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    CDC Growth Charts 2000: Centers For Disease Control and Prevention

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    Juita Auglina Pasaribu
    The document summarizes the CDC Growth Charts 2000, which introduced BMI-for-age charts for children ages 2 to 20. Key features include BMI charts to screen for overweight and risk of overweight, updated growth references based on recent health surveys, and minor changes to percentile cutoffs resulting in small changes to prevalence rates for nutritional indicators. The CDC recommends using BMI-for-age to evaluate weight status in children as it relates to health risks and tracks into adulthood. Accurate measurements and periodic assessment are important for screening and interpretation.

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    CDC Growth Charts 2000: Centers For Disease Control and Prevention

    Uploaded by

    Juita Auglina Pasaribu
    24 views47 pages
    The document summarizes the CDC Growth Charts 2000, which introduced BMI-for-age charts for children ages 2 to 20. Key features include BMI charts to screen for overweight and risk of overweight, updated growth references based on recent health surveys, and minor changes to percentile cutoffs resulting in small changes to prevalence rates for nutritional indicators. The CDC recommends using BMI-for-age to evaluate weight status in children as it relates to health risks and tracks into adulthood. Accurate measurements and periodic assessment are important for screening and interpretation.

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    CDCGrowthCharts5-2002

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    The document summarizes the CDC Growth Charts 2000, which introduced BMI-for-age charts for children ages 2 to 20. Key features include BMI charts to screen for overweight and risk of overweight, updated growth references based on recent health surveys, and minor changes to percentile cutoffs resulting in small changes to prevalence rates for nutritional indicators. The CDC recommends using BMI-for-age to evaluate weight status in children as it relates to health risks and tracks into adulthood. Accurate measurements and periodic assessment are important for screening and interpretation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    24 views47 pages

    CDC Growth Charts 2000: Centers For Disease Control and Prevention

    Uploaded by

    Juita Auglina Pasaribu
    The document summarizes the CDC Growth Charts 2000, which introduced BMI-for-age charts for children ages 2 to 20. Key features include BMI charts to screen for overweight and risk of overweight, updated growth references based on recent health surveys, and minor changes to percentile cutoffs resulting in small changes to prevalence rates for nutritional indicators. The CDC recommends using BMI-for-age to evaluate weight status in children as it relates to health risks and tracks into adulthood. Accurate measurements and periodic assessment are important for screening and interpretation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 47

    CDC Growth Charts 2000

    Centers for Disease Control and Prevention


    National Center for Chronic Disease Prevention and Health Promotion

    Division of Nutrition and Physical Activity

    Maternal and Child Nutrition Branch

    Revised June 2002

    Training Objectives
    Science behind development of growth charts Rationale for including BMI-for-age Using BMI-for-age as a screening tool

    What growth charts are available?

    New Features of the Growth Charts


    BMI-for-age charts (2-20 years)
    85th percentile (at risk of overweight) 3rd and 97th percentiles available Lower limits of length (45 vs. 49 cm) and height (77 vs. 90 cm) extended Smoothed percentile curves and z-scores agree Correction in the disjunction

    Disjunction: Smoothed in New Charts


    120 110 Length/height in cm 100 90 80 70 60 50 40 0 6 12 18 24 30 36 42 48 54 60 Age in month Length/height in cm 120

    1977

    110 100 90 80 70 60 50

    2000

    40 0

    12 18 24 30 36 42 48 54 60 Age in month

    Reference Population for CDC Growth Charts


    Racially and ethnically diverse
    Infants: Birth to 36 months
    Children and Adolescents: 2 to 20 years Breast- and formula-fed infants

    Reference Data Sets: Birth to 36 Months


    Head Circum

    Length

    Weight

    Weight-for-Length
    B 3 6 9 12 15 18 Age in Months 21 24 27 30 33 36

    MO/WI Natality Fels NHANES I ('71-'74)

    National Natality NHANES III ('88-'94)

    PedNSS NHANES II ('76-'80)

    Reference Data Sets: 2 to 20 Years


    Stature

    Weight/BMI

    8 10 Age in Years

    12

    14

    16

    18

    20

    NHANES III ('88-'94) NHES III ('66-'70)

    NHANES II ('76-'80) NHES II ('63-'65)

    NHES II ('63-65)

    Exclusions from the Reference Data


    Very low birth weight (VLBW) infants (<1500 g) were excluded because they have different growth patterns
    NHANES III weight data for 6+ year olds were excluded to avoid an upward shift in weight-for-age and BMI-for-age curves

    Age-Adjusted Prevalence of Overweight1 From NHANES I to III 2


    NHANES I 20 15 10 5 0 Boys 6-11 y Boys 12-17 y Girls 6-11 y Girls 12-17 y II III

    Sex and Age Group


    1>95th

    percentile BMI-for-age 2 http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm

    CDC Growth Charts Are for All Racial and Ethnic Groups Combined
    Environmental influences appear to contribute to variations in growth more than genetic influences

    Inadequate sample data for racial- and ethnicspecific charts


    The effect of race and ethnicity on BMI-forage is unclear

    Age Adjusted Prevalence of Low Height-for-Age by Ethnic Groups, Children Aged 0 to 5 Years1
    15

    10

    White Asian
    5

    79 80 81 82 83 84 85 86 87 88 89 90 91 92 93

    Year of Visit
    Mei, Yip and Trowbridge, Asia Pacific J Clin Nutr 1998; 7(2): 111-116
    1

    Breast-Fed vs. Formula-Fed Infants


    Mode of infant feeding can influence growth
    New charts represent the combined growth patterns of breast-fed and formula-fed infants Working group of the World Health Organization (WHO) is developing growth charts for infants and children through age 5 using data collected on infants following WHO feeding recommendations

    Indicators of Nutritional Status


    Head circumference-for-age <5th percentile >95th percentile

    Stunting/shortness length or stature-for-age Underweight weight-for-length BMI-for-age

    <5th percentile

    <5th percentile

    Indicators of Nutritional Status

    Overweight

    Weight-for-length BMI-for-age

    >95th percentile

    Risk of overweight
    BMI-for-age

    85th to 95th percentile

    Prevalence of Nutritional Status Indicators New Reference Curves Compared with Old Curves*
    < 2 Years Old

    Nutrition Indicator
    Stunting/shortness length-for-age <5th Underweight weight-for-length <5th Overweight weight-for-length >95th
    * NHANES III

    Change in Prevalence
    1% to 2% lower 1% to 2% higher 2% lower for females 2% higher for males

    Prevalence of Nutritional Status Indicators New Reference Curves Compared with Old Curves*
    Children 2 to 5 years of age Nutrition Indicator Stunting/shortness stature-for-age <5th Underweight** <5th Overweight** 95th
    * NHANES III **BMI-for-age, weight-for-stature

    Change in Prevalence
    1% lower 3% to 4% higher No change for females 1% higher for males

    What Is BMI?
    Body mass index (BMI) = weight (kg)/height (m)2 BMI is an effective screening tool; it is not a diagnostic tool For children, BMI is age and gender specific, so BMI-for-age is the measure used

    Advantages of BMI-for-Age
    Provides a reference for adolescents that
    was not previously available

    Consistent with adult index so it can be

    used continuously from 2 years of age to adulthood

    Tracks childhood overweight into


    adulthood

    Tracking BMI-for-Age from Birth to 18 Years with Percent of Overweight Children who Are Obese at Age 251

    100

    BMI < 85th

    BMI >=85th
    69 52 36 55

    BMI >=95th
    83 75 67 77

    % obese as adults

    80 60 40 26 20 0 Birth 1 to 3 16 17 15 19 12 11

    10

    3 to 6 6 to 10 Age of child (years)

    10 to 15

    15 to 18

    Whitaker et al. NEJM: 1997;337:869-873

    Advantages of BMI-for-Age
    BMI-for-age relates to health risks
    Correlates with clinical risk factors for cardiovascular disease including hyperlipidemia, elevated insulin, and high blood pressure BMI-for-age during pubescence is related to lipid levels and high blood pressure in middle age

    BMI-for-Age Compares Well with

    Weight-for-stature measurements Measures of body fat

    Mei et al., Am J Clin Nutr 2002;75:978-85.

    Why Use BMI-for-Age?


    Recommended by expert committees to evaluate overweight
    Guidelines

    for Overweight in Adolescent Preventive

    Services (Am J Clin Nutr 1994;59:307-316)

    Obesity Evaluation and Treatment: Expert Committee


    Recommendations (Pediatrics 1998 Sept;(102)3:e 29)

    Assessment of Childhood and Adolescent Obesity:


    International Obesity Task Force (Am J Clin Nutr 1999,

    70,suppl)

    Shape of Weight-for-Stature Curve versus BMI-for-Age Curve


    35 30
    95th 50th 5th

    35 30
    BMI
    95th

    Weight (kg)

    25 20 15 10 5

    25 20 15 10

    50th 5th

    0
    80 90 100 110 120 130 Stature (cm)

    24

    72

    120 168 216

    Age (months)

    BMI

    BMI

    Boys: 2 to 20 years

    Shape of BMI-forAge Growth Curve: Adiposity Rebound (AR)


    Example: Early AR
    Age (mos) 26 32 38 41 BMI 18.2 17.4 18.5 18.7

    BMI

    BMI

    BMI

    For Children, BMI Changes with Age


    BMI

    BMI

    Boys: 2 to 20 years

    Example: 95th Percentile Tracking Age 2 yrs 4 yrs 9 yrs 13 yrs BMI 19.3 17.8 21.0 25.1

    BMI

    BMI

    BMI-for-Age Cutoffs
    > 95th percentile 85th to < 95th percentile Overweight Risk of overweight

    < 5th percentile

    Underweight

    Performance of BMI-for-Age as a Screening Tool


    Using the 85th and 95th percentiles as cut points, few children are incorrectly identified as over-fat but some over-fat children will be missed. It is desirable to correctly identify those children not at risk of overweight or overweight.

    Calculating BMI with the Metric System


    Formula: weight (kg)/[height (m)]2
    Calculation: [weight (kg)/ height (cm)/
    height (cm)] x 10,000
    Example: A childs weight=16.9 kg and height=105.4 cm

    BMI = [16.9 kg / 105.4 cm / 105.4 cm] x 10,000 = 15.2

    Calculating BMI with the English System


    Formula: weight (lb)/[height (in)]2 x 703
    Calculation: [weight (lb)/height (in)/height (in)] x 703
    Example: A childs weight = 37 pounds, 4 ounces and height = 41 1/2 inches (convert fractions to decimal value) BMI = [37.25 lb / 41.5 in / 41.5 in] x 703 = 15.2

    Can you see risk?


    This boy is 3 years, 3 weeks old. Is his BMI-for-age
    - >85th to <95th percentile: at risk for overweight?

    Photo from UC Berkeley Longitudinal Study, 1973

    Plotted BMI-for-Age
    BMI BMI

    Measurements:
    Age=3 y 3 wks Height=100.8 cm (39.7 in) Weight=18.6 kg (41 lb) BMI=18.3 BMI-for-age= >95th percentile overweight

    Boys: 2 to 20 years

    BMI

    BMI

    Can you see risk?


    This girl is 4 years, 4 weeks old. Is her BMI-for-age

    - >85th to <95th percentile: at risk for overweight?

    Photo from UC Berkeley Longitudinal Study, 1974

    Plotted BMI-for-Age
    BMI

    Girls: 2 to 20 years

    BMI

    Measurements: Age= 4 y 4 wks


    Height=106.4 cm (41.9 in) Weight=15.7 kg (34.5 lb) BMI=13.9 BMI-for-age= 10th percentile Normal

    BMI

    BMI

    Can you see risk?


    This girl is 4 years old. Is her BMI-for-age - >85th to <95th percentile: at risk for overweight?

    Photo from UC Berkeley Longitudinal Study, 1973

    Plotted BMI-for-Age
    BMI BMI

    Girls: 2 to 20 years

    Measurements: Age=4 y
    Height=99.2 cm (39.2 in)
    Weight=17.55 kg (38.6 lb) BMI=17.8 BMI-for-age= between 90th 95th percentile

    BMI

    BMI

    At risk for overweight

    Accurate Measurements are Critical


    BMI BMI

    Boys: 2 to 20 years

    5 1/2 year old boy Weight: 41.5 lb Height: 43 in BMI= 15.8

    BMI-for-age=50th %tile
    Inaccurate height measurement: 42.25

    BMI=16.3
    BMI BMI

    BMI-for-age=75th %tile

    Interpreting the BMI-for-Age Cutoffs


    > 95th percentile 85th to < 95th percentile Overweight Risk of overweight

    < 5th percentile

    Underweight

    Interpreting the BMI-for-Age Chart


    BMI-for-age indicates a childs weight in relation to his/her height for a specific age and gender Need a series of BMI plots to determine the growth trend If indices deviate from normal growth patterns, further assessment may be needed

    Example: Sam
    Name: Sam Weight: 37 lb 4 oz (16.9 kg) Height: 41.5 inches (105 cm) Age: 3.5 years BMI: 15.2

    Sams BMI Plotted on Boys BMI-for-Age Chart


    BMI BMI

    Boys: 2 to 20 years

    Interpretation: Sams BMI-for-age is slightly below the 25th %tile so it falls within the normal range.
    Of 100 boys who are the same age, fewer than 25 have a BMI-for-age lower than Sams.

    BMI

    BMI

    Summary of Using BMI-for-Age


    BMI-for-age is the recommended method for screening overweight and underweight For children, BMI is age and gender specific; for adults there are fixed cut points Accurate and periodic measurements are important elements of any anthropometric screening

    Steps to Plot BMI-for-Age


    Obtain accurate weight and height measurements Select the appropriate growth chart Record the data Calculate BMI Plot measurements Interpret plotted measurements

    Please visit:

    http://www.cdc.gov/growthcharts/
    For additional training materials

    related to the growth charts

    For tools related to the growth charts To download the growth charts

    www.cdc.gov/growthcharts

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