Peer-reviewed article
Prevalence thresholds for wasting, overweight and stunting in children under 5 years
Mercedes de Onís, Elaine Borghi, Mary Arimond, Patrick M. Webb, Trevor N. Croft et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This paper presents standardized prevalence thresholds for classifying levels of malnutrition (wasting, stunting) and overweight in children under 5 years across countries. The thresholds were developed by a WHO-UNICEF expert group based on the WHO Child Growth Standards and are designed to enable consistent global monitoring and comparison. The thresholds can help governments, donors and global actors identify priority countries and trigger targeted nutrition interventions. Data from 134 countries were used to classify countries by severity levels using these new thresholds.
Key points
- Thresholds for wasting and overweight are set at approximately 6 times the 'very low' baseline level of 2.5%
- Thresholds for stunting are set at approximately 12 times the 'very low' baseline level of 2.5%
- The thresholds are based on standard deviations from the WHO Child Growth Standards normative distribution
- Thresholds enable countries to be classified by severity levels for monitoring and programme targeting
- Harmonized terminology across indicators aims to reduce confusion and promote appropriate interventions
Limitations
This document establishes classification thresholds but does not evaluate the effectiveness of any specific interventions to address malnutrition or overweight. It provides normative standards rather than evidence about what works to improve child nutrition outcomes.
Abstract
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.