Prevalence thresholds for wasting, overweight and stunting in children under 5 years

Public Health Nutr. 2019 Jan;22(1):175-179. doi: 10.1017/S1368980018002434. Epub 2018 Oct 9.


Objective: Prevalence ranges to classify levels of wasting and stunting have been used since the 1990s for global monitoring of malnutrition. Recent developments prompted a re-examination of existing ranges and development of new ones for childhood overweight. The present paper reports from the WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring.

Design: Thresholds were developed in relation to sd of the normative WHO Child Growth Standards. The international definition of 'normal' (2 sd below/above the WHO standards median) defines the first threshold, which includes 2·3 % of the area under the normalized distribution. Multipliers of this 'very low' level (rounded to 2·5 %) set the basis to establish subsequent thresholds. Country groupings using the thresholds were produced using the most recent set of national surveys.

Setting: One hundred and thirty-four countries.

Subjects: Children under 5 years.

Results: For wasting and overweight, thresholds are: 'very low' (≈6 times 2·5 %). For stunting, thresholds are: 'very low' (≈12 times 2·5 %).

Conclusions: The proposed thresholds minimize changes and keep coherence across anthropometric indicators. They can be used for descriptive purposes to map countries according to severity levels; by donors and global actors to identify priority countries for action; and by governments to trigger action and target programmes aimed at achieving 'low' or 'very low' levels. Harmonized terminology will help avoid confusion and promote appropriate interventions.

Keywords: Children; Malnutrition; Overweight; Stunting; Wasting.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anthropometry
  • Child Nutrition Disorders / epidemiology*
  • Child, Preschool
  • Female
  • Growth Disorders / epidemiology*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Nutrition Surveys / standards*
  • Overweight / epidemiology*
  • Prevalence
  • Reference Standards
  • Wasting Syndrome / epidemiology*