Publication:

Stunting in under-five children with chronic kidney disease: Indian synthetic growth charts are more accurate than World Health Organization growth standards

Background Accurate growth monitoring is critical in pediatric chronic kidney disease (CKD), where impaired linear growth is common. The WHO multicentre growth reference study (MGRS) 2006 standards are widely used but may overestimate stunting in Indian children due to ethnogenetic and environmental differences. Indian synthetic growth charts, developed using the LMS method and based on national data, may offer a more appropriate reference. This study compared stunting prevalence in under-five children with CKD using world health organization (WHO) standards and Indian synthetic growth charts.

Methods This cross-sectional observational study was conducted at a tertiary care centre in Pune, Maharashtra, over 18 months (January 2023-June 2024). A total of 120 term-born children aged 0-60 months with confirmed CKD were enrolled. Standardized anthropometric measurements of length/height were obtained. Length/height-for-age Z-scores were calculated using WHO AnthroPlus software and LMS values for Indian synthetic charts. Stunting was defined as a Z-score<-2 SD. CKD severity was categorized as mild, moderate, or severe based on clinical, biochemical, and imaging criteria.

Results Across all age groups, Z-scores were consistently higher when assessed using Indian synthetic charts compared to WHO standards. The prevalence of stunting was significantly lower using synthetic charts (boys 5.9%, girls 1.9%) than WHO charts (boys 13.4%, girls 5.7%). Synthetic charts demonstrated superior discrimination of growth impairment across CKD severity, with a larger Z-score difference between mild and severe CKD (0.597 SD vs. 0.440 SD with WHO).

Conclusions Indian synthetic growth charts provide a more accurate, population-specific assessment of growth in children with CKD. Their use reduces overdiagnosis of stunting and improves identification of clinically meaningful growth deficits, supporting their integration into routine pediatric CKD monitoring in India.