Public Health Nutrition

Research Article

Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes

Mercedes de Onisa1 c1, Adelheid W Onyangoa1, Elaine Borghia1, Cutberto Garzaa2, Hong Yanga1 and WHO Multicentre Growth Reference Study Group

a1 Department of Nutrition, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland

a2 Boston College, Chestnut Hill, MA, USA


Objectives To compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards (‘the WHO standards’) and the National Center for Health Statistics (NCHS)/WHO international growth reference (‘the NCHS reference’), and discuss implications for child health programmes.

Design Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives.

Settings Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe.

Subjects Respectively 4787, 10 381 and 226 infants and children.

Results Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%.

Conclusions The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.

(Received May 23 2006)

(Accepted June 27 2006)


c1 *corresponding author: Email


† Members of the WHO Multicentre Growth Reference Study Group are listed in the Appendix.