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Zuguo Mei, MD, MPH; Ray Yip, MD, MPH; Laurence M. Grummer-Strawn, PhD; Frederick L. Trowbridge, MD, MSc

Arch Pediatr Adolesc Med. 1998;152:471-479.

Objective  To better characterize childhood growth and further assess potential limitations of the current National Center for Health Statistics and World Health Organization international growth reference.

Design  The LMS method was used for curve fitting to summarize the changes in height and weight distributions by 3 curves representing the skewness (L), median (M), and coefficient of variation (S). A series of polynomial regression procedures was applied to smooth the L, M, and S curves.

Setting  Subset data from 18 states contributing clinic data to the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System were used for this research reference.

Methods  We chose only those clinics in which the height and weight distributions of children closely matched with those of the first and second National Health and Nutrition Examination Surveys.

Results  Unlike the current international growth reference, the new reference has no disjunction at 24 months of age because it is based on a single data source for children aged 0 to 59 months. The reference also better characterizes the growth for infants than the current international reference, a fact we demonstrated with data from the National Health and Nutrition Examination Surveys, Pediatric Nutrition Surveillance System 1995, and the Davis Area Research on Lactation, Infant Nutrition, and Growth studies.

Conclusions  The current National Center for Health Statistics and World Health Organization international growth reference needs to be updated. The methods used in this study will be useful to evaluate other data sets and to evaluate future modifications of growth references.

From the Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Mei, Grummer-Strawn, and Trowbridge); and United Nations Children's Fund, Jakarta, Indonesia (Dr Yip).

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