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

Tim J Cole, Katherine M Flegal, Dasha Nicholls, Alan A Jackson, Tim J Cole, Katherine M Flegal, Dasha Nicholls, Alan A Jackson

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.

Conflict of interest statement

Competing interests: None declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1934447/bin/colt438457.f1.jpg
Fig 1 Centiles by age and sex defined to pass through BMI 17 at age 18 years in six datasets
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1934447/bin/colt438457.f2.jpg
Fig 2 Centiles by age and sex defined to pass through BMI 18.5 at age 18 years in six datasets
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1934447/bin/colt438457.f3.jpg
Fig 3 Centiles by age and sex defined to pass through BMI 16 at age 18 years in six datasets
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1934447/bin/colt438457.f4.jpg
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
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/1934447/bin/colt438457.f5.jpg
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

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Source: PubMed

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