarve): 529 girls and 437 boys aged between 10 and 16 years	--	--	--	--	✓	X	✓
Wózniacka et al., 2018⁴⁰40. Woźniacka R, Bac A, Kowal M, Matusik S. Differences in the prevalence of overweight and obesity in 5- to 14-year-old children in Kraków, Poland, using three national BMI cut-offs. J Biosoc Sci. 2018;50:365-79. https://doi.org/10.1017/s0021932017000426 https://doi.org/10.1017/s002193201700042...	Cross-sectional — Poland (Kraków): 1,674 girls and 1,731 boys aged between 5 and 14 years	--	--	--	✓	X	--	✓
Regecová et al., 2018⁴¹41. Regecová V, Hamade J, Janechová H, Ševčíková Ľ. Comparison of Slovak reference values for anthropometric parameters in children and adolescents with international growth standards: implications for the assessment of overweight and obesity. Croat Med J. 2018;59:313-26. https://doi.org/10.3325/cmj.2018.59.313 https://doi.org/10.3325/cmj.2018.59.313...	Cross-sectional — Slovakia: 19,220 girls and 19,472 boys aged between 7 and 18 years	✓	--	X	✓	--	X	Ө
Kakinami et al., 2012⁴²42. Kakinami L, Henderson M, Delvin EE, Levy E, O’Loughlin J, Lambert M, et al. Association between different growth curve definitions of overweight and obesity and cardiometabolic risk in children. Can Med Assoc J. 2012;184:E539-50. https://doi.org/10.1503/cmaj.110797 https://doi.org/10.1503/cmaj.110797...	Cross-sectional — Canada (Quebec): 1,262 girls and 1,204 boys aged 9, 13 and 16 years old	--	--	--	--	✓	✓	--
Moselakgomo e van Staden, 2017⁴³43. Moselakgomo KV, Van Staden M. Diagnostic comparison of Centers for Disease Control and Prevention and International Obesity Task Force criteria for obesity classification in South African children. Afr J Prim Health Care Fam Med. 2017;9:e1-7. https://doi.org/10.4102/phcfm.v9i1.1383 https://doi.org/10.4102/phcfm.v9i1.1383...	Cross-sectional — South Africa (Mpumalanga and Limpopo): 683 girls and 678 boys aged between 9 and 13 years	--	--	--	--	Ө	--	Ө

Authors and year of publication	Study design and population	Main results
		Length/ height-for-age			BMI-for-age
		NAT	CDC	WHO	NAT	CDC	WHO	IOTF
Rosario et al., 2011¹²12. Rosario AS, Schienkiewitz A, Neuhauser H. German height references for children aged 0 under 18 years compared to WHO and CDC growth charts. Ann Hum Biol. 2011;38:121-30. https://doi.org/10.3109/03014460.2010.521193 https://doi.org/10.3109/03014460.2010.52...	Cross-sectional — Germany: 8,408 girls and 8,671 boys aged between 0 and 18 years	✓	X	X	--	--	--	--
Hughes et al., 2014⁴⁴44. Hughes I, Harris M, Cotterill A, Garnett S, Bannink E, Pennell C, et al. Comparison of Centers for Disease Control and Prevention and World Health Organization references/standards for height in contemporary Australian children: Analyses of the Raine Study and Australian National Children’s Nutrition and Physical Activity cohorts. J Paediatr Child Health. 2014;50:895-901. https://doi.org/10.1111/jpc.12672 https://doi.org/10.1111/jpc.12672...	Longitudinal and cross-sectional — Australia: 2,979 girls and 3,117 boys aged between 2 and 16 years	✓	X	X	--	--	--	--
Oliveira et al., 2013⁴⁵45. Oliveira GJ, Barbiero SM, Cesa CC, Pellanda LC. Comparison of NCHS, CDC, and WHO curves in children with cardiovascular risk. Rev Assoc Med Bras. 2013;59:375-80. https://doi.org/10.1016/s2255-4823(13)70490-9 https://doi.org/10.1016/s2255-4823(13)70...	Longitudinal — Brazil (Porto Alegre): 54 girls and 64 boys aged between 2 and 19 years+B29	--	--	--	--	X	✓	--
Zong e Li, 2013⁴⁶46. Zong XN, Li H. Construction of a new growth references for China based on urban Chinese children: comparison with the WHO growth standards. PLoS One. 2013;8:e59569. https://doi.org/10.1371/journal.pone.0059569 https://doi.org/10.1371/journal.pone.005...	Cross-sectional — China: 47,213 girls and 47,089 boys aged between 0 and 18 years	✓	--	X	✓	--	X	--
Al Herbish et al., 2009⁴⁷47. Al Herbish AS, El Mouzan MI, Al Salloum AA, Al Qureshi MM, Al Omar AA, Foster PJ, et al. Body mass index in Saudi Arabian children and adolescents: a national reference and comparison with international standards. Ann Saudi Med. 2009;29:342-7. https://doi.org/10.4103/0256-4947.55162 https://doi.org/10.4103/0256-4947.55162...	Cross-sectional — Saudi Arabia (SA) (13 regions): 17,399 girls and 17,880 boys aged between 0 and 19 years	--	--	--	✓	X	X	--
El Mouzan et al., 2008⁴⁸48. El Mouzan MI, Al Herbish AS, Al Salloum AA, Foster PJ, Al Omar AA, Qurachi MM, et al. Comparison of the 2005 growth charts for Saudi children and adolescents to the 2000 CDC growth charts. Ann Saudi Med. 2008;28:334-40. https://doi.org/10.4103/0256-4947.51688 https://doi.org/10.4103/0256-4947.51688...	Cross-sectional — Saudi Arabia (SA) (13 regions): 17,399 girls and 17,880 boys aged between 0 and 19 years	✓	X	--	✓	X	--	--
Wilde et al., 2015⁴⁹49. Wilde JA, Van Dommelen P, Van Buuren S, Middelkoop BJ. Height of South Asian children in the Netherlands aged 0-20 years: secular trends and comparisons with current Asian Indian, Dutch and WHO references. Ann Hum Biol. 2015;42:38-44. https://doi.org/10.3109/03014460.2014.926988 https://doi.org/10.3109/03014460.2014.92...	Longitudinal — Netherlands (South Asian immigrants): 2,198 girls and 2,195 boys aged 0-20 years	✓	--	X	--	--	--	--

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[1] *Corresponding author. E-mail: marianehelen@usp.br (M. H. de Oliveira).