Km. Flegal et al., Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index, AM J CLIN N, 73(6), 2001, pp. 1086-1093
Background: Several different sets of reference body mass index (BMI) value
s are available to define overweight in children.
Objective: The objective of this study was to compare the prevalence of ove
rweight in US children calculated with 3 sets of reference BMI values: the
revised growth charts of the Centers for Disease Control and Prevention (CD
C-US growth charts), international standards proposed by Cole et al, and va
lues developed by Must et al.
Design: Data for children and adolescents came from cross-sectional nationa
lly representative US surveys: cycles II and III of the National Health Exa
mination Survey (1963-1965 and 1966-1970) and the first, second, and third
National Health and Nutrition Examination Surveys: NHANES I (1971-1974), II
(1976-1980), and III (1988-1994). The reference values of Cole et al equiv
alent to a BMI of 25 were compared with the 85th percentiles from the other
2 methods; the values equivalent to a BMI of 30 were compared with the 95t
Results: The 3 methods gave similar but not identical results. The referenc
e values of Cole et al gave lower estimates than did the CDC-US growth char
ts for young children but higher estimates for older children. The referenc
e values of Must et al gave much higher prevalences for younger girls than
did the other 2 methods.
Conclusions: Differences between methods were related to differences in dat
a sets, smoothing methods, and theoretical approaches. All 3 methods are ba
sed on statistical criteria and incorporate arbitrary assumptions. These me
thods should be used cautiously, with awareness of the possible limitations