Dange, Nimisha S.Khadilkar, VamanGondhalekar, KetanKhadilkar, Anuradha V.2025-08-132025-08-132025-06Dange Nimisha S., Khadilkar Vaman, Gondhalekar Ketan, Khadilkar Anuradha V. . Double Burden of Malnutrition in Under-Five Children (NFHS-5 Data) Using Extended CIAF: WHO 2006 Growth Standard Versus 2019 Indian Growth References. Indian Pediatrics. 2025 Jun; 62(6): 428-4320019-60610974-7559https://imsear.searo.who.int/handle/123456789/251348OBJECTIVES To compare the double burden of malnutri?on (DBM) in under-five children using extended composite index of anthropometric failure (eCIAF) using WHO 2006 and 2019 Indian standards. METHODS Data of 2,32,920 under-five children as per Na?onal Family Health Survey-5 were eligible for inclusion. Incomplete records and extreme z-scores were excluded. eCIAF categories included: A No failure; B Wasted; C Wasted + Underweight; D Wasted + Stunted + Underweight; E Stunted + Underweight; F Stunted; G Stunted + Overweight; H Overweight; Y Underweight; Underfailure (UF): A + B + C + D + E + F + Y; Overfailure (OF): G + H. RESULTS Records of 1,96,015 under-five children were analyzed. 50.1% versus 74% children were categorized as no failure using WHO and Indian standards, respec?vely ( P < 0.001). Prevalence of DBM, UF and OF using WHO reference was significantly higher than using Indian references [49.9% vs. 26%; 48.4% vs. 24.7%; 3.5% vs. 1.9%, respec?vely]. CONCLUSION Using Indian references prevents misclassifica?on of DBM in under- fives.Composite index of anthropometric failureNational Family Health SurveyNFHS-5OvernutritionUndernutritionDouble Burden of Malnutrition in Under-Five Children (NFHS-5 Data) Using Extended CIAF: WHO 2006 Growth Standard Versus 2019 Indian Growth ReferencesJournal ArticleIndiaDepartment of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra 411001, IndiaDepartment of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra 411001, India; Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, IndiaDepartment of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra 411001, IndiaDepartment of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra 411001, India; Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.