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Multicenter Study
. 2007 Jul 28;335(7612):194.
doi: 10.1136/bmj.39238.399444.55. Epub 2007 Jun 25.

Body mass index cut offs to define thinness in children and adolescents: international survey

Tim J Cole  1 , Katherine M Flegal, Dasha Nicholls, Alan A Jackson
Affiliations
Multicenter Study

Body mass index cut offs to define thinness in children and adolescents: international survey

Tim J Cole et al. BMJ. .

Abstract

Objective: To determine cut offs to define thinness in children and adolescents, based on body mass index at age 18 years.

Design: International survey of six large nationally representative cross sectional studies on growth.

Setting: Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States.

Subjects: 97 876 males and 94 851 females from birth to 25 years.

Main outcome measure: Body mass index (BMI, weight/height(2)).

Results: The World Health Organization defines grade 2 thinness in adults as BMI <17. This same cut off, applied to the six datasets at age 18 years, gave mean BMI close to a z score of -2 and 80% of the median. Thus it matches existing criteria for wasting in children based on weight for height. For each dataset, centile curves were drawn to pass through the cut off of BMI 17 at 18 years. The resulting curves were averaged to provide age and sex specific cut-off points from 2-18 years. Similar cut offs were derived based on BMI 16 and 18.5 at 18 years, together providing definitions of thinness grades 1, 2, and 3 in children and adolescents consistent with the WHO adult definitions.

Conclusions: The proposed cut-off points should help to provide internationally comparable prevalence rates of thinness in children and adolescents.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Fig 1 Centiles by age and sex defined to pass through BMI 17 at age 18 years in six datasets
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Fig 2 Centiles by age and sex defined to pass through BMI 18.5 at age 18 years in six datasets
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Fig 3 Centiles by age and sex defined to pass through BMI 16 at age 18 years in six datasets
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Fig 4 Cut offs for thinness by age and sex defined to pass through BMI 16, 17, and 18.5 at 18 years, with the international cut offs for overweight and obesity based on BMI 25 and 30
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Fig 5 Comparison of cut offs for BMI at 18 and WHO BMI growth standard z scores from −3 to 3 at ages 2-5 years
See this image and copyright information in PMC

Comment in

References

    1. Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev 2004;5(suppl 1):4-85. - PubMed
    1. Pelletier DL. The relationship between child anthropometry and mortality in developing countries: implications for policy, programs and future research. J Nutr 1994;124:2047-81S. - PubMed
    1. Pelletier DL, Frongillo EA. Changes in child survival are strongly associated with changes in malnutrition in developing countries. J Nutr 2003;133:107-19. - PubMed
    1. El-Ghannam AR. The global problems of child malnutrition and mortality in different world regions. J Health Soc Policy 2003;16:1-26. - PubMed
    1. Staton DM, Harding MH. Protecting child health worldwide. Implementation is the biggest challenge slowing efforts to reduce childhood morbidity and mortality in developing countries. Pediatr Ann 2004;33:647-55. - PubMed

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