TY - JOUR
T1 - A Longitudinal Comparison of Alternatives to Body Mass Index Z-Scores for Children with Very High Body Mass Indexes
AU - Freedman, David S.
AU - Davies, Amy J.Goodwin
AU - Kompaniyets, Lyudmyla
AU - Lange, Samantha J.
AU - Goodman, Alyson B.
AU - Phan, Thao Ly Tam
AU - Cole, F. Sessions
AU - Dempsey, Amanda
AU - Pajor, Nathan
AU - Eneli, Ihuoma
AU - Christakis, Dimitri A.
AU - Forrest, Christopher B.
N1 - Funding Information:
Funded in part by a grant (1306-01556) from the Patient-Centered Outcomes Research Institute (PCORI). This report's findings and conclusions are those of the authors and do not represent the Centers for Disease Control and Prevention's official position. The research reported in this report was conducted using PEDSnet, A Pediatric Learning Health System, and includes data from the following PEDSnet institutions: Children's Hospital of Philadelphia; Cincinnati Children's Hospital Medical Center; Children's Hospital of Colorado; Nationwide Children's Hospital; Nemours Children's Health System (a Delaware and Florida health system); Seattle Children's Hospital; and St. Louis Children's Hospital/Washington University School of Medicine. The authors declare no conflicts of interest.
Funding Information:
Funded in part by a grant (1306-01556) from the Patient-Centered Outcomes Research Institute (PCORI). This report's findings and conclusions are those of the authors and do not represent the Centers for Disease Control and Prevention's official position. The research reported in this report was conducted using PEDSnet, A Pediatric Learning Health System, and includes data from the following PEDSnet institutions: Children's Hospital of Philadelphia; Cincinnati Children's Hospital Medical Center; Children's Hospital of Colorado; Nationwide Children's Hospital; Nemours Children's Health System (a Delaware and Florida health system); Seattle Children's Hospital; and St. Louis Children's Hospital/Washington University School of Medicine. The authors declare no conflicts of interest.
Publisher Copyright:
© 2021
PY - 2021/8
Y1 - 2021/8
N2 - Objective: The current Centers for Disease Control and Prevention (CDC) body mass index (BMI) z-scores are inaccurate for BMIs of ≥97th percentile. We, therefore, considered 5 alternatives that can be used across the entire BMI distribution: modified BMI-for-age z-score (BMIz), BMI expressed as a percentage of the 95th percentile (%CDC95th percentile), extended BMIz, BMI expressed as a percentage of the median (%median), and %median adjusted for the dispersion of BMIs. Study design: We illustrate the behavior of the metrics among children of different ages and BMIs. We then compared the longitudinal tracking of the BMI metrics in electronic health record data from 1.17 million children in PEDSnet using the intraclass correlation coefficient to determine if 1 metric was superior. Results: Our examples show that using CDC BMIz for high BMIs can result in nonsensical results. All alternative metrics showed higher tracking than CDC BMIz among children with obesity. Of the alternatives, modified BMIz performed poorly among children with severe obesity, and %median performed poorly among children who did not have obesity at their first visit. The highest intraclass correlation coefficients were generally seen for extended BMIz, adjusted %median, and %CDC95th percentile. Conclusions: Based on the examples of differences in the BMI metrics, the longitudinal tracking results and current familiarity BMI z-scores and percentiles. Both extended BMIz and extended BMI percentiles may be suitable replacements for the current z-scores and percentiles. These metrics are identical to those in the CDC growth charts for BMIs of <95th percentile and are superior for very high BMIs. Researchers' familiarity with the current CDC z-scores and clinicians with the CDC percentiles may ease the transition to the extended BMI scale.
AB - Objective: The current Centers for Disease Control and Prevention (CDC) body mass index (BMI) z-scores are inaccurate for BMIs of ≥97th percentile. We, therefore, considered 5 alternatives that can be used across the entire BMI distribution: modified BMI-for-age z-score (BMIz), BMI expressed as a percentage of the 95th percentile (%CDC95th percentile), extended BMIz, BMI expressed as a percentage of the median (%median), and %median adjusted for the dispersion of BMIs. Study design: We illustrate the behavior of the metrics among children of different ages and BMIs. We then compared the longitudinal tracking of the BMI metrics in electronic health record data from 1.17 million children in PEDSnet using the intraclass correlation coefficient to determine if 1 metric was superior. Results: Our examples show that using CDC BMIz for high BMIs can result in nonsensical results. All alternative metrics showed higher tracking than CDC BMIz among children with obesity. Of the alternatives, modified BMIz performed poorly among children with severe obesity, and %median performed poorly among children who did not have obesity at their first visit. The highest intraclass correlation coefficients were generally seen for extended BMIz, adjusted %median, and %CDC95th percentile. Conclusions: Based on the examples of differences in the BMI metrics, the longitudinal tracking results and current familiarity BMI z-scores and percentiles. Both extended BMIz and extended BMI percentiles may be suitable replacements for the current z-scores and percentiles. These metrics are identical to those in the CDC growth charts for BMIs of <95th percentile and are superior for very high BMIs. Researchers' familiarity with the current CDC z-scores and clinicians with the CDC percentiles may ease the transition to the extended BMI scale.
KW - BMI
KW - PEDSnet
KW - children
KW - metrics
KW - obesity
UR - http://www.scopus.com/inward/record.url?scp=85103698994&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2021.02.072
DO - 10.1016/j.jpeds.2021.02.072
M3 - Article
C2 - 33676932
AN - SCOPUS:85103698994
SN - 0022-3476
VL - 235
SP - 156
EP - 162
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -