Since the 1970s, the World Health Organization (WHO) has recommended the use of the growth references developed by the United States National Center for Health Statistics (NCHS) based on national survey data collected in the 1960s and 1970s. These references are known as the WHO or NCHS/WHO growth references. Over the past three decades, the WHO or NCHS/WHO growth references have played an important role internationally in the assessment of child and adolescent growth and nutritional status. However, the references have a number of weaknesses. The limitations of the infant portion of the references were thoroughly assessed in WHO's effort to develop a new international growth reference for infants and preschool children. The present report discusses the limitations of the NCHS/WHO references for school-aged children and adolescents, including a number of conceptual, methodological, and practical problems. The global obesity epidemic poses another challenge that the NCHS/WHO reference cannot appropriately meet. There is a need for a single international reference to assess the nutritional status and growth of school-aged children and adolescents across different countries.
de OnisMYipR. The WHO growth chart: historical considerations and current scientific issues. Bibl Nutr Dieta1996;(53):74–89.
2.
Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser1995; 854:1–452.
3.
de OnisMHabichtJP. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr1996;64:650–8.
4.
de OnisMGarzaCHabichtJP. Time for a new growth reference. Pediatrics1997;100:E8.
5.
Garza C, de Onis M, for the WHO Multicentre Growth Referende Group. A new international growth reference for young children. Am J Clin Nutr1999;70(1 pt 2):169S-–72S.
6.
GarzaCde OnisM. Rationale for developing a new international growth reference. Food Nutr Bull2004;25: S5–14.
7.
World Health Organization. An evaluation of infant growth: the use and interpretation of anthropometry in infants. WHO Working Group on Infant Growth. Bull World Health Organ1995; 73:165–74.
8.
KuczmarskiRJOgdenCLGrummer-StrawnLMFlegalKMGuoSSWeiRMeiZCurtinLRRocheAFJohnsonCL. CDC growth charts: United States. Adv Data2000;(314):1–27.
9.
KuczmarskiRJOgdenCLGuoSSGrummer-StrawnLMFlegalKMMeiZWeiRCurtinLRRocheAFJohnsonCL. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat112002;(246):1–190.
10.
World Health Organization. Use and interpretation of anthropometric indicators of nutritional status. WHO Working Group. Bull World Health Organ1986; 64:929–41.
HamillPVDrizdTAJohnsonCLReedRBRocheAF. NCHS growth curves for children birth–18 years. United States. Vital Health Stat 11 1977;(165)i–iv, 1–74.
13.
HamillPVDrizdTAJohnsonCLReedRBRocheAFMooreWM. Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr1979;32:607–29.
14.
DibleyMJGoldsbyJBStaehlingNWTrowbridgeFL. Development of normalized curves for the International Growth Reference: historical and technical considerations. Am J Clin Nutr1987;46:736–48.
15.
GraitcerPLGentryEM. Measuring children: one reference for all. Lancet1981;2(8241):297–9.
World Health Organization. A growth chart for international use in maternal and child healthcare: guidelines for primary health care personnel. Geneva: WHO1978.
18.
MustADallalGEDietzWH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr1991;53:839–46.
19.
OwenGM. Measurement, recording, and assessment of skinfold thickness in childhood and adolescence: report of a small meeting. Am J Clin Nutr1982;35:629–38.
20.
JohnsonCLFulwoodRAbrahamSBrynerJD. Basic data on anthropometric measurements and angular measurements of the hip and knee joints for selected age groups 1–74 years of age. Vital Health Stat111981;(219):1–68.
21.
WangYWangJQ. A comparison of international references for the assessment of child and adolescent overweight and obesity in different populations. Eur J Clin Nutr2002;56:973–82.
22.
de OnisMOnyangoAW. The Centers for Disease Control and Prevention 2000 growth charts and the growth of breastfed infants. Acta Paediatr2003;92:413–9.
23.
BarlowSEDietzWH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics1998;102:E29.
24.
ColeTJBellizziMCFlegalKMDietzWH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ2000;320:1240–3.
25.
HimesJHDietzWH. Guidelines for overweight in adolescent preventive services: recommendations from an Expert Committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. Am J Clin Nutr1994;59:307–16.
26.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser2000;894:i-xii, 1–253.
27.
DietzWHRobinsonTN. Use of the body mass index (BMI) as a measure of overweight in children and adolescents. J Pediatr1998;132:191–3.
28.
PrenticeAMJebbSA. Beyond body mass index. Obes Rev2001;2:141–7.
29.
WangY. Epidemiology of childhood obesity—methodological aspects and guidelines: What is new?Int J Obes Relat Metab Disord2004;28(suppl 3):S21–8.
30.
ColeTJ. A method for assessing age-standardized weight-for-height in children seen cross-sectionally. Ann Hum Biol1979;6:249–68.
31.
ColeTJ. Weight/heightp compared to weight/height2 for assessing adiposity in childhood: influence of age and bone age on p during puberty. Ann Hum Biol1986;13:433–51.
32.
FranklinMF. Comparison of weight and height relations in boys from 4 countries. Am J Clin Nutr1999;70:157S–62S.
33.
FreedmanDSThorntonJCMeiZWangJDietzWHPiersonRNJrHorlickM. Height and adiposity among children. Obes Res2004;12:846–53.
34.
Reilly JJ, Dorosty AR, Emmett PM; Avon Longitudinal Study of Pregnancy and Childhood Study Team. Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology. Int J Obes Relat Metab Disord2000;24:1623–7.
35.
SarriaAMorenoLAGarcia-LlopLAFletaJMorellonMPBuenoM. Body mass index, triceps skinfold and waist circumference in screening for adiposity in male children and adolescents. Acta Paediatr2001;90:387–92.
36.
WangYRimmEBStampferMJWillettWCHuFB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr2005;81:555–63.
37.
Koh-BanerjeePWangYHuFBSpiegelmanDWillettWCRimmEB. Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men. Am J Epidemiol2004;159:1150–9.
38.
North American Association for the Study of Obesity (NAASO) and the National Heart, Lung, and Blood Institute (NHLBI). The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. 2000. NIH Publication No. 00-4084. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/practgde.htm. Accessesd 4 September 2006.
39.
PelletierD. Theoretical considerations related to cutoff points. Food Nutr Bull2006;27(suppl):S224–36.
40.
WaterlowJCBuzinaRKellerWLaneJMNichamanMZTannerJM. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bull World Health Organ1977;55:489–98.
41.
DibleyMJStaehlingNNieburgPTrowbridgeFL. Interpretation of Z-score anthropometric indicators derived from the international growth reference. Am J Clin Nutr1987;46:749–62.
42.
ColeTJFaithMSPietrobelliAHeoM. What is the best measure of adiposity change in growing children: BMI, BMI%, BMI z-score or BMI centile?Eur J Clin Nutr2005;59:419–25.
43.
ColeTJ. Fitting smoothed centile curves to reference data (with discussion). J R Stat Soc A1988;151:385–418.
44.
ColeTJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr1990;44:45–60.
45.
ColeTJGreenPJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med1992;11:1305–19.
46.
HammerLDKraemerHCWilsonDMRitterPLDornbuschSM. Standardized percentile curves of body-mass index for children and adolescents. Am J Dis Child1991;145:259–63.
47.
ColeTJ. The secular trend in human physical growth: a biological view. Econ Hum Biol2003;1:161–8.
48.
DeurenbergPYapMvan StaverenWA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord1998;22:1164–71.
49.
DeurenbergPDeurenberg-YapMFooLFSchmidtGWangJ. Differences in body composition between Singapore Chinese, Beijing Chinese and Dutch children. Eur J Clin Nutr2003;57:405–9.
50.
EvelethPBTannerJM. Worldwide variation in human growth. Cambridge, UK: Cambridge University Press, 1990.
51.
FalknerFTannerJM. Human growth: a comprehensive treatise. Methodology and ecological, genetic, and nutritional effects on growth. New York: Plenum Press, 1986.
52.
KarlbergJ. Secular trends in pubertal development. Horm Res2002;57(suppl 2):19–30.
53.
WellsJCCowardWAColeTJDaviesPS. The contribution of fat and fat-free tissue to body mass index in contemporary children and the reference child. Int J Obes Relat Metab Disord2002;26:1323–8.
54.
ZellnerKJaegerUKromeyer-HauschildK. Height, weight and BMI of schoolchildren in Jena, Germany—Are the secular changes levelling off?Econ Hum Biol2004;2:281–94.
55.
HabichtJPMartorellRYarbroughCMalinaRMKleinRE. Height and weight standards for preschool children. How relevant are ethnic differences in growth potential?Lancet1974;1(7858):611–4.
56.
AshcroftMTDesaiP. Ethnic differences in growth potential of children of African, Indian, Chinese and European origin. Trans R Soc Trop Med Hyg1977;70:433–8.
57.
FreemanJVColeTJChinnSJonesPRWhiteEMPreeceMA. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child1995;73:17–24.
58.
GeKZhaiFYanH. The dietary and nutritional status of Chinese population: 1992 National Nutrition Survey. Vol 2 (children and adolescents). Beijing: People's Medical Publishing House, 1999.
59.
SempeMPedronGRoy PernotMP. Auxologie, methodes et sequences. Paris: Theraplix, 1979.
60.
CacciariEMilaniSBalsamoADammaccoFDe LucaFChiarelliFPasquinoAMToniniGVanelliM. Italian cross-sectional growth charts for height, weight and BMI (6–20 y). Eur J Clin Nutr2002;56:171–80.
61.
FredriksAMvan BuurenSBurgmeijerRJMeulmeesterJFBeukerRJBrugmanERoedeMJVerloove-VanhorickSPWitJM. Continuing positive secular growth change in the Netherlands 1955–1997. Pediatr Res2000;47:316–23.
62.
HernandezM. Curvas y tabla de crecimiento. Madrid: Garsi, 1988.
63.
LindgrenGStrandellAColeTHealyMTannerJ. Swedish population reference standards for height, weight and body mass index attained at 6 to 16 years (girls) or 19 years (boys). Acta Paediatr1995;84:1019–28.
64.
WiklandKALuoZCNiklassonAKarlbergJ. Swedish population-based longitudinal reference values from birth to 18 years of age for height, weight and head circumference. Acta Paediatr2002;91:739–54.
65.
GoldsteinHTannerJM. Ecological considerations in the creation and the use of child growth standards. Lancet1980;1(8168 pt 1):582–5.
66.
BeunenGPRogolADMalinaRM. Indicators of biological maturation and secular changes in biological maturation. Food Nutr Bull2006; 27(suppl):S244–56.
67.
HaasJDCampiranoF. Interpopulation variation in height from 7 to 18 years of age. Food Nutr Bull2006;27(suppl):S212–23.
68.
de OnisMDasguptaPSahaSSenguptaDBlossnerM. The National Center for Health Statistics reference and the growth of Indian adolescent boys. Am J Clin Nutr2001;74:248–53.
69.
HakeemRShaikhAHAsarF. Assessment of linear growth of affluent urban Pakistani adolescents according to CDC 2000 references. Ann Hum Biol2004;31:282–91.
70.
EckhardtCLAdairLS. Differences in stunting prevalences calculated from two similar growth references may be large and inconsistent in undernourished children. Ann Hum Biol2002;29:566–78.
71.
MoestueHde PeeSHallAHyeASultanaNIshtiaqueMZHuqNBloemMW. Conclusions about differences in linear growth between Bangladeshi boys and girls depend on the growth reference used. Eur J Clin Nutr2004;58:725–31.
72.
LobsteinTBaurLUauyR; IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Obes Rev2004;5(suppl 1):4–104.
73.
WangYMustA. Global burden of childhood obesity. In: KennedyEDeckelbaumRJ, eds. The nation's nutrition. Washington DC: International Life Sciences Institute (in press).
74.
PoskittEM. Defining childhood obesity: the relative body mass index (BMI). European Childhood Obesity Group. Acta Paediatr1995;84:961–3.
75.
Rolland-CacheraMFColeTJSempeMTichetJRossignolCCharraudA. Body mass index variations: centiles from birth to 87 years. Eur J Clin Nutr1991;45:13–21.
76.
ColeTJFreemanJVPreeceMA. Body mass index reference curves for the UK, 1990. Arch Dis Child1995; 73:25–9.
77.
LucianoABressanFZoppiG. Body mass index reference curves for children aged 3–19 years from Verona, Italy. Eur J Clin Nutr1997;51:6–10.
78.
Group of China Obesity Task Force. Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Chin J Epidemiol2004; 25:97–102 (in Chinese).
79.
ZimmermannMBHessSYHurrellRF. A national study of the prevalence of overweight and obesity in 6–12 y-old Swiss children: body mass index, body-weight perceptions and goals. Eur J Clin Nutr2000;54:568–72.
80.
Al-SendiAMShettyPMusaigerAO. Prevalence of overweight and obesity among Bahraini adolescents: a comparison between three different sets of criteria. Eur J Clin Nutr2003;57:471–4.
81.
MorabiaACostanzaMC. International variability in ages at menarche, first livebirth, and menopause. World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives. Am J Epidemiol1998;148:1195–205.
82.
PowerCLakeJKColeTJ. Measurement and long-term health risks of child and adolescent fatness. Int J Obes Relat Metab Disord1997;21:507–26.
83.
SerdulaMKIveryDCoatesRJFreedmanDSWilliamsonDFByersT. Do obese children become obese adults? A review of the literature. Prev Med1993;22:167–77.
84.
WangYGeKPopkinBM. Tracking of body mass index from childhood to adolescence: a 6-y follow-up study in China. Am J Clin Nutr2000;72:1018–24.
85.
Mo-suwanLTongkumchumPPuetpaiboonA. Determinants of overweight tracking from childhood to adolescence: a 5 y follow-up study of Hat Yai schoolchildren. Int J Obes Relat Metab Disord2000;24:1642–7.
86.
ChinnSRonaRJ. International definitions of overweight and obesity for children: a lasting solution?Ann Hum Biol2002;29:306–13.
87.
ReillyJJ. Assessment of childhood obesity: national reference data or international approach?Obes Res2002;10:838–40.
88.
World Health Organization. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet2004; 363(9403):157–63.
89.
WangY. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics2002;110:903–10.
90.
WangYAdairL. How does maturity adjustment influence the estimates of overweight prevalence in adolescents from different countries using an international reference?Int J Obes Relat Metab Disord2001;25: 550–8.
91.
Rolland-CacheraMFDeheegerMBellisleFSempeMGuilloud-BatailleMPatoisE. Adiposity rebound in children: a simple indicator for predicting obesity. Am J Clin Nutr1984;39:129–35.
92.
WhitakerRCPepeMSWrightJASeidelKDDietzWH. Early adiposity rebound and the risk of adult obesity. Pediatrics1998;101:E5.
93.
ColeTJ. Children grow and horses race: Is the adiposity rebound a critical period for later obesity?BMC Pediatr2004;4:6.
