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Implications of adopting the WHO 2006 Child Growth Standard in the UK: two prospective cohort studies

¹ Division of Developmental Medicine, University of Glasgow, Glasgow, UK
² MRC Epidemiology Unit, Cambridge, UK
³ Community based Medicine, University of Bristol, Bristol, UK
⁴ Department of Paediatrics, University of Cambridge, Cambridge, UK

Correspondence to:
Dr K K Ong, MRC Group Leader & Paediatric Endocrinologist, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Box 285, Cambridge CB2 0QQ, UK; ken.ong{at}mrc-epid.cam.ac.uk

Background: The WHO 2006 Child Growth Standard is based on data from international optimally nourished breastfed infants from birth to age 5 years.

Objective: To assess the potential effect of its use on weight and growth monitoring of UK children.

Participants: Full-term members of two population-based UK birth cohorts: the Children in Focus sub-cohort of the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 1335) and the Gateshead Millennium Baby Study (GMS; n = 923).

Design: Growth data from birth to 5 years were converted into z-scores relative to the WHO 2006 standard.

Results: Compared with the WHO standard, both UK cohorts had higher birth weights (mean z-scores: GMS, 0.17; ALSPAC, 0.34) and ALSPAC had higher birth lengths. After birth, length showed a good fit at all ages. By 2–4 months, both cohorts were similar in weight to the WHO median (mean WHO weight z-score at 4 months: GMS, 0.01; ALSPAC, –0.07), but thereafter the UK cohorts were heavier (mean WHO weight z-score at 12 months: GMS, 0.57; ALSPAC, 0.65). At age 12 months, the risk of being classified as underweight (weight <2nd centile) was considerably lower according to the WHO standard than by the UK 1990 Growth Reference (RR = 0.15, 95% CI = 0.07 to 0.32), and the risk of being classified as obese at 4–5 years (body mass index >98th centile) was slightly increased (RR = 1.35, 95% CI = 1.02 to 1.78).

Conclusions: Adoption of the WHO 2006 Growth Charts would set a markedly lower standard of weight gain beyond the age of 4 months for UK infants and could support efforts to avoid future childhood obesity. However, the WHO standard is not representative of size at birth in the UK.