Comparison of weight-for-height and BMI-for-age for estimating overnutrition burden in under-five population with high stunting prevalence

Abstract

Background: Overnourished under-five children are anthropometrically classified as either being at possible risk of overweight, overweight or obese and defined so, when either weight-for-height or Body-Mass-Index-for-age (BMI-for-age) are >1SD to 2SD, >2SD to 3SD and >3SD, respectively of the analogous World Health Organization standards. Aim: To compare weight-for-height and BMI-for-age definitions for quantifying overnutrition burden. Methods: Theoretical consequences of ignoring age were evaluated by comparing, at varying height-for-age zscores, the age- and sex-specific cut-offs of BMI that would define overnutrition with these two metrics. Overnutrition prevalence was then compared in simulated populations (short, intermediate and tall) and real-life datasets from India. Results: In short (-2SD) children, the BMI cut-offs with weight-for-height criteria were lower in comparison to BMI-for-age till 7-8 months, but higher at later ages. In National Family Health Survey-4, India dataset (short population), overnutrition (>1SD) prevalence with weight-for-height was higher from 0-0.5 years (exclusive breastfeeding age), but lower at subsequent ages. The prevalence difference (weight-for-height - BMI-for-age) in 0.5-5 years was -2.26% (6.57% vs 8.83%); this attenuated in 0-5 years (-1.55%; 7.23% vs 8.78%). The discrepancy was maximal for stunted children and was lower in girls. A similar pattern, of lower magnitude, was observed for overweight (>2SD) comparison. In intermediate and tall populations, there were no meaningful differences. Conclusion: The two definitions produce cut-offs, and hence estimates of overnutrition, that differ with the age, sex, and height of under-five children. The relative invariance, with age and height, of BMI-for-age, favours its use.

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ORCID for Clive Osmond: orcid.org/0000-0002-9054-4655

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