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Br J Nutr. 2019 Aug 23:1-25. doi: 10.1017/S0007114519002046. [Epub ahead of print]

Distance and Percent Distance from Median BMI as Alternatives to BMI z-score.

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Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, GA.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.
Division of Cardiology, LSU Health New Orleans Medical Center, New Orleans, LA.
Population, Policy and Practice Programe, UCL Great Ormond Street Institute of Child Health, London, UK.


Body mass index z-score (BMIz) based on the CDC growth charts is widely used, but it is inaccurate above the 97th percentile. We explored the performance of alternative metrics based on the absolute distance or % distance of a child's BMI from the median BMI for sex and age.We used longitudinal data from 5628 children who were first examined < 12 y to compare the tracking of three BMI metrics: distance from median, % distance from median, and % distance from median on a log scale. We also explored the effects of adjusting these metrics for age differences in the distribution of BMI. The intra-class correlation coefficient (ICC) was used to compare tracking of the metrics.


%BMIp95 BMI expressed as a percentage of the 95th percentile; BMI; BMI body mass index; BMIz BMI-for-age z-score; CDC Centers for Disease Control and Prevention; L power transformation for normality; M median; S coefficient of variation; children; metrics; obesity


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