title: Appropriate body mass index cut-offs to determine thinness, overweight and obesity in South Asian children in the Netherlands.
abstract: BACKGROUND
  Asian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI) than other ethnic groups. Therefore, lower adult BMI cut-offs to determine overweight and obesity are recommended to assess the associated health risks for Asian (23 and 27.5 kg/m(2) respectively) and Asian Indian (23, 25 kg/m(2)) populations. The objective of this study was to develop BMI cut-offs for thinness, overweight, and obesity for South Asian children in the Netherlands, and to compare the BMI cut-offs and distribution with an Asian Indian reference, the WHO Child Growth Reference, and universal BMI cut-offs.
  
  
  METHODS
  A reference cohort of 546 Surinamese South Asian boys and 521 girls, born between 1974-1976 (during the pre-obesity era) with 3408 and 3267 BMI measurements respectively, was retrospectively analysed. BMI-for-age charts were created with the LMS method. BMI centile curves passing through the cut-off points of 15 (thinness), 23 (overweight), 25 and 27.5 kg/m(2) (obesity) at 18y were drawn as cut-off levels.
  
  
  RESULTS
  The BMI of Surinamese South Asian children had a similar distribution to the Asian Indian reference, apart from a lower mean and less variation. The BMI distribution differed considerably from the WHO reference and universal BMI criteria. The calculated BMI cut-offs corresponding to a BMI of 15, 23, 25, and 27.5 kg/m(2) at 18y were at the 7.1, 81.1, 89.8, and 95.5 percentile respectively in boys, and at the 2.7, 79.5, 89.2, and 95.2 percentile in girls.
  
  
  CONCLUSIONS
  This is the first study proposing BMI cut-offs for South Asian children based on measurements from a prosperous population unaffected by the obesity epidemic. We recommend the use of these cut-offs in South Asian children in the Netherlands as these better reflect the health risks associated with thinness, overweight and obesity, and therefore may prevent the development of cardiometabolic disorders.
authors.affiliation: Department of Youth Health Care, Municipal Health Service The Hague (GGD Den Haag), The Hague, The Netherlands ; Department of Child Health, Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands.
authors.forename: Jeroen A
authors.initials: JA
authors.lastname: de Wilde
authors.affiliation: Department of Life Style, Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands.
authors.forename: Paula
authors.initials: P
authors.lastname: van Dommelen
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands ; Department of Epidemiology, Municipal Health Service The Hague (GGD Den Haag), The Hague, The Netherlands.
authors.forename: Barend J C
authors.initials: BJ
authors.lastname: Middelkoop
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D009765:Obesity / Q000175:diagnosis*; D050177:Overweight / Q000175:diagnosis*; D012189:Retrospective Studies; D013851:Thinness / Q000175:diagnosis*