Growth Monitoring of Children Under Five Years Using National Reference Charts Versus International Growth Standards, 2007–2023: A Systematic Review

BACKGROUND: Growth charts are commonly used for monitoring attained size at a specified age relative to a population average considered to represent expected growth. OBJECTIVES: To evaluate the impact of the application of international growth charts for children under five on common growth metrics when compared to national reference charts. SEARCH STRATEGY: We conducted a systematic literature search across five electronic databases: CINAHL Complete (EBSCOhost), EMBASE (Ovid), MEDLINE (PubMed), Scopus, and Web of Science. SELECTION CRITERIA: Studies published in English between 2007 and 2023 that made comparisons between national reference charts and either INTERGROWTH-21st (IG-21st) or WHO Child Growth (WHO CGS) charts. DATA COLLECTION AND ANALYSIS: Common growth metrics were compared using either z-scores or centiles. The prevalence of small- and large-for-gestational age, stunting, wasting, underweight, overweight, and obesity was compared when calculated using international standards versus national charts. MAIN RESULTS: We identified 1556 records, of which 314 were excluded as they were duplicates, 1069 after reading the title and abstract, 90 after reading the full texts, and 7 we could not retrieve the full texts. Z-score or centile values of local references were more often reported to be higher than values of WHO CGS when evaluating weight-, length-, or head circumference- for- age. Seven of 11 studies reported higher rates of small-for-gestational age, while four of five studies reported lower rates of large-for-gestational age using local references compared to IG-21st standards. CONCLUSIONS: Meaningful differences exist in growth assessment between national and international charts that have implications for identifying at-risk infants.