[Downloaded free from http://www.ijem.in on Monday, March 30, 2020, IP: 42.106.68.

54]

Original Article

Are the current Indian growth charts really

representative? Analysis of anthropometric
assessment of school children in a South Indian
district
V. Kumaravel, Vanishree Shriraam1, M. Anitharani1, S. Mahadevan2, A. N. Balamurugan3,
B. W. C. Sathiyasekaran1
Institute of Diabetes and Endocrinology, Alpha Hospital and Research Center, Madurai, Departments of 1Community Medicine, and
2
Endocrinology and Diabetes, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India,
3
Clinical Islet Transplant Program, Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN 55455, USA

A B S T R A C T

Background: India currently is posed by the double threat of thinness and overweight/obesity among children. Different growth charts
have taken different population and give different cut-off points to assess these conditions. Objective: The objective of this study is to
assess the anthropometry of school children, 5-18 years of age and thereby estimate the prevalence of childhood thinness, overweight
and obesity. To analyze how the study population compares with that of Agarwal’s growth chart. Materials and Methods: The
anthropometric measurements of all the students who were studying from 1st to 12th standards were taken from 27 randomly selected
Government and private schools. Prevalence of thinness, overweight and obesity were assessed using two standards – Indian standard
given by Agarwal and International Standards given by International Obesity Task Force (IOTF). Results: The prevalence of thinness,
overweight and obesity among 18,001 students enrolled as per Indian standard were 12.2%, 9.5% and 3% and as per International
standard were 15.3%, 8.1% and 2.6% respectively. The mean and the 95th percentile values of body mass index for both boys and
girls at all ages in this study are falling short of Agarwal’s and IOTF values. Using international cut-offs as well as Indian cut-offs given
by Agarwal, underestimate the prevalence of obesity among boys and girls of all age groups. Conclusion: This study shows that
under and over-nutrition among school children is in almost equal proportions. There is an underestimation of obesity among children
whenever an Indian or an International growth chart is used. Thus, this study brings out the need for a really representative growth chart.

Key words: Growth chart, obesity, prevalence, school children, thinness

INTRODUCTION 2004.[1] Both problems have serious consequences when

started in childhood as there is a long period of exposure
“For the first time in human history, the number of before they reach adulthood.
overweight people rivals the number of underweight
people.…” as quoted by the World Watch Institute in Childhood obesity is strongly associated with cardiovascular
diseases, diabetes, orthopedic problems, mental disorders,
non-alcoholic fatty liver disease and sleep-associated
Access this article online
breathing disorders as they age.[2,3] Obese children often
Quick Response Code:
suffer from stigmatization[2] and it is found that 50-80%
Website:
www.ijem.in of them will continue as obese adults.[4] Under-nutrition
manifesting as stunting was found to increase the risk of
DOI: morbidity, impair cognitive development and reduce work
10.4103/2230-8210.126541 productivity in later life.[5] The consequences of under
nutrition are extended not only in later life, but also into

Corresponding Author: Dr. Vanishree Shriraam, Department of Community Medicine, Sri Ramachandra Medical College and Research Institute,
Porur, Chennai - 600 116, Tamil Nadu, India. E-mail: docvanishri@yahoo.com

56 Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1

[Downloaded free from http://www.ijem.in on Monday, March 30, 2020, IP: 42.106.68.54]

Kumaravel, et al.: Are the current Indian growth charts really representative?

future generations.[6] Thinness results in poor pregnancy Anthropometric measurements were taken by four
outcomes, in particular low birth weight.[7] Both childhood study team members who were trained adequately. The
obesity and thinness are linked to underachievement in students removed their shoes and any heavy items before
school and lower self-esteem.[8,9] measurement. Height and weight were measured using
standardized stadiometer and weighing scale to the nearest
India being a developing country, undergoing a rapid 0.5 cm and 0.1 kg respectively.
epidemiological and nutritional transition along with
demographic transition, is posed by the double threat of The calculation of thinness, overweight and obesity were
under and over nutrition.[10] Cross-sectional studies performed based on two standards. Indian standards used in this
in various parts of India among school children report the study was that given by Agarwal et al. which represents the
prevalence of overweight to range between 2.3% and 25.1% measurements of affluent school children from 23 public
and that of obesity to range from 0.3% to 11.3%.[11-26] The schools of different cities in India.[30,15] The International
prevalence of under-nutrition among school children vary Standard was that of the IOTF as described by Cole et al.
from 17% to 65%.[6,13-16,27,28] Most studies performed among which is based on pooled international data for body mass
school children in India assess the prevalence of overweight/ index (BMI) where the adult cut-off points of BMI was
obesity in isolation.[13,18-26] Many studies restrict themselves to linked to BMI centiles for children and have provided
either one sex or a narrow age range.[12-14,16,18-26] Furthermore, age and sex specific cut-off points for children aged
these studies use different cut-off points to assess the same. 2-18 years.[32,33]
These cut-off points are derived from studies done at different
places, time points and including different study population. Data entry and analysis of the variables was performed
using the Statistical Package for Social Sciences version 15
Therefore, this study was undertaken to assess the software. Descriptive statistics of mean, standard deviation
anthropometry of school children, both boys and girls from and centiles were calculated for height, weight and BMI of
1st to 12th standards in the district of Madurai in the state students of all ages and both sexes. Analysis for testing the
of Tamil Nadu in order to get an overall picture of their difference between the boys and girls for the continuous
nutritional status. The prevalence of childhood thinness, variables (height, weight and BMI) was performed by
overweight and obesity were determined based on the independent sample t-test and for testing difference
growth chart compiled by Agarwal et al.[29,30] as recommended in proportion of thinness, overweight and obesity by
by the Indian Association of Pediatrics (IAP)[31] as well as Chi-square test.
the international standard as proposed by the International
Obesity Task Force (IOTF).[32,33] Since the growth chart RESULTS
proposed by Agarwal et al. is more than two decades
old now, this study assesses how the current population There were 19668 students aged 5-18 years in the 27
compares with that of Agarwal. schools. Of them, 1667 students (8.5%) were absent on
the day of measurement. A total of 18,001 students aged
MATERIALS AND MATHODS 5-18 years were enrolled. Boys constituted 55.1% of them.
Of them, 9918 students (55.1%) were from government
Madurai is one of the 32 districts and the second largest schools and the remaining 8083 (44.9%) were from private
municipal corporation in Tamil Nadu, that is located in schools.
southern part of India with a population of 3,041,038
(2011 census). About 60% of the district is urbanized and Table 1 shows the mean and standard deviation of height,
the literacy rate is about 81.7%. There are totally 369 primary, weight and BMI of boys and girls in the current study. The
secondary and higher secondary schools in Madurai city.[34] height, weight and BMI followed a normal distribution in
Out of them, 50 schools, 25 government and 25 private were all the age groups except at 18 years where the sample size
randomly selected, which included primary, middle, high was very small (n = 87).
schools and higher secondary schools. A request letter seeking
permission for anthropometric assessment was sent to the Boys become taller than girls from 14 years and girls
school authorities. Out of them, 10 government and 17 private become heavier than boys from 10 years; however, there
schools agreed to participate. An appointment was fixed with is a crossing over (no difference) in weight at 15 years and
the school authorities. The anthropometric measurements of from 16 years of age, the boys become heavier. There is no
all the students who were studying from 1st to 12th standards difference in mean BMI between boys and girls until 9 years
present on that day were taken. Children with disabilities or of age and from 10 years onward, the mean BMI of girls at
history of chronic illness were excluded from analysis. each age is higher compared with that of boys (P < 0.01).

Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1 57

[Downloaded free from http://www.ijem.in on Monday, March 30, 2020, IP: 42.106.68.54]

Kumaravel, et al.: Are the current Indian growth charts really representative?

The prevalence of thinness (12% vs. 12.4%), overweight When compared with that given by Agarwal et al., in this
(9.7% vs. 9.3%) and obesity (3.1% vs. 3%) among study, the mean height of boys is lower from 15 years and
government and private school students were almost that of girls from 12 years of age. In the study by Agarwal,
similar (P = 0.675). there is difference in height between boys and girls until
13 years of age, which is not seen in this study. Even
The children were grouped into 4 age groups as 5-9, 10-12 though, the trend in mean weight among boys and girls in
(early adolescence), 13-15 (mid adolescence) and 16-18 (late the current study is exactly similar to that in Agarwal’s study,
adolescence) for calculating the prevalence.[35] the mean weight of boys and girls in this study are lower
compared to Agarwal’s from 13 years of age [Figure 1].
Thinness is more prevalent among boys compared with
girls in all the age groups. The International standard In this study, the BMI curve of girls rises more steadily as
overestimates the prevalence of thinness when compared compared with that of boys. The mean BMI values of boys
to Indian standard among all ages and both sexes except and girls at all ages in this study is lesser than that given
among mid adolescent girls. As compared with boys, the by Agarwal et al. though the difference is very minimal up
proportion of overweight and obesity among girls is lower to 12 years for boys and up to 9 years for girls. In spite of
in the younger age groups and higher in the older age this difference, the trend was similar in both the studies
groups. As per the international standard, the prevalence [Figure 1].
of obesity and overweight are higher among girls compared
to boys in all the age groups. Furthermore seen from the The 95th percentile values of BMI in the present study were
table is that the international standard underestimates lower than that of Agarwal’s and international cut-off at
the prevalence of obesity among boys and girls of all age all ages and both sexes except at 5 years for boys and at
groups as compared with Indian standard [Table 2]. 17 years for both sexes. The values are comparable with

Table 1: Mean (SD) values of height, weight, and BMI of study population (n=18,001)
Age n Height (cm) mean (SD) Weight (kg) mean (SD) BMI (kg/m2) mean (SD)
(years) Boys Girls Boys Girls Boys Girls Boys Girls
5 453 372 105.8 (6.1) 105.2 (6.1) 16.3 (3.9) 15.9 (2.8) 14.4 (1.7) 14.3 (1.7)
6 610 478 111.7 (6.5) 111.1 (6.9) 17.9 (3.5) 17.7 (3.8) 14.3 (1.7) 14.2 (2.1)
7 622 515 117.4 (6.1) 117.0 (6.2) 20.4 (4.2) 20.2 (4.0) 14.7 (2.1) 14.7 (2.1)
8 531 413 123.2 (6.5) 122.4 (6.7) 23.0 (5.0) 22.9 (5.1) 15.1 (2.3) 15.2 (2.4)
9 523 428 129.2 (6.9) 128.6 (7.1) 25.8 (5.7) 26.2 (6.0) 15.4 (2.4) 15.7 (2.5)
10 656 575 132.9 (6.8) 132.6 (7.5) 27.5 (5.8) 28.4 (6.7)* 15.5 (2.4) 16.1 (2.8)*
11 836 680 137.5 (7.7) 137.8 (8.3) 31.4 (7.9) 32.3 (8.1)§ 16.4 (3.1) 16.9 (3.2)*
12 885 693 142.9 (8.2) 143.1 (8.3) 34.6 (8.9) 36.2 (8.7)* 16.8 (3.1) 17.5 (3.3)*
13 1195 1123 148.7 (9.0) 148.2 (7.6) 37.2 (9.0) 39.8 (8.8)* 16.7 (2.9) 18.1 (3.4)*
14 1371 963 154.5 (9.6) 152.2 (7.0)* 41.(9.8) 42.9 (8.9)* 17.1 (3.0) 18.5 (3.5)*
15 1016 947 159.5 (9.0) 153.5 (6.3)* 45.7 (10.7) 45.3 (9.3) 17.8 (3.2) 19.2 (3.6)*
16 774 708 164.9 (8.3) 154.2 (6.5)* 50.9 (10.8) 47.2 (9.5)* 18.7 (3.4) 19.8 (3.7)*
17 380 167 166.6 (7.7) 153.8 (6.3)* 54.0 (12.7) 47.9 (9.3)* 19.4 (4.0) 20.2 (3.5)§
18 59 28 165.3 (7.1) 152.4 (5.9)* 54.3 (9.6) 49.8 (10.2)§ 19.8 (3.3) 21.4 (4.5)
Independent sample t test was applied to test difference in means between boys and girls, (*P<0.01, §P<0.05). SD: Standard deviation, BMI: Body mass index

Table 2: Prevalence of thinness, overweight and obesity as per Indian and international standards
Age Sex N Prevalence of thinness (%) Prevalence of overweight (%) Prevalence of obesity (%)
group Indian standard# IOTF standard¥ Indian standard# IOTF standard¥ Indian standard# IOTF standard¥
5-9 M 2739 12.1 17.3 10.9 4.5 4.6 2.3
F 2206 9.2* 17.4 12.6 7.2* 2.7* 2.4
10-12 M 2377 9.4 13.3 10.9 8.4 3.7 1.9
F 1948 8 10.0* 8.1* 10.6* 2.5* 2.1
13-15 M 3582 15.9* 18.8 8.5 6.0 1.7 0.9
F 3033 13.3 12.3* 7.7 8.9* 2.3 1.7*
16-18 M 1213 16.3 17.7 7.5 8.1 4 2.0
F 903 11.6* 14.6 9.9 9.6 5 2.7
Total M 9911 13.4 17.0 9.6 7.3 3.2 1.7
Total F 8090 10.7* 13.4* 9.4 9.0* 2.7 2.1*
Total 18,001 12.2 15.3 9.5 8.1 3 2.6
Chi-square test to test the difference in proportion between boys and girls;*P<0.01. Thinness: #<5th percentile value, ¥BMI analogue for age and sex<BMI value of 17 in
adults. Overweight: #85th percentile but<95th percentile value, ¥BMI analogue for age and sexBMI value of 25 kg/m2 but<30 kg/m2 in adults. Obesity: #95th percentile
value, ¥BMI analogue for age and sexBMI value 30 kg/m2 in adults. IOTF: International obesity task force, BMI: Body mass index

58 Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1

[Downloaded free from http://www.ijem.in on Monday, March 30, 2020, IP: 42.106.68.54]

Kumaravel, et al.: Are the current Indian growth charts really representative?

180 60

170
50
160
Height in cms

Weight in kgs
150 40
140

130 30

120
20
110

100 10
5 6 7 8 9 10 11 12 13 14 15 16 17 18 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in years Age in years
22

21

20

19 Present study Boys

BMI in kg/sq.m

Agarwal et al Boys
18
Present study Girls
17
Agarwal et al Girls
16

15

14

13
5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in years

Figure 1: Comparison of mean height, weight, and body mass index of boys and girls at different ages between present study and Agarwal’s study.
(For this comparison the cut-offs at mid-year values from the tables were used)

Agarwal’s cut-off until 11 years for boys and 9 years for areas or government schools. However, the prevalence of
girls after which the difference increases [Table 3]. underweight being much higher in boys compared to girls at
all age groups is just similar to that found by NNMB survey.[28]
DISCUSSION
The prevalence of overweight/obesity in the current
This study gives the height, weight and BMI values of study is lesser than that found by studies done in
18,001 children (both boys and girls) of age 5-18 years New Delhi, Ahmedabad, matriculation and corporation
in the South Indian city of Madurai. The prevalence of schools in Coimbatore and Pune and comparable to
underweight (12.2%) was nearly equal to the prevalence that found in Mangalore, Mysore, Panchayat schools in
of overweight and obesity (12.5%) in the study population. Coimbatore.[12,14-16,20,22,26] The prevalence of overweight/
obesity found in this study is higher than that found in
The prevalence of thinness found in this study is much lower Hyderabad, Wardha and Jaipur.[13,18,25] Thus, the district
than that found by the National Nutritional Monitoring of Madurai stands in between the metropolitan cities and
Bureau (NNMB) survey performed in 2004-06 in rural other towns/cities in India in terms of BMI.
areas across nine states (57% in 10-13 years and 30% in
14-17 years).[28] Furthermore, it is lower than that found by In both developed and developing countries, there are
studies in various parts of India such as Mysore, Vadodara, proportionately more obese girls than boys.[36] This
Coimbatore, Jaipur and Wardha.[6,11,13-16] This might be study follows the same pattern as per IOTF standard.
because of the inclusion of children from both rural and Furthermore, the mean BMI of girls were significantly
urban areas studying in government and private schools in higher than that of boys since 10 years of age. This finding
contrast to other studies where they have included only rural is opposed to that found in New Delhi or Ahmedabad.[12,26]

Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1 59

[Downloaded free from http://www.ijem.in on Monday, March 30, 2020, IP: 42.106.68.54]

Kumaravel, et al.: Are the current Indian growth charts really representative?

Table 3: Comparison of 95th percentile of BMI among The reasons might be the inclusion of school children
boys and girls in the present study with those of Indian irrespective of whether they are from urban or rural
standard given by Agarwal et al. and the IOTF standard background or their economic status. Furthermore the
Age Present Indian IOTF age at sexual maturity might have been later than that of
study Standard standard Agarwal’s owing to the above reasons, which will reflect
Boys Girls Boys Girls Boys Girls on the anthropometric parameters.
5 17.30 17.44 17.0 18.3 19.30 19.17
6 17.35 17.71 17.8 18.8 19.78 19.65
7 18.60 18.60 18.8 19.7 20.63 20.51
From Table 3, we can infer that, there might be an
8 19.50 19.60 19.7 21.4 21.6 21.57 underestimation of obesity when we use Agarwal’s or IOTF
9 20.36 20.26 21.0 21.7 22.77 22.81 standards for the current population. The Indian Council of
10 20.32 21.84 22.1 23.2 24 24.11
Medical Research (ICMR) growth chart devised in 1956-65
11 22.70 22.60 23.4 24.5 25.1 25.42
12 23.11 24.00 23.8 25.7 26.02 26.67 was based largely on children from lower socio-economic
13 22.62 24.18 25.3 27.1 26.84 27.76 status and so its use was dismissed as it was thought to
14 22.64 25.20 25.3 27.4 27.63 28.57 underestimate the prevalence of underweight.[40] The
15 23.52 26.20 27.3 27.7 28.3 29.11
16 25.65 27.21 27.6 27.4 28.88 29.43
growth charts devised by Agarwal, Kadilkar or Marwaha
17 27.69 26.82 26.8 25.9 29.41 29.69 are based on the height and weight parameters from school
18 28.0 - 30 30 children who are from urban and affluent background.
BMI: Body mass index, IOTF: International obesity task force The rational for such a selection was that in a developing
country such as India, children belonging to affluent
In contrast to the findings from the studies performed in families in urban areas have fewer constraints on growth
Delhi, Coimbatore or Udupi district of Karnataka, wherein than other children. Another rationale was that affluent
there was a significant difference in the prevalence of children of our country approach the western children
thinness, overweight, and obesity among government and in growth.[29,36,37] This rationale has been proven right
private school children, there is no such difference in this when in the studies by Kadilkar or Marwaha, the 85th and
study.[14,24,26] In Madurai, the private schools do not equate 95th centiles of BMI of Indian urban affluent children were
to the affluent urban public schools included in the other found to be comparable or higher than the IOTF cut- offs
studies. They cater to similar population as that of the at corresponding ages.
Government schools.
Any prescription of standard should be correlated with
When the trend in 95th percentile of BMI is compared future health outcomes. Usage of growth charts based
between the three studies, [Table 3] girls have a higher only on urban affluent school children may underestimate
cut-off compared to boys from 5-14 years of age in the the prevalence of overweight and obesity, labeling such
study by Agarwal et al. where as in the other 2 studies, the children as having “normal BMI.” In this scenario, when
centiles of boys and girls are comparable until 12 years of the prevalence of non-communicable diseases is rising,
age after which girls overtake boys. This will have an impact India becoming the diabetic capital of the world, childhood
in the assessment of prevalence of obesity, such that in obesity is increasing; doubt arises on the appropriateness
the younger age groups, there will be an underestimation of usage of parameters based only on urban and affluent
of obesity among girls compared to boys when assessed school children for prescribing growth standards. The
by Indian Standard as depicted in Table 2. time tested practice of taking +2 standard deviation
from the mean taken from a representative sample would
Although, there are more recently published growth charts itself tell about the status of overweight/obesity in the
in India by Khadilkar et al. and Marwaha et al., the height, population. Given these, it is suggested that Indian growth
weight and BMI cut-offs are much higher for both boys chart must be devised from a representative sample of
and girls at all age groups compared to that given by all currently healthy children, both urban and rural and
Agarwal.[29,37,38] The authors have themselves suggested also across all socio-economic groups. For estimating the
changing the definition of overweight to the 75th centile prevalence of short stature/thinness, we may continue to
from the traditionally used 85th centile while using their utilize the chart given by Agarwal et al. as it is proven not
cut-offs. This might lead to confusion in definitions.[39] to overestimate them.[40] Utilizing IOTF chart tends to
Therefore in this study we took the Indian standard as overestimate thinness and underestimate obesity for most
Agarwal’s as recommended by IAP.[31] But to our surprise ages in both sexes.
found that even after 2 decades have elapsed, the mean
and the 95th percentile values of BMI for both boys and The major strength of this study is the huge sample size
girls at all ages in this study are falling short of Agarwal’s. covering a wide range of age group of 5-18 years among

60 Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1

[Downloaded free from http://www.ijem.in on Monday, March 30, 2020, IP: 42.106.68.54]

Kumaravel, et al.: Are the current Indian growth charts really representative?

both sexes, such that the height, weight and BMI followed school going children: Its relationship with socioeconomic status and
a normal distribution curve at all ages except at 18 years associated lifestyle factors. J Assoc Physicians India 2010;58:151-8.
13. Gupta R, Rastogi P, Arora S. Low obesity and high under nutrition
where the sample size was small. The limitation of this prevalence in lower socioeconomic status school girls: A double
study is that it does not take into account the sexual jeopardy. Hum Ecol 2006;14:120-32.
maturity among adolescents. 14. Rema N, Vasanthamani G. Prevalence of nutritional and lifestyle
disorders among school going children in urban and rural
CONCLUSION areas of Coimbatore in Tamil Nadu, India. Indian J Sci Technol
2011;4:131-40.
15. Premanath M, Basavanagowdappa H, Shekar MA, Vikram SB,
From this large study on anthropometry of school going Narayanappa D. Mysore childhood obesity study. Indian Pediatr
children from the south Indian city of Madurai, we conclude 2010;47:171-3.
that we are facing a twin problem of both under (12.2%) 16. Saraswathi YS, Najafi M, Gangadhar MR, Malini SS. Prevalence of
childhood obesity in school children from rural and urban areas in
and overnutrition (12.5%), in almost equal proportions in Mysore, Karnataka, India. J Life Sci 2011;3:51-5.
the current economic scenario. There is an underestimation 17. Kaur S, Sachdev HP, Dwivedi SN, Lakshmy R, Kapil U. Prevalence
of obesity among children whenever an Indian or an of overweight and obesity amongst school children in Delhi, India.
International growth chart is used. Thus, this study brings Asia Pac J Clin Nutr 2008;17:592-6.
18. Laxmaiah A, Nagalla B, Vijayaraghavan K, Nair M. Factors
out the need for a really representative growth chart.
affecting prevalence of overweight among 12- to 17-year-old
urban adolescents in Hyderabad, India. Obesity (Silver Spring)
ACKNOWLEDGMENT 2007;15:1384-90.
19. Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK,
We thank Ms. Syed Ali Fathima for helping us in coordinating Sheeba L, et al. Prevalence of overweight in urban Indian adolescent
with the schools and data collection. school children. Diabetes Res Clin Pract 2002;57:185-90.
20. Khadilkar VV, Khadilkar AV. Prevalence of obesity in affluent school
boys in Pune. Indian Pediatr 2004;41:857-8.
REFERENCES 21. Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of
obesity amongst affluent adolescent school children in Delhi. Indian
1. Gardner G, Halweil B. Chronic hunger and obesity epidemic Pediatr 2002;39:449-52.
eroding global progress. Available from: http://www.web.archive. 22. Kotian MS, S GK, Kotian SS. Prevalence and determinants of
org/web/20030316051456/http://www.worldwatch.org/press/ overweight and obesity among adolescent school children of South
news/2000/03/04/. [Accessed on 2012 Sep 5]. Karnataka, India. Indian J Community Med 2010;35:176-8.
2. Dietz WH. Health consequences of obesity in youth: Childhood 23. Kumar S, Mahabalaraju DK, Anuroopa MS. The prevalence of
predictors of adult disease. Pediatrics 1998;101:518-25. obesity and its influencing factor among affluent school children of
3. Lobstein T, Baur L, Uauy R, IASO International Obesity Task Force. Davangere city. Indian J Community Med 2007;32:15-7.
Obesity in children and young people: A crisis in public health. Obes 24. Kumar MK, Prashanth K, Baby KE, Rao KR, Kumarkrishna B,
Rev 2004;5 Suppl 1:4-104. Hegde K, et al. Prevalence of obesity among high school children
4. Styne DM. Childhood and adolescent obesity. Prevalence and in Dakshina Kannada and Udupi districts. Nitte Univ J Health Sci
significance. Pediatr Clin North Am 2001;48:823-54, vii. 2011;1:16-20.
5. World Health Organization. Fact sheet EURO/06/05: The health of 25. Bharati DR, Deshmukh PR, Garg BS. Correlates of overweight and
children and adolescents in Europe. Copenhagen, Bucharest: World obesity among school going children of Wardha city, Central India.
Health Organization; 2005. Indian J Med Res 2008;127:539-43.
6. Bhoite R, Iyer U. Magnitude of malnutrition and iron deficiency 26. Gupta DK, Shah P, Misra A, Bharadwaj S, Gulati S, Gupta N,
anemia among rural school children: An appraisal. Asian J Exp Biol et al. Secular trends in prevalence of overweight and obesity from
Sci 2011;2:354-61. 2006-2009 in urban Asian Indian adolescents aged 14-17 years.
7. Kramer MS. Determinants of low birth weight: Methodological PLoS One 2011;6:e17221.
assessment and meta-analysis. Bull World Health Organ 27. National Nutrition Monitoring Bureau (NNMB), Diet and nutritional
1987;65:663-737. status of rural population, Report No. 21, National Institute of
8. Adolescents’ nutrient and dietary intake: The gap adolescent nutrition: Nutrition, Indian Council of Medical Research Hyderabad, India:;
A review of the situation in selected South-East Asian countries. 2002.
Available from: http://www.searo.who.int/LinkFiles/Nutrition_for_ 28. National Nutrition Monitoring Bureau (NNMB), Diet and nutritional
Health_and_Development_Adolescent_Nutrition_%28Nut-163%29. status of population and prevalence of hypertension among adults
pdf. [Accessed on 2012 Jul 18]. in rural areas.-Report No. 24, National Institute of Nutrition, Indian
9. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Council of Medical Research, Hyderabad, India:; 2006.
Bonneux L, et al. Obesity in adulthood and its consequences for life 29. Agarwal DK, Agarwal KN, Upadhyay SK, Mittal R, Prakash R, Rai S.
expectancy: A life-table analysis. Ann Intern Med 2003;138:24-32. Physical and sexual growth pattern of affluent Indian children from
10. Misra A, Khurana L. Obesity and the metabolic syndrome in 5-18 years of age. Indian Pediatr 1992;29:1203-82.
developing countries. J Clin Endocrinol Metab 2008;93:S9-30. 30. Agarwal KN, Saxena A, Bansal AK, Agarwal DK. Physical growth
11. Deshmukh PR, Gupta SS, Bharambe MS, Dongre AR, Maliye C, assessment in adolescence. Indian Pediatr 2001;38:1217-35.
Kaur S, et al. Nutritional status of adolescents in rural Wardha. Indian 31. Khadilkar VV, Khadilkar AV, Choudhury P, Agarwal KN, Ugra D,
J Pediatr 2006;73:139-41. Shah NK. IAP growth monitoring guidelines for children from birth
12. Goyal RK, Shah VN, Saboo BD, Phatak SR, Shah NN, Gohel MC, to 18 years. Indian Pediatr 2007;44:187-97.
et al. Prevalence of overweight and obesity in Indian adolescent 32. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard

Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1 61

[Downloaded free from http://www.ijem.in on Monday, March 30, 2020, IP: 42.106.68.54]

Kumaravel, et al.: Are the current Indian growth charts really representative?

definition for child overweight and obesity worldwide: International 38. Marwaha RK, Tandon N, Ganie MA, Kanwar R, Shivaprasad C,
survey. BMJ 2000;320:1240-3. Sabharwal A, et al. Nationwide reference data for height, weight
33. Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut and body mass index of Indian schoolchildren. Natl Med J India
offs to define thinness in children and adolescents: International 2011;24:269-77.
survey. BMJ 2007;335:194. 39. Bhatia V. Growth charts, the secular trend and the growing concern
34. Available from: http://www.en.wikipedia.org/wiki/Madurai. [Accessed of childhood obesity. Natl Med J India 2011;24:260-2.
on 2012 Aug 20]. 40. Khadgawat R, Dabadghao P, Mehrotra RN, Bhatia V. Growth
charts suitable for evaluation of Indian children. Indian Pediatr
35. Funke OM. Prevalence of underweight: A matter of concern among
1998;35:859-65.
adolescents in Osun State, Nigeria. Pak J Nutr 2008;7:503-8.
36. Elamin A. Obesity: Epidemiologic and aetio-pathological aspects. Cite this article as: Kumaravel V, Shriraam V, Anitharani M, Mahadevan S,
Khartoum Med J 2010;3:457-65. Balamurugan AN, Sathiyasekaran B. Are the current Indian growth charts really
37. Khadilkar VV, Khadilkar AV, Cole TJ, Sayyad MG. Crosssectional representative? Analysis of anthropometric assessment of school children in a
South Indian district. Indian J Endocr Metab 2014;18:56-62.
growth curves for height, weight and body mass index for affluent
Indian children, 2007. Indian Pediatr 2009;46:477-89. Source of Support: Nil, Conflict of Interest: No.

62 Indian Journal of Endocrinology and Metabolism / Jan-Feb 2014 / Vol 18 | Issue 1