# Smoothed Growth Trajectories for Weight, Length/Height, and BMI Percentiles of Children Aged 3 to 60 Months in Punjab, Pakistan

## TL;DR

This study creates growth charts for children in Punjab, Pakistan, showing they are smaller and lighter than global standards.

## Contribution

The study provides new smoothed growth percentile charts for children in Punjab using advanced statistical modeling.

## Key findings

- Median weight and height increased significantly in both boys and girls from 3 to 60 months.
- Boys had higher mean values than girls for all anthropometric variables.
- Punjabi children were smaller, lighter, and had lower BMI compared to WHO standards and global studies.

## Abstract

Background/Objectives: This study aims to examine the crucial role of children’s growth in assessing population health trends and developing targeted interventions. Specifically, the research aims to determine prevalent anthropometric trajectories among children from Punjab, Pakistan, and to compare these patterns with global and national growth standards established by the World Health Organization (WHO). Methods: A cross-sectional survey was conducted to assess the weight and height of 20,845 children (51.48% boys and 48.52% girls) aged 3 to 60 months in Punjab, Pakistan. Growth reference charts for boys and girls were developed using the generalized additive model for location, scale, and shape, utilizing the Box–Cox power exponential distribution. The parameters analyzed included weight-for-age, length/height-for-age, and body mass index (BMI)-for-age. Results: The 3rd, 5th, 15th, 25th, 50th, 75th, 85th, 95th, and 97th smoothed percentile values with L, M, and S for weight, length/height, and BMI for both sexes from 3 to 60 months were presented. The median weight and length/height were increased significantly in both sexes. The median BMI increased steeply in early life, with a peak at 12 months, then declined in both boys and girls. Boys had a higher mean value than girls had in all the anthropometric variables. Punjabi children demonstrate smaller measurements compared to their counterparts in previous studies. The children were smaller, lighter and had lower BMI than that referred to in the WHO standards. The findings highlighted significant disparities between the growth metrics of children in Punjab and the WHO standards, and findings from other global studies. Conclusions: The study highlights the need for a multicentric approach in future research to better understand pediatric growth patterns in Punjabi children, considering their significant differences from WHO standards and other global studies.