Assessing Child Growth Using the Body Mass Index (BMI)-for-age Growth Charts: A Training for Health...
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Transcript of Assessing Child Growth Using the Body Mass Index (BMI)-for-age Growth Charts: A Training for Health...
Assessing Child Growth Using the
Body Mass Index (BMI)-for-age Growth Charts:
A Training for Health Care ProvidersAdapted by the CHDP Bay Area Nutrition Subcommittee
(BANS) from
Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health
Promotion
Division of Nutrition and Physical Activity
Maternal and Child Nutrition BranchMarch 2006
BMI-for-age Growth Chart is:BMI-for-age Growth Chart is:
considered standard practice by the American Academy of Pediatrics.
now required as part of the well-child exam for children ages 2 through 19 by the Child Health and Disability Prevention (CHDP) Program.
Training ObjectivesTraining Objectives
Understand BMI and how it is useful to Understand BMI and how it is useful to screen for normal growthscreen for normal growth
Learn how to plot BMI on the BMI-for-Learn how to plot BMI on the BMI-for-age growth chartsage growth charts
Learn how to assess a child’s growth Learn how to assess a child’s growth using BMI-for-age growth charts for using BMI-for-age growth charts for early identification of childhood early identification of childhood overweightoverweight
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1985
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1986
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1987
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1988
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1989
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1990
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1991
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1992
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1993
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1994
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1995
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1996
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1997
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1998
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1999
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 2001
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity* Trends Among U.S. AdultsBRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Hispanic 22.50%
Asian/PI 11.90%
Black15.60%
0%
10%
20%
30%
40%
50%HispanicAsian/PIBlackWhiteAll Races
All Races
17.90%
not
en
ough
dat
a
Pediatric Nutrition Surveillance System (PedNSS) Growth Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forStatistics for
City and County of San Francisco 2004City and County of San Francisco 2004BMI for age > 95% for Children 2-4 YearsBMI for age > 95% for Children 2-4 Years
Hispanic 26.60%
Asian/PI 11.40%
Black 24.90%
0%
10%
20%
30%
40%
50%HispanicAsian/PIBlackWhiteAll Races
All Races
19.20%
White 17.90%
Pediatric Nutrition Surveillance System (PedNSS) Growth Pediatric Nutrition Surveillance System (PedNSS) Growth Statistics forStatistics for
City and County of San Francisco 2004City and County of San Francisco 2004BMI for age > 95% for Children 5-19 YearsBMI for age > 95% for Children 5-19 Years
A number that compares a A number that compares a child’s weight to her heightchild’s weight to her height
Body Mass Index (BMI) = Body Mass Index (BMI) =
Weight (kg) / Height (m)²Weight (kg) / Height (m)²
BMI is an effective BMI is an effective SCREENING tool; alone it is nottool; alone it is not a diagnostic a diagnostic tooltool
What is BMI?What is BMI?
BMI is Not the Same for BMI is Not the Same for Adults and ChildrenAdults and Children
Adult BMI is evaluated by use of cut-off Adult BMI is evaluated by use of cut-off numbers; for example BMI >30 is numbers; for example BMI >30 is indicative of adult obesityindicative of adult obesity
There are no BMI cut-off numbers for There are no BMI cut-off numbers for children. The BMI number must be plotted children. The BMI number must be plotted on the BMI-for-age growth charton the BMI-for-age growth chart
The BMI for children is useful only when it The BMI for children is useful only when it is plotted on the is plotted on the “BMI-for-age Growth “BMI-for-age Growth Chart”Chart”
Example: 95th percentile tracking Age BMI 2 yrs 19.3 4 yrs 17.8 9 yrs 21.013 yrs 25.1
For Children, BMI Changes with Age
Boys: 2 to 20 years
BMI BMI
BMI BMI
Tracking tool for body size starting Tracking tool for body size starting at age 2 years through adulthoodat age 2 years through adulthood
Only indicator that examines weight, Only indicator that examines weight, stature AND age for a child on a stature AND age for a child on a single growth chartsingle growth chart
Correlates with clinical risk factors Correlates with clinical risk factors for chronic disease including for chronic disease including hyperlipidemia, elevated insulin, and hyperlipidemia, elevated insulin, and high blood pressurehigh blood pressure
Importance of Using BMI-for-Importance of Using BMI-for-ageage
BMI is Only an Indirect BMI is Only an Indirect Measure of Body FatMeasure of Body Fat
> 95th percentile Overweight
85th to < 95th Risk of percentileoverweight
< 5th percentileUnderweight
Using BMI-for-age Percentiles to Assess Risk
What is a What is a Percentile?Percentile?
95th
5th
50th Percentile
85th
CDC CDC StandardizeStandardized d Growth Growth ChartChart
Formula to calculate BMI
Published May 30, 2000
Percentiles (5th,10th,25th, 50th, 75th,85th,90th,95th)
> 95th percentileOverweight?
85th to < 95th Risk of percentile overweight?
< 5th percentileUnderweight?
Growth acceleration or deceleration across 2 percentile lines
Using BMI-for-age Percentiles to Assess Risk
What is “Adiposity” Rebound (AR)?
BMI
•A rebound or increase in BMI that occurs after it reaches its lowest point, usually between ages 4 to 6.
• Normal pattern of growth
• An early "adiposity" rebound, occurring before ages 4 to 6, is associated with obesity in adulthood.
Normal “Adiposity”
Rebound
BMI BMI
Early “Adiposity”
Rebound
Steps to Plot BMI-for-ageSteps to Plot BMI-for-age1.1. Obtain accurate weight and Obtain accurate weight and
height measurements height measurements
2.2. Select the appropriate growth Select the appropriate growth chartchart
3.3. Record the dataRecord the data
4.4. Calculate BMICalculate BMI
5.5. Plot measurementsPlot measurements
6.6. Interpret plotted Interpret plotted measurementsmeasurements
5 year old boy
Weight: 43.5 lb
Height: 43 in
BMI= 16.5
BMI-for-age = 75-84th %tile
Inaccurate height measurement: 42.5 in
BMI=17
BMI-for-age = 85-94th %tile
1. Obtain Accurate Weight and Height Measurements
Accurate Measurements are Critical
Boys: 2 to 20 years
BMI BMI
BMI BMI
2. Select the Appropriate 2. Select the Appropriate Growth ChartGrowth Chart
For ages birth to 36 months old:For ages birth to 36 months old:““Length-for-age,” and “Weight-for-age” Length-for-age,” and “Weight-for-age” ““Weight-for-length,” and “Head Weight-for-length,” and “Head
Circumference-for-age” Circumference-for-age”
For ages 2 to 20 years: For ages 2 to 20 years: ““Weight-for-age,” and “Stature-for-age”Weight-for-age,” and “Stature-for-age”Body Mass Index “BMI-for-age”Body Mass Index “BMI-for-age”
3. Record Data3. Record Data
4. Calculate BMI4. Calculate BMI
English:
Wt (lbs.) ÷Ht (in.) ÷ Ht (in.) x 703
Metric: Wt (kg.) ÷Ht (cm.) ÷ Ht (cm.) x 10,000
4. Calculate BMI4. Calculate BMI
Use a Pediatric BMI WheelUse a Pediatric BMI Wheel
5. Plot Measurements5. Plot Measurements
Age
BMI
50th
75th
85th
5th
95th
6. Interpret the BMI-for-age Chart6. Interpret the BMI-for-age Chart
Need a series of BMI plots to Need a series of BMI plots to determine the growth trenddetermine the growth trend
If growth deviates from If growth deviates from expected growth pattern, expected growth pattern, further assessment may be further assessment may be neededneeded
Practice using Practice using “BMI-for-age” Growth Chart“BMI-for-age” Growth Chart
Liz (4 y)Pete (3 y) Gabriella (4 y)Photos from UC Berkeley Longitudinal Study, 1973
Please Plot Pete Perfectly
Photo from UC Berkeley Longitudinal Study, 1973
Measurements for Pete:
Age= 3 y 3 wks
Weight= 41 lbs (18.6 kg)
Height= 39.7 in (100.8 cm)
Find BMI, plot, & interpret growth trend
BMI= Wt ( lbs) ÷ Ht (in) ÷ Ht (in) x 703
BMI=18.3
Boys: 2 to 20 years
BMI BMI
BMI BMI
Interpretation:
• BMI-for-age = >95th
percentile
• Overweight
• Of 100 boys the same age, more than 95 have a lower BMI-for-age
Answers: Pete’s “BMI-for-age”
Let’s Look at LizLet’s Look at Liz
Liz
Liz’s - BMILiz’s - BMI
Liz
17.7
2-3-02
Graph Gabriella’s Growth Graph Gabriella’s Growth
Gabriella’s BMI Gabriella’s BMI
Please Identify Overweight Please Identify Overweight Children on PM160Children on PM160
Put comments here
ex: overweight, > 95th % BMI
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)
Centers for Disease Control and Prevention Website (www.cdc.gov/growthcharts)
American Academy of Pediatrics Policy Statement: Prevention of Pediatric Overweight and Obesity (Pediatrics 2003 Aug (112)2; 424-430)
References
• For additional training materials related to the growth charts
• For tools related to the growth charts
• To download the growth charts
Please visit:
www.cdc.gov/growthcharts/