Effect of body composition in the assessment of growth of Sri Lankan children and need for local references

Abstract

Measuring growth provides the opportunity to assess an individual’s health and nutritional status as well as reflect the quality of life and social wellbeing. Global standards and references for child and adolescent growth have been adopted by many countries including Sri Lanka, but it is questionable whether these charts are appropriate. They are known to over-diagnose undernutrition and under-diagnose over-nutrition in many low-and-middle-income countries. This article reviews the effect of body composition and ethnicity on the assessment of growth of Sri Lankan children. Growth has been documented since early civilization. Standards and references for assessing intrauterine, infant, child and adolescent growth have evolved for regional, national, and international use. Attention has been focused on socio-economic, political, and emotional (SEPE) factors as primary determinants of growth as well as ethnicity. Growth charts are based on the distribution of growth parameters in the population. Cut-off values are defined by statistical distributions rather than by the biological meaning of growth measurements. As most of the adverse health outcomes are related to an individual’s body composition, anthropometry should correctly reflect body composition and critical cut-off values should help assessing health risks. Yet, the distributions of height, weight, and BMI of healthy children of many low-and-middle-income countries differs from the global growth standards recommended for use by the WHO, and Sri Lankan children differ and show a shift to the left. In 5- to 15-year-old healthy children height, weight, and BMI range between -3SD and +1SD. Thus, applying global standards will often lead to false estimates when defining stunting, thinness, and obesity in these children. This highlights the importance of local rather than universal growth standards. Many countries have meanwhile taken the initiative to develop national growth charts. Further, Sri Lanka needs local growth charts and relevant cut-off values for the correct assessment of height, weight and BMI.