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Measuring growth and obesity across childhood and adolescence

  • H. David McCarthy (a1)

The dramatic rise in childhood obesity has driven the demand for tools better able to assess and define obesity and risk for related co-morbidities. In addition, the early life origins of non-communicable diseases including type 2 diabetes are associated with subtle alterations in growth and body composition, including total and regional body fatness, limb/trunk length and skeletal muscle mass (SMM). Consequently improved tools based on national reference data, which capture these body components must be developed as the limitations of BMI as a measure of overweight and obesity and associated cardiometabolic risk are now recognised. Furthermore, waist circumference as a measure of abdominal fatness in children is now endorsed by the International Diabetes Federation and National Institute for Clinical and Health Excellence for diagnostic and monitoring purposes. The present paper aims to review the research on growth-related variations in body composition and proportions, together with how national references for percentage body fat, SMM and leg/trunk length have been developed. Where collection of these measures is not possible, alternative proxy measures including thigh and hip circumferences are suggested. Finally, body ratios including the waist:height and muscle:fat ratios are highlighted as potential measures of cardiometabolic disease risk. In conclusion, a collection of national references for individual body measures have been produced against which children and youths can be assessed. Collectively, they have the capacity to build a better picture of an individual's phenotype, which represents their risk for cardiometabolic disease beyond that of the capability of BMI.

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Corresponding author
Corresponding author: Professor H. D. McCarthy, fax 020 7133 4062, email
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1. Cole, TJ (2012) The development of growth references and growth charts. Ann Hum Biol 39, 382394.
2. Office for National Statistics (2011) Leading causes of death in England and Wales 2009.
3. Barker, DJP (1998) Mothers, Babies, and Disease in Later Life. Edinburgh: Churchill Livingstone.
4. Hales, CN & Barker, DJ (1992) Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35, 595601.
5. Wells, JC (2011) The thrifty phenotype: an adaptation in growth or metabolism? Am J Hum Biol 23, 6575.
6. Cole, TJ, Freeman, JV & Preece, MA (1995) Body mass index reference curves for the UK, 1990. Arch Dis Child 73, 2529.
7. Cole, TJ, Bellizzi, MC, Flegal, KM et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 320, 12401245.
8. NICE clinical guideline 43 (2006) Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children.
9. National Child Measurement Programme: 2010/11 school year, headline results; available at
10. WHO Expert Consultation (2004) Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403), 157163.
11. Viner, RM, Fry, T, Gupta, S et al. (2010) Insufficient evidence to support separate BMI definitions for obesity in children and adolescents from south Asian ethnic groups in the UK. Int J Obes Relat Metab Dis (Lond) 34, 656658.
12.Call to rethink child BMI testing.
13. Shah, NR & Braverman, ER (2012) Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin. PLoS ONE 7, e33308.
14. Brambilla, P, Bedogni, G, Moreno, LA et al. (2006) Cross validation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int J Obes Relat Metab Dis (Lond) 30, 2330.
15. Flodmark, CE, Sveger, T & Nilsson-Ehle, P (1994) Waist measurement correlates to a potentially atherogenic lipoprotein profile in obese 12–14-year-old children. Acta Paediatr 83, 941945.
16. Freedman, DS, Serdula, MK, Srinivasan, SR et al. (1999) Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 69, 308317.
17. Manco, M, Bedogni, G, Marcellini, M et al. (2008) Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut 57, 12831287.
18. Choy, CS, Chan, WY, Chen, TL et al. (2011) Waist circumference and risk of elevated blood pressure in children: a cross-sectional study. BMC Public Health 11, 613.
19. Sinzinger, H, Shengelia, N, Schmid, P et al. (2007) Waist circumference in Viennese school children is closely related to inflammatory, endothelial, and oxidation markers. Circulation 115, E243 (abstract).
20. Hirschler, V, Aranda, C, Calcagno Mde, L et al. (2005) Can waist circumference identify children with the metabolic syndrome? Arch Pediatr Adolesc Med 159, 740744.
21. McCarthy, HD, Crawley, HF & Jarrett, KV (2001) Development of waist circumference percentiles in British children aged 5·0–16·0 years. Eur J Clin Nutr 55, 902907.
22. Poh, BK, Jannah, AN, Chong, LK et al. (2011) Waist circumference percentile curves for Malaysian children aged 6–16y. Int J Pediatr Obes 6, 229235.
23. Kromeyer-Hauschild, K, Dortschy, R, Stolzenberg, H et al. (2011) Nationally representative waist circumference percentiles in German adolescents aged 11·0–18·0 years. Int J Pediatr Obes 6, e129e137.
24. Nawarycz, LO, Krzyzaniak, A, Stawińska-Witoszyńska, B et al. (2010) Percentile distributions of waist circumference for 7–19-year-old Polish children and adolescents. Obes Rev 11, 281288.
25. NICE clinical guideline 155 (2013) Psychosis and schizophrenia in children and young people.
26.The IDF consensus definition of the metabolic syndrome in children and adolescents. International Diabetes Federation 2007.
27. McCarthy, HD & Samani-Radia, D (2013) Development of age- and gender-related waist circumference percentile cut-offs equating to adult cut-offs at age 18 years. Obes Facts 6, Suppl. 1, P143.
28. McCarthy, HD, Cole, TJ, Fry, T et al. (2006) Body fat reference curves for children. Int J Obes Relat Metab Dis 30, 598602.
29. Sung, RY, So, HK, Choi, KC et al. (2009) Body fat measured by bioelectrical impedance in Hong Kong Chinese children. Hong Kong Med J 15, 110117.
30. Kurtoglu, S, Mazicioglu, MM, Ozturk, A et al. (2010) Body fat reference curves for healthy Turkish children and adolescents. Eur J Pediatr 169, 13291335.
31. Samani-Radia, D & McCarthy, HD (2009) Bioelectrical impedance analysis exposes the overfat children classified as normal weight by the Body Mass Index. Proc Nutr Soc 69, E120.
32. Pliakas, T & McCarthy, HD (2010) Relative leg length and total and regional body fatness in children. Ann Hum Biol 37, 1022.
33. Smith, GD, Greenwood, R, Gunnell, D et al. (2001) Leg length, insulin resistance, and coronary heart disease risk: the Caerphilly Study. J Epidemiol Commun Health 55, 867872.
34. Whitley, E, Martin, RM, Davey Smith, G et al. (2012) The association of childhood height, leg length and other measures of skeletal growth with adult cardiovascular disease: the Boyd-Orr cohort. J Epidemiol Commun Health 66, 1823.
35. Pomeroy, E, Stock, JT, Stanojevic, S et al. (2012) Trade-offs in relative limb length among Peruvian children: extending the thrifty phenotype hypothesis to limb proportions. PLoS ONE 7, e51795.
36. Kinra, S, Sarma, KV, Hards, M et al. (2011) Is relative leg length a biomarker of childhood nutrition? Long-term follow-up of the Hyderabad Nutrition Trial. Int J Epidemiol 40, 10221029.
37. Liu, J, Akseer, N, Faught, BE et al. (2012) Use of leg length to height ratio to assess the risk of childhood overweight and obesity: results from a longitudinal cohort study. Ann Epidemiol 22, 120125.
38. Dangour, AD, Schilg, S, Hulse, JA et al. (2002) Sitting height and subischial leg length centile curves for boys and girls from Southeast England. Ann Hum Biol 29, 290305.
39. Freedman, DS, Thornton, JC, Mei, Z et al. (2004) Height and adiposity in children. Obes Res 12, 846852.
40. Metcalf, BS, Hosking, J, Frémeaux, AE et al. (2011) BMI was right all along: taller children really are fatter (implications of making childhood BMI independent of height) EarlyBird 48. Int J Obes Relat Metab Dis 35, 541547.
41. Navti, LK, Samani-Radia, D & McCarthy, HD (2013) Children's body fatness and prevalence of obesity in relation to height for age. Ann Hum Biol; Epublication 25 November 2013.
42. Demerath, EW, Jones, LL, Hawley, NL et al. (2009) Rapid infant weight gain and advanced skeletal maturation in childhood. J Pediatr 155, 355361.
43. Johnson, W, Stovitz, SD, Choh, AC et al. (2011) Patterns of linear growth and skeletal maturation from birth to 18 years of age in overweight young adults. Int J Obes Relat Metab Dis 36, 535541.
44. Stovitz, SD, Pereira, MA, Vazquez, G et al. (2008) The interaction of childhood height and childhood BMI in the prediction of young adult BMI. Obesity 16, 2336–2241.
45. Stovitz, SD, Hannan, PJ, Lytle, LA et al. (2010) Child height and the risk of young adult obesity. Am J Prev Med 38, 7477.
46. Samani-Radia, D & McCarthy, HD (2010) Socioeconomic status and body fatness in children: role of height growth limitation. Int J Obes Relat Metab Dis 35, 128133.
47. Moffat, T, Galloway, T & Latham, J (2005) Stature and adiposity among children in contrasting neighborhoods in the City of Hamilton, Ontario, Canada. Am J Hum Biol 17, 355367.
48. Benson, AC, Torode, ME & Singh, MA (2006) Muscular strength and cardiorespiratory fitness is associated with higher insulin sensitivity in children and adolescents. Int J Pediatr Obes 1, 222231.
49. Steene-Johannessen, J, Anderssen, SA, Kolle, E et al. (2009) Low muscle fitness is associated with metabolic risk in youth. Med Sci Sports Exerc 41, 13611367.
50. Sayer, AA, Syddall, H, Martin, H et al. (2008) The developmental origins of sarcopenia. J Nutr Health Aging 12, 427432.
51. McCarthy, HD, Samani-Radia, D, Jebb, SA et al. (2013) New skeletal muscle mass percentile curves for children and youths aged 5–18 years. Pediatr Obes; Epublication 18 June 2013.
52. Webber, CE & Barr, RD (2012) Age- and gender-dependent values of skeletal muscle mass in healthy children and adolescents. J Cachexia Sarcopenia Muscle 3, 2529.
53. Heitmann, BL & Frederiksen, P (2009) Thigh circumference and risk of heart disease and premature death: prospective cohort study. Br Med J 339, b3292.
54. McCarthy, HD (2011) Thigh circumference percentile curves for the UK child and youth population. Proc Nutr Soc 70, E80.
55. McCarthy, HD, Rigby, RA & Stasinopoulos, DM (2010) Hip circumference percentile curves for the British child and youth population. Proc Nutr Soc 69, E424.
56. Frayn, KN (2010) Adipose tissue and the insulin resistance syndrome. Proc Nutr Soc 60, 375380.
57. Manolopoulos, KN, Karpe, F & Frayn, KN (2010) Gluteofemoral body fat as a determinant of metabolic health. Int J Obes Relat Metab Dis 34, 949959.
58. Kim, TN, Park, MS, Lim, KI et al. (2011) Skeletal muscle mass to visceral fat area ratio is associated with metabolic syndrome and arterial stiffness: the Korean Sarcopenic Obesity Study (KSOS). Diabetes Res Clin Pract 93, 285291.
59. Browning, LM, Hsieh, SD & Ashwell, M (2010) A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value. Nutr Res Rev 23, 247269.
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