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Prevalence of High Weight-for-recumbent Length Among Infants and Toddlers From Birth to 24 Months of Age: United States, 1971–1974 Through 2017–2018
by Cheryl D. Fryar, M.S.P.H., Margaret D. Carroll, M.S.P.H., and Joseph Afful, M.S., Division of Health and Nutrition Examination Surveys
Excess weight in infants is often defined using weight-for-recumbent length. The Centers for Disease Control and Prevention (CDC) recommends using the World Health Organization (WHO) growth standards to monitor growth in children under age 2 years in the United States (1). The recommended definition of excess weight in infants is +2 z scores (corresponding to the 97.7th percentile) on the WHO sex-specific weight-for-recumbent length growth standards (2). Some analyses have used the 95th percentile on the CDC sex-specific weight-for-recumbent length growth charts (3) as a cut point for excess weight in infants. Consequently, this report presents estimates of excess weight using both definitions.
Based on the WHO growth standards, results from the 2017–2018 National Health and Nutrition Examination Survey (NHANES), using measured recumbent lengths and weights, indicate that an estimated 9.6% of infants and children under age 24 months have high weight-for-recumbent length. Based on the CDC growth charts, an estimated 9.9% of infants and children under 24 months have high weight-for-recumbent length.
Table 1 shows the unweighted sample sizes for infants and toddlers with measured recumbent length and weight by age for each survey cycle. Because data collection began at different ages in different surveys, Table 2 shows the prevalence of high weight-for-recumbent length from birth to 24 months, from birth to 6 months, from 6 to 24 months, and from 12 to 24 months by survey years. The 1971–1974 NHANES included individuals starting at 12 months, the 1976–1980 NHANES included individuals starting at 6 months, and the 1988–1994 NHANES included individuals aged 2 months and over (data beginning at 6 months are shown in the tables). Beginning with 1999–2000, NHANES included individuals from birth. Consequently, trends from 1971–1974 to the present can be reported only for the 12- to 24-month age group. The variability and statistical reliability of the 2-year estimates over time and for a specific age group are consistent with what might be observed in the smaller sample size of infants and toddlers in NHANES.
NHANES, conducted by the National Center for Health Statistics, uses a stratified, multistage probability sample of the civilian noninstitutionalized U.S. population. A household interview and a physical examination are conducted for each survey participant. During the physical examination, conducted in a mobile examination center, recumbent length and weight are measured as part of a more comprehensive set of body measurements. These measurements are taken by trained health technicians, using standardized measuring procedures and equipment. Observations for persons missing a valid recumbent length or weight measurement are not included in the data analysis.
For additional information on NHANES methods, visit: https://wwwn.cdc.gov/nchs/nhanes/ analyticguidelines.aspx.
For more detailed estimates, see:
Ogden CL, Fryar CD, Martin CB, Freedman DS, Carroll MD, Gu Q, Hales CM. Trends in obesity prevalence by race and Hispanic origin—1999–2000 to 2017–2018. JAMA 324(12):1208–10. 2020. doi:10.1001/jama.2020.14590.
References
1. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC). Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep 59(RR–9):1–15. 2010.
2. World Health Organization. WHO child growth standards. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. 2006.
3. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts for the United States: Methods and development [PDF – 5 MB]. National Center for Health Statistics. Vital Health Stat 11(246). 2002.
This Health E-Stat supersedes the earlier version, “Prevalence of High Weight-for-recumbent Length Among Infants and Toddlers From Birth to 24 Months of Age: United States, 1971–1974 Through 2015–2016”.
Suggested citation
Fryar CD, Carroll MD, Afful J. Prevalence of high weight-for-recumbent length among infants and toddlers from birth to 24 months of age: United States, 1971–1974 through 2017–2018. NCHS Health E-Stats. 2020.
Tables
| Survey period | ||||
|---|---|---|---|---|
| Birth to under 24 months | Birth to under 6 months | 6–24 months | 12–24 months | |
| 1971–1974 | – – – | – – – | – – – | 553 |
| 1976–1980 | – – – | – – – | 1,014 | 719 |
| 1988–1994 | – – – | – – – | 2,442 | 1,287 |
| 1999–2000 | 671 | 205 | 466 | 256 |
| 2001–2002 | 667 | 179 | 488 | 256 |
| 2003–2004 | 766 | 192 | 574 | 332 |
| 2005–2006 | 822 | 220 | 602 | 345 |
| 2007–2008 | 719 | 195 | 524 | 295 |
| 2009–2010 | 703 | 182 | 521 | 317 |
| 2011–2012 | 584 | 181 | 403 | 219 |
| 2013–2014 | 609 | 159 | 450 | 240 |
| 2015–2016 | 630 | 165 | 465 | 272 |
| 2017–2018 | 535 | 172 | 363 | 221 |
– – – Data not available.
SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Surveys, 1971–1974, 1976–1980, 1988–1994, and 1999–2018.
| Survey period | ||||||||
|---|---|---|---|---|---|---|---|---|
| WHO growth standards1 | CDC growth charts2 | |||||||
| Birth to under | 6–24 months |
12–24 months |
Birth to under | 6–24 months |
12–24 months |
|||
| 24 months | 6 months | 24 months | 6 months | |||||
| Percent (standard error) | ||||||||
| 1971–1974 | – – – | – – – | – – – | 6.5 (1.2) | – – – | – – – | – – – | 6.7 (1.3) |
| 1976–1980 | – – – | – – – | 6.3 (1.0) | 6.8 (1.1) | – – – | – – – | 7.1 (1.0) | 7.2 (1.2) |
| 1988–1994 | – – – | – – – | 7.8 (0.7) | 8.0 (1.0) | – – – | – – – | 8.8 (0.7) | 8.5 (1.1) |
| 1999–2000 | 9.2 (1.3) | *7.5 (2.3) | 9.8 (1.7) | 7.9 (2.1) | 10.4 (1.6) | *10.3 (4.0) | 10.5 (1.6) | 7.8 (2.1) |
| 2001–2002 | 7.8 (1.1) | 8.3 (1.5) | 7.7 (1.3) | 6.3 (1.3) | 7.9 (1.1) | 8.1 (1.3) | 7.8 (1.3) | 6.4 (1.3) |
| 2003–2004 | 8.5 (1.2) | *6.3 (2.0) | 9.0 (1.7) | 9.0 (2.1) | 9.5 (1.3) | *6.8 (1.9) | 10.1 (1.6) | 9.8 (2.1) |
| 2005–2006 | 7.1 (1.0) | 7.4 (1.5) | 7.1 (1.4) | 6.7 (1.7) | 8.2 (1.1) | 8.5 (1.8) | 8.1 (1.5) | 6.9 (1.7) |
| 2007–2008 | 8.8 (0.9) | *5.7 (1.9) | 9.7 (1.1) | 9.7 (1.1) | 9.5 (1.1) | *6.2 (2.0) | 10.4 (1.2) | 10.1 (1.2) |
| 2009–2010 | 8.6 (1.3) | *5.0 (2.1) | 9.6 (1.7) | 9.4 (2.1) | 9.7 (1.1) | 6.6 (1.6) | 10.7 (1.6) | 9.6 (2.0) |
| 2011–2012 | 7.1 (1.3) | *4.0 (1.3) | 8.2 (1.6) | *7.1 (2.2) | 8.1 (1.2) | 7.7 (2.0) | 8.2 (1.6) | *6.3 (2.0) |
| 2013–2014 | 8.1 (1.2) | 7.3 (1.9) | 8.4 (1.5) | 7.9 (1.8) | 9.1 (1.4) | 7.3 (1.9) | 9.5 (1.7) | 8.3 (1.7) |
| 2015–2016 | 8.9 (0.9) | 8.4 (2.3) | 9.0 (1.1) | 8.4 (1.3) | 9.9 (1.2) | 8.9 (1.9) | 10.2 (1.3) | 8.1 (1.5) |
| 2017–2018 | 9.6 (2.1) | 7.7 (2.2) | 10.3 (2.7) | *12.3 (3.6) | 9.9 (1.9) | 8.6 (1.9) | 10.3 (2.7) | *11.9 (3.5) |
– – – Data not available.
* Estimate has a confidence interval width between 5 and 30 and a relative confidence interval width greater than 130%, and does not meet National Center for Health Statistics standards of reliability; see Series Report 2, Number 175.
1High weight-for-recumbent length is at or above the 97.7th percentile of the sex-specific weight-for-recumbent length World Health Organization (WHO) growth standards.
2High weight-for-recumbent length is at or above the 95th percentile of the sex-specific weight-for-recumbent length 2000 Centers for Disease Control and Prevention (CDC) growth charts.
SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Surveys, 1971–1974, 1976–1980, 1988–1994, and 1999–2018.