Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score or BMI centile?

A Corrigendum to this article was published on 02 June 2005

Abstract

Background:

Weight control programs for obese children monitor change in body mass index (BMI) adjusted for age. However, change can be measured in several ways: raw (kg/m2) units, percentage, z-scores or centiles. The suitability of the different measures is not known.

Aim:

To identify the optimal BMI measure for change, whose short-term variability is most consistent for children across the spectrum of adiposity.

Setting:

An Italian kindergarten.

Subjects:

A total of 135 (66 female) children aged 29–68 months at baseline, with BMI measured three times over a 9-month period.

Methods:

Each child's short-term variability in adiposity was summarized by the standard deviation (s.d.) of BMI and BMI % adjusted for age, and BMI z-score and BMI centile. The s.d.'s were then compared in obese and nonobese children, and also correlated with each child's baseline BMI z-score.

Results:

The within-child s.d.s of BMI z-score and BMI centile were significantly smaller in obese than nonobese children, while the s.d.s of BMI and BMI % were similar in the two groups. Also, the within-child s.d.s of z-score and centile, and to a lesser extent BMI %, were significantly inversely correlated with baseline z-score, whereas the s.d. of BMI was not. The changes in adiposity over time, as assessed by the four measures, were very highly correlated with each other, particularly for BMI with BMI %.

Discussion:

Even though BMI z-score is optimal for assessing adiposity on a single occasion, it is not necessarily the best scale for measuring change in adiposity, as the within-child variability over time depends on the child's level of adiposity. Better alternatives are BMI itself or BMI %. Our results underscore the importance of using a relatively stable method to assess adiposity change when following children at risk of obesity.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  • Barlow SE, Trowbridge FL, Klish WS & Dietz WH (2002): Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners and registered dietitians. Pediatrics 110, 229–235.

    PubMed  Google Scholar 

  • Cole TJ (1997): Growth monitoring with the British 1990 growth reference. Arch Dis. Child 76, 47–49.

    Article  CAS  Google Scholar 

  • Cole TJ (2000): Sympercents: symmetric percentage differences on the 100 loge scale simplify the presentation of log transformed data. Stat. Med. 19, 3109–3125.

    Article  CAS  Google Scholar 

  • Ellis KJ (2000): Human body composition. In vivo methods. Physiol. Rev. 80, 649–680.

    Article  CAS  Google Scholar 

  • Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF & Johnson CL (2000): CDC Growth Charts: United States. Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS & Siervogel RM (2001): Childhood body composition in relation to body mass index. Pediatrics 107, 344–350.

    Article  CAS  Google Scholar 

  • Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G & Heymsfield SB (1998): Body mass index as a measure of adiposity among children and adolescents: a validation study. J. Pediatr. 132, 204–210.

    Article  CAS  Google Scholar 

  • Power C, Lake JK & Cole TJ (1997): Measurement and long term health risks of child and adolescent fatness. Int. J. Obes. 21, 507–526.

    Article  CAS  Google Scholar 

  • Zannolli R & Morgese G (1996): Distribution of BMI in children: prevalence of wasting and fattening conditions. Ann. Hum. Biol. 23, 63–69.

    Article  CAS  Google Scholar 

  • Zemel BS, Riley EM & Stallings VA (1997): Evaluation of methodology for nutritional assessment in children: anthropometry, body composition, and energy expenditure. Annu. Rev. Nutr. 17, 211–235.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A Pietrobelli.

Additional information

Guarantor: A Pietrobelli.

Contributors: AP designed the study and collected the data. MSF, MH, AP and TJC analysed the data, wrote the manuscript and gave final approval of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cole, T., Faith, M., Pietrobelli, A. et al. What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score or BMI centile?. Eur J Clin Nutr 59, 419–425 (2005). https://doi.org/10.1038/sj.ejcn.1602090

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602090

Keywords

This article is cited by

Search

Quick links