The Nutritional Status of Elites in India, Kenya, and Zambia: An appropriate guide for developing reference standards for undernutrition?

Assessments of undernutrition are typically based on comparisons
between anthropometric indicators of children and a reference
standard from the US. Due to a number of problems associated with
this reference standard, WHO is currently engaged in generating a
new international reference standard for child growth based on
well­to­do populations in a sample of poor and rich countries. The
focus on socioeconomic elites is to ensure that the measured growth
reflects their genetic potential (and not according their
constrained environment). Based on an analysis of the Demographic
and Health Surveys from Kenya, India, and Zambia, we identify a
number of problems associated with using socioeconomic elites as
representative of the genetic potential of a population. First,
there are several, non­overlapping ways to identify elites. Second,
the anthropometric status of elites appears to depend to a
considerable degree on the nutrition and health status of
non­elites. Third, there is a danger that the elites are not a
random sample of the growth potential of the population. And
lastly, it appears that the nutritional status of elites differs
substantially between the three countries so that it is unclear how
one can combine them to generate one international reference
standard.