Anthropometric standardization, structural inequity and diagnostic justice in Wayuu children: a critical integrative review and equity-oriented framework

World Health Organization (WHO) growth standards support comparable screening and surveillance, but a z score is not an etiologic diagnosis. In Wayuu children, interpretation occurs amid nutritional deprivation and barriers to care. This review examined evidence for anthropometric misclassification and developed an equity-oriented conceptual framework. This critical integrative review incorporated a documented search update completed on 14 September 2026. PubMed and Europe PMC returned 309 records, yielding 207 unique records for screening; targeted regional and repository searches supplemented retrieval. Evidence was separated by population, age, design, and inferential role. Bibliographic exports and selection decisions were retained. Synthesis was narrative, with a proposition audit and no formal certainty grading. The update added eight empirical sources and two associated bibliographic records. Community studies document substantial nutritional impairment, while selected clinical samples show heterogeneous findings. Mixed-age growth reports, adolescent bioimpedance measurements, and qualitative observations of care require distinct interpretation. They do not establish a benign mesomorphic phenotype in young children, water-saving metabolic adaptation, or a quantified WHO false-positive rate. Food insecurity, language barriers, service access, and situated measurement practices inform potential diagnostic-equity risks; their consequences require direct evaluation. WHO standards should remain available for comparable screening and surveillance, with interpretation incorporating serial growth, clinical and dietary assessment, structural conditions, accessible communication, and Wayuu knowledge. The reviewed evidence does not currently justify recommending immediate development or clinical adoption of Wayuu-specific growth curves. The seven-component framework is preliminary, non-validated, and not a clinical guideline. Wayuu-led co-design and prospective evaluation are required before its adoption.