Local anthropometric parameters for assessing double burden of malnutrition in South Asian and Southeast Asian countries: a review and retrospective analysis

Abstract

The double burden of malnutrition (DBM) is a significant public health issue in South and Southeast Asia (SA and SEA). This study aimed to assess the impact of using local and regional ethnicity-specific anthropometric references versus international references on the prevalence of DBM in these regions.A narrative review of DBM prevalence using local versus international standards was conducted. Additionally, deidentified datasets from India and Indonesia were analyzed to evaluate the effectiveness of different growth standards in identifying DBM. Anthropometric Z-scores were compared, and sensitivity, specificity, and positive predictive value (PPV) were calculated.WHO standards had the lowest specificity for identifying short stature in India and Indonesia. BMI-for-age charts using WHO Growth Reference (2007) had lower sensitivity and higher specificity for metabolic risk. Local references showed lower stunting and higher overweight or obesity prevalence. International standards overestimated stunting and underestimated obesity, leading to misclassification and missed cases of metabolic risk.

Funding: None.

Keywords: Anthropometry; Double burden; Local; Malnutrition; Regional; Southeast Asia.

Fig. 1

a) Prevalence of stunting in children under 60 months of age. b): Prevalence of overweight/obese in children under 60 months of age. Footnote: References for figure [Bangladesh 2011, Bangladesh 2014, Bhutan 2010, Cambodia 2010, Cambodia 2014, India 2005, India 2015, Maldives 2009, Nepal 2011, Nepal 2016, Pakistan 2012, Srilanka 2016, Timor Leste 2009, Timore Leste 2016],^, Indonesia 2007, Indonesia 2010, Indonesia 2013, Indonesia 2018, Indonesia 2020, Malaysia 2019, Thailand 2006, Thailand 2015.^,

Fig. 2

a) Prevalence of stunting in children over 5 years age. b): Prevalence of overweight/obese in children over 5 years age. Footnote: References for figure Indonesia 2018, Indonesia 2011, Indonesia 2004, Indonesia 2013, Indonesia 2013, Malaysia 2019, Vietnam 2013-16.

Fig. 3

a) 3rd percentile for height for girls- 6–18 years. b: 3rd percentile for height for boys- 6–18 years. Footnote: Ref.^,,

Fig. 4

False positives for short stature by sex using various reference datasets in comparison to the Indonesian reference data (n = 10,161). Footnote: The Y-axis represents % false positive subjects classified as short (Z-score < -2.0) and X-axis represents various reference datasets used to compute height Z-score. The n for boys is 5121 and girls is 5040.