The Indian Council of Medical Research (ICMR) has invited Expressions of Interest (EOIs) from researchers for the second phase of the UNNATI (Upgrading Norms for Nutrition, Growth, and Development Assessment of Indian Children) initiative. This phase involves a multicentre study to collect data for developing India-specific growth standards for children aged 2-18 years, aiming to replace reliance on international benchmarks that may not accurately reflect healthy growth patterns in the country.
Phase 1 Progress and Phase 2 Objectives
Under Phase 1 of UNNATI, data are being collected from children aged 0-2 years who have grown in optimal environments across six centres—Delhi, Bengaluru, Indore, Purulia, Pune, and Shillong. This data will be used to develop growth and developmental standards for Indian children during early childhood. Phase 2 extends this work to older children, creating a seamless growth reference from birth to 18 years.
Currently, India relies on the World Health Organisation (WHO) Child Growth Standards, developed nearly two decades ago using data from six countries. According to ICMR, these standards may not adequately represent the growth trajectory of healthy Indian children. An official from ICMR stated, “Growth monitoring of every child, through regular tracking of height, weight, and other parameters, helps in ensuring that every child is developing as expected. Any deviation from expected growth trajectory may indicate nutritional deficiencies. Presently in India, growth assessments currently rely on the WHO Child Growth Standards, developed nearly two decades ago using data from six countries. Early identification of a child’s growth is critical for improving overall health; if the development is not as per expectations it can be prevented.”
Need for India-Specific Standards
The WHO Multicentre Growth Reference Study (WHO-MGRS) established international growth standards for children aged 0-5 years. However, comparable national or global standards for children older than five years are currently unavailable. ICMR has identified the need to review and refine existing benchmarks by generating cross-sectional data for children aged 2-18 years. The cross-sectional component of the UNNATI study is critical to ensuring continuity in growth curves around the transition age of two years, when growth patterns begin shifting from rapid early-life changes to more gradual and stable trajectories.
The EOI document notes that the timing and progression of puberty vary significantly among individuals, making it difficult for a small longitudinal cohort to capture the full spectrum of early and late maturers. A cross-sectional study will enable the inclusion of children at different stages of biological maturation across all age groups, resulting in more representative and robust growth standards.
Impact on Child Health Monitoring
Developing India-specific growth standards is expected to improve early detection of growth faltering, malnutrition, and obesity. By using benchmarks tailored to Indian children, healthcare providers can more accurately identify deviations from expected growth trajectories and intervene promptly. This initiative aligns with national nutrition and health programmes, potentially reducing the burden of diet-related disorders.
The ICMR official emphasized that early identification of growth issues is critical for improving overall health outcomes. The UNNATI initiative aims to provide tools that are scientifically validated for the Indian population, ensuring that growth monitoring is both accurate and actionable.
