Prevalence of Nutritional Status Indicators: Comparison of the New Reference Curves with the 1977 Reference Curves Using NHANES III Data

To look at the impact that the new reference has on the prevalence of nutritional status indicators including overweight, underweight, and shortness, NHANES III data were used to compare the 1977 reference (old) with the 2000 reference (new). The following table summarizes the comparisons and shows that there are only slight differences in the prevalence rates of specific indicators when using the new versus the old reference. The greatest difference is found in the prevalence of underweight in 2 to 5 year-old girls and boys.

Summary: Impact of the New Reference on the Prevalence of Nutritional Status Indicators

	Nutritional Status Indicators Changes in Prevalence by Age Groups Using the New Reference <2 years 2 to 5 years 6 to 11 years 12 to 19 years Overweight1 Female Male 2% lower 2% higher No change4 1% higher 1% higher No change NA5 NA Underweight2 Female Male 2% higher 1% higher 3% higher 4% higher 1% higher 1% higher NA NA Shortness3 Female Male 2% lower 1% lower 1% lower 1% lower 2% higher No Change No Change 1% lower

¹ Overweight: for children < 2 years old: weight-for-length >95th percentile; for children 2-19 years: BMI-for-age > 95th percentile for the new reference and weight-for-height > 95th percentile for the old reference
² Underweight: for children < 2 years old: weight-for-length < 5th percentile; for children 2-19 years: BMI-for-age < 5th percentile for the new reference and weight-for-height < 5th percentile for the old reference
³ Shortness: for children < 2 years old: length < 5th percentile; for children 2-19 years: height-for-age < 5th percentile
⁴ No change means the change between the two references is a < 0.2 % change in either direction.
⁵ Values are not available for comparison for the 12 to 19 year-old group since the 1977 weight-for-height percentiles were provided only for girls up to approximately 10 years and for boys up to 11.5 years

Summary

The CDC 2000 growth charts provide health care providers and researchers with an improved tool to assess the growth of infants, children and adolescents up to 20 years of age.

CDC promotes one set of growth charts for all racial and ethnic groups.

The CDC growth charts can be used for both breast and formula fed infants because the growth charts represent the combined growth pattern of breast and formula fed infants. The growth of exclusively breastfed infants must be interpreted with caution because they have different growth patterns than formula fed infants.

The CDC growth charts can be used to assess the growth of both LBW and VLBW infants. However, because VLBW infants were excluded from the reference population gestation-adjusted age must be calculated and their growth pattern must be interpreted with caution because they have different patterns of growth than infants with higher birth weight. An additional option is to use the IHDP growth charts to assess growth of VLBW infants.