Development of a WHO growth reference for school-aged children and adolescents.
OBJECTIVE
To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults.


METHODS
Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1-24 years) were merged with data from the under-fives growth standards' cross-sectional sample (18-71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0-5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample.


RESULTS
The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m(2) to 0.1 kg/m(2). At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m(2) for boys and 25.0 kg/m(2) for girls. These values are equivalent to the overweight cut-off for adults (> or = 25.0 kg/m(2)). Similarly, the +2 SD value (29.7 kg/m(2) for both sexes) compares closely with the cut-off for obesity (> or = 30.0 kg/m(2)).


CONCLUSIONS
The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group.
de Onis
Mercedes
M
Department of Nutrition, World Health Organization, Geneva, Switzerland. deonism@who.int
Onyango
Adelheid W
AW
Borghi
Elaine
E
Siyam
Amani
A
Nishida
Chizuru
C
Siekmann
Jonathan
J
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D019992:Databases as Topic; D005260:Female; D048788:Growth and Development / Q000502:physiology*; D006801:Humans; D008297:Male; D014944:World Health Organization