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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.
Findings 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^sup 2^ to 0.1 kg/m^sup 2^. At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m^sup 2^ for boys and 25.0 kg/m^sup 2^ for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m^sup 2^). Similarly, the +2 SD value (29.7 kg/m^sup 2^ for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m^sup 2^).
Conclusion 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.
Bulletin of the World Health Organization 2007;85:660-667.
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Introduction
The need to develop an appropriate single growth reference for the screening, surveillance and monitoring of schoolaged children and adolescents has been stirred by two contemporary events: the increasing public health concern over childhood obesity1 and the April 2006 release of the WHO Child Growth Standards for preschool children based on a prescriptive approach.2 As countries proceed with the implementation of growth standards for children under 5 years of age, the gap across all centiles between these standards and existing growth references for older children has become a matter of great concern. It is now widely accepted that using descriptive samples of populations that reflect...