Do anthropometric health risk indicators of South African primary school children require national growth charts? In-sights from the NW-CHILD study

Citation

Moran C, Muller X, Pienaar A, Gerber B, Brooks N & Kruger D (2026) Do anthropometric health risk indicators of South African primary school children require national growth charts? In-sights from the NW-CHILD study. Children.

Abstract
Background/ Objectives: Growth monitoring and screening are vital indicators for child wellness. Controversy exists regarding the use of national versus international growth charts for school-going children. This study investigated the suitability of existing global references, con-sidering the influence of age, gender, and socioeconomic status (SES), and the specific growth patterns across multiple anthropometric health indicators (AHIs). Methods: A total of 349 chil-dren (boys = 165, girls = 184, low SES = 201, high SES = 148) were measured longitudinally at ages 6, 9, and 12 years while attending primary school. AHI included stature, body mass, body mass index (BMI), body fat percentage (BFP), skinfold thickness, skeletal muscle, and waist circum-ference (WC). Results: Three-way interaction effects were found for age, gender, and SES on WC and skeletal muscle (p = 0.05). Several two-way interactions emerged for age and gender (height, BMI, skeletal muscle; p < 0.01), as well as age and SES (height, BMI, skeletal muscle; p < 0.01) and gender and SES (height, skeletal muscle, WC, p < 0.05). Cut-points for height, body mass, and BMI at the median, compared to universal standards, indicate that the total group fell at, or slightly above, World Health Organization (WHO) standards. The low-SES group aligned with WHO standards, whereas the high-SES group trend above the reference values at most points. Con-clusions: The WHO growth standards are suitable for general monitoring in South African chil-dren aged 6–12 years but provide limited context-specific interpretation across age, gender, and socioeconomic backgrounds. National age-, gender-, and SES-specific growth references, incor-porating additional anthropometric indicators, are needed to support locally relevant screening.

Keywords
Body composition; Profiles; Primary school children; Growth charts; Growth monitoring