Annals of Human Biology

ISSN: 0301-4460 (Print) 1464-5033 (Online) Journal homepage: http://www.tandfonline.com/loi/iahb20

Weight-for-length/height growth curves for

children and adolescents in China in comparison
with body mass index in prevalence estimates of
malnutrition

Xinnan Zong, Hui Li, Yaqin Zhang & Huahong Wu

To cite this article: Xinnan Zong, Hui Li, Yaqin Zhang & Huahong Wu (2016): Weight-for-
length/height growth curves for children and adolescents in China in comparison with
body mass index in prevalence estimates of malnutrition, Annals of Human Biology, DOI:
10.1080/03014460.2016.1232750

To link to this article: http://dx.doi.org/10.1080/03014460.2016.1232750

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Weight-for-length/height growth curves for children and adolescents

in China in comparison with body mass index in prevalence estimates

of malnutrition

Xinnan Zong, Hui Li, Yaqin Zhang and Huahong Wu

Department of Growth and Development, Capital Institute of Pediatrics,

Beijing, China 100020

Correspondence to: Hui Li, Department of Growth and Development,

Capital Institute of Pediatrics, No.2 Yabao Road, Chaoyang District,

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Beijing, China 100020. Tel: 86-10-85695553. E-mail:

huiligrowth@163.com
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Running head: Weight-for-length/height growth curves in China
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Weight-for-length/height growth curves for children and adolescents

in China in comparison with body mass index in prevalence estimates

of malnutrition

Running head: Weight-for-length/height growth curves in China

ABSTRACT

Background: It is important to update weight-for-length/height growth

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curves in China and reexamine their performance in screening

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malnutrition. Aim: To develop weight-for-length/height growth curves

for Chinese children and adolescents. Subjects and methods: A total of

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94,302 children aged 0-19 years with complete sex, age, weight and
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length/height data were obtained from two cross-sectional large-scaled

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national surveys in China. Weight-for-length/height growth curves were

constructed using the LMS method before and after average

spermarcheal/menarcheal ages, respectively. Screening performance in

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prevalence estimates of wasting, overweight and obesity was compared

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between weight-for-height and body mass index (BMI) criteria based on a

test population of 21,416 children aged 3-18. Results: The smoothed

weight-for-length percentiles and Z-scores growth curves with length

46-110 cm for both sexes and weight-for-height with height 70-180 cm

for boys and 70-170 cm for girls were established. The weight-for-height
and BMI-for-age had strong correlation in screening wasting, overweight

and obesity in each age-sex group. There was no striking difference in

prevalence estimates of wasting, overweight and obesity between two

indicators except for obesity prevalence at ages 6-11. Conclusion: This

set of smoothed weight-for-length/height growth curves may be useful in

assessing nutritional status from infants to post-pubertal adolescents.

KEYWORDS: Weight-for-height, Weight-for-length, Growth curve,

Body mass index, Malnutrition

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INTRODUCTION
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Weight-for-length/height has been commonly used to define wasting
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and overweight in childhood (de Onis et al., 2006; Waterlow et al., 1977;
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WHO Working Group, 1986), which allows physical proportion and

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nutritional status to be assessed when age is not known, and also allows

direct plotting in charts without calculation. In outpatient services and

emergency screening, weight-for-length/height has been considered to be

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an effective and simple indicator to describe current nutritional status of

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older children, but it seems to be more and more marginalised relative to

body mass index (BMI) in recent years (Rousham et al., 2011). The

performance of weight-for-length/height may be necessarily reexamined

and further validated in the aspect of screening malnutrition among

children and adolescents.

 In China, the National Center for Health Statistics (NCHS)/World

Health Organization (WHO) weight-for-height reference (Dibley et al.,

1987; Hamill et al., 1979) and the 1985 Chinese weight-for-height

median reference (Working Group on Physical Health of Chinese

school students, 1987) were widely used in pre-school children and

school-age children, respectively. The 1985 Chinese median reference

was actually the 80th percentile weight on the same height population

created from the 1985 Chinese National Survey on Students Constitution

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and Health, which was just a temporary expedient for low levels of

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physical growth in China at that time. Furthermore, positive secular

trends in weight and height in China over the past decades (Zong & Li,
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2014) also suggest that it is necessary to update the 1985 Chinese

median reference in the 21st century.

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The objectives of this paper are to construct smoothed

weight-for-length/height growth curves for Chinese children and

adolescents from birth to 18 years based on two nationally representative,

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randomly sampled surveys in China and to compare the screening

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performance of weight-for-height with BMI-for-age in prevalence

estimates of wasting, overweight and obesity among children and

adolescents.
SUBJECTS AND METHODS

Data and subjects

Measurement data of length/height and weight of children and

adolescents from 0 to 19 years were obtained from two nationally

representative surveys in China: the 4th National Survey on the Physical

Growth and Development of Children in the Nine Cities in China

(NSPGDC) conducted in 2005 (Li, 2008) and the 5th Chinese National

Survey on Students Constitution and Health (CNSSCH) conducted in

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2005 (Ji, 2007).

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Children from 0 to 6 years: The 4th NSPGDC was performed in the 9

cities of China between May and October 2005. The series of the
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NSPGDC was the largest nationally representative sample of infants and
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pre-school children under 7 years in China. In the 9 cities, Beijing and

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Shanghai are municipalities, and the other seven are provincial capital

cities, including Harbin, Xi'an, Nanjing, Wuhan, Guangzhou, Fuzhou, and

Kunming (Fig. 1). Children under 7 years were divided into 22 age
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groups at an empirical interval: newborn to 3 days, monthly for 1-6

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months, bi-monthly for 6-12 months, tri-monthly for 12-24 months,

half-yearly for 2-6 years and yearly for 6-7 years, and about 150-200

children were recruited for each sex-age specific group in each city. A

total of 69,760 subjects with 34,901 boys and 34,859 girls (Table 1) were

randomly selected by stratified cluster from urban areas of the 9 cities.

Exclusion criteria were temporary residents, history of premature birth,

birth weight less than 2500 g, acute illness within a month, chronic illness,

obviously malnourished, physically handicap.

Children from 6 to 19 years: The 5th CNSSCH was undertaken in the

31 provinces/municipalities between May and July 2005. The series of

the CNSSCH was the largest nationally representative sample of

school-age children and adolescents from 6 to 19 years. Four

subpopulations were stratified by sex and area of residence (urban or

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rural) in each province/municipality. Several primary and secondary

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schools were randomly selected from urban and rural residential areas

according to a list compiled by the local Board of Education. A list of

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students from grades 1-12 was compiled, and a random selection of two
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or three classes (depending on their size) was made from each grade level.
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Each yearly age group of each of the four groups consisted of equal

numbers of individuals for each province/municipality. A total of 24,542

subjects with 12,188 boys and 12,354 girls (Table 1) were naturally
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selected from urban areas of Beijing and Shanghai and the other 7
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provinces which corresponded to the aforementioned 7 provincial capital

cities. The 7 provinces were Heilongjiang (provincial capital, Harbin),

Shaanxi (Xian), Jiangsu (Nanjing), Hubei (Wuhan), Guangdong

(Guangzhou), Fujian (Fuzhou), and Yunnan (Kunming) (Fig. 1).

Data from urban areas of the 4th NSPGDC was merged with data
from urban areas of the corresponding 9 provinces/municipalities of the

5th CNSSCH to smooth the transition at the age of 6 years and the

continuity for the entire 0-19 years. This reference sample used in this

study was the same as that used for constructing a New Growth

References for China (Zong and Li, 2013). Data below -4 or above +5

standard deviations (SD) from the mean for observed

weight-for-length/height were excluded as outliers from final dataset, and

0.47% of the data were excluded for this reason. The NSPGDC and

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CNSSCH protocols had been approved by the Ethics Committees of the

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Capital Institute of Pediatrics and the School of Public Health of the

Peking University respectively.

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Measurements and quality control
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Weight and height of all subjects were measured and recorded by two
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trained anthropometrists (physicians or nurses or technicians) in a

standardised way. Weight was measured to the nearest 0.05kg in the

NSPGDC or 0.1kg in the CNSSCH with a lever scale while subjects wore
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the lightest vest, shorts or underwear. Height was measured to the nearest
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0.1 cm as supine length on an examining table for children under 3 years

and as standing height on the stadiometer with bare feet for those from 3

years onwards. All the field investigators participated in rigorous training

and passed an examination before starting the survey. Unified measuring

tools/instruments were equipped to minimise the influence of

measurement errors for each field site. All the measurements were

undertaken at least one hour after a meal. Measurement errors were not

more than 0.05kg in the NSPGDC or 0.1kg in the CNSSCH for weight

and not more than 0.05cm for length/height among measurement groups

and between two repeated measurements.

Construction of weight-for-length/height growth curves in China

We constructed the smoothed weight-for-length/height centiles curves for

boys and girls using the Coles LMS method (Cole, 1992). To minimise

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the influence of pubertal maturity that reflected nonlinear growth with

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age through adolescence (Cole et al., 2008; Wright et al., 2012), we

separately constructed the LMS models of weight-for-length/height

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between birth and 13 years and between 14 and 19 years for boys and
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followed a similar method for girls between birth and 11 years and
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between 12 and 19 years. In the CNSSCH, the average ages at onset of

spermarche and menarche were 14.02 years and 12.64 years, respectively

(Ji, 2007); thereforewe used the ages of 14 years for boys and 12 years
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for girls as evidence of dividing age of puberty maturity. To fit a single

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model similar to that applied to constructing length/height-for-age curve,

0.7 cm was added to the height values (3-14 years for boys and 3-12

years for girls) to make height continuous with length, and then the

weight-for-length curves were fitted by the single model based on the

merged data of length and height for boys and girls, respectively. After
the models were produced, the weight-for-length percentile (or Z-score)

curves in the length interval 46 to 110 cm were derived directly as the

weight-for-length references for both sexes and the length range of 70.7

to 151.7 cm was shifted back by 0.7 cm to derive the weight-for-height

references corresponding to the height range of 70 to 151 cm for boys,

and similarly the weight-for-height references corresponding to the height

range of 70 to 140 cm for girl were also obtained. After the LMS models

of weight-for-height curves (14-19 years for boys and 12-19 years for

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girls) were established, a smooth transition at about 151cm for boys and

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140 cm for girls was observed, the weight-for-height of 151 to 180 cm for

boys and 140 to 170 cm for girls were extracted empirically for the
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continuity of the curves in the whole height range. Finally, we obtained
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the weight-for-length (46-110 cm) for boys and girls and

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weight-for-height (70-180 cm for boys and 70-170 cm for girls) growth

curves.

Weight-for-length/height growth curves for WHO and CDC2000

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The WHO curves are based on population-based multicentre data

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collected in Brazil, Ghana, India, Norway, Oman, and the United States

between 1997 and 2003, including weight-for-length 45-110 cm and

weight-for-height 65-120 cm for boys and girls (WHO Multicenter

Growth Reference Study Group, 2006). The set of references was

available on the WHO website (www.who.int/childgrowth/en). The

CDC2000 charts are based on national data collected in a series of 5

surveys between 1963 and 1994, including weight-for-length 45-103.5

cm and weight-for-height 77-121.5 cm for both sexes (Kuczmarski et al.,

2002). The set of references was available on the CDC website

(www.cdc.gov/growthcharts).

BMI-for-age reference values in China

The height-based BMI-for-age centile curves (2-18 years) and the

length-based BMI-for-age curves (0-2 years) were constructed separately

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to address the difference between squared length and height in the

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denominator. The sample population used to fit the BMI-for-age curves

was also used to develop weight-for-length/height curves presented in

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this paper, and more details are in the literature (Li et al., 2009).
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Test population
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The test population was collected as part of the Beijing Child and

Adolescent Metabolic Syndrome Study (BCAMSS) in 2004, with 10700

boys and 10716 girls aged 3-18 years (Shan et al., 2010) which was used
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to compare the screening performance of weight-for-height with

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BMI-for-age in prevalence estimates of wasting, overweight and obesity.

We defined wasting for grade 2 and grade 1 as below -2 and -1 SD from

the median for weight-for-height or BMI-for-age, similar to overweight

and obesity as above +1 and +2 SD from the median,

Statistics analysis

LmsChartMaker Pro software 2.3 was used to construct smoothed

weight-for-length/height percentiles and Z-scores growth curves before

and after average spermarcheal/menarcheal ages, respectively. We

compared the differences on the 3rd, 50th and 97th percentiles of

weight-for-length/height curves among this study, WHO and CDC2000.

We assessed the screening performance in prevalence estimates of

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wasting, overweight and obesity between WFH and BMI criteria. Data

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were analysed with SAS version 9.2 (SAS Institute Inc., Cary, NC).
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RESULTS
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Weight-for-length/height growth curves in China

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Table 1 presents sample sizes, median, mean and SD of weight by

sex-height specific groups. Figure 2 depicts smoothed weight-for-length

Z-scores curves between length 46 cm and 110 cm for Chinese children

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and figure 3 exhibits smoothed weight-for-height Z-scores curves

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between height 70 and 180 cm for boys and between height 70 and 170

cm for girls. There is an increasing weight velocity over height according

to the weight-for-height curves after the height of about 100 cm.

Generally the growth pattern was similar for boys and girls, and boys

were heavier than girls at counterpart height, especially at the height

ranges of 120 to 150 cm and 160 to 170 cm.

Comparison of weight-for-length/height among this study, WHO and

CDC2000

Figure 4 shows comparisons of the P3, P50 and P97 of weight-for-length

curves among this study, WHO and CDC2000. Although their growth

patterns are similar, there are still some differences. First, Chinese boys

are slightly heavier than the WHO and the CDC2000 at the length of 60

to 75 cm. Second, Chinese girls are lighter than the CDC2000 at P97

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curve at length >75 cm. Third, Chinese children are somewhat lighter

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than the WHO but heavier than the CDC at the P3 curve at length <50 cm.

Figure 5 displays comparisons of the P3, P50 and P97 of

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weight-for-height curves among the 3 sets of curves. Chinese boys seem
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to be not obviously different from the WHO and CDC2000 at the median
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but lighter than the CDC2000 at the P97 curve at height >100 cm. Chinese

girls are lighter than the WHO and CDC2000 at the median at

height >110 cm, and obviously lighter than the WHO and CDC2000 at
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the P97 curve at height >100 cm.

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Comparison of prevalence estimates of wasting, overweight and obesity

between WFH and BMI

Table 2 indicates the differences of prevalence estimates in screening

wasting, overweight and obesity derived from weight-for-height and

BMI-for-age criteria. The two indicators have strong correlation in

screening wasting, overweight and obesity at each age group for each sex,

presenting overall correlation coefficients of 0.89 for boys and 0.86 for

girls. In general, there was no striking difference in prevalence estimates

of wasting and overweight between these two indicators. The obesity

prevalence based on weight-for-height was lower than that based on

BMI-for-age at ages 6-11, but no obvious difference was observed at

other age groups.

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DISCUSSION

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The report for worldwide implementation of the WHO Child Growth

Standards showed over 70% of the surveyed countries adopted

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weight-for-length/height, and the figure was only 29% for BMI-for-age
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(de Onis et al., 2012). So, at present, a set of reliable

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weight-for-length/height curves is still very useful for the assessment of

physical proportion and the surveillance of malnutrition in pediatric

outpatients and public health. Although weight-for-height growth curves

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for adolescent children have not been constructed or released by many

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countries or organisations in recent years, some countries still insist on

establishing their own weight-for-height references for older children

with the height of over 145 cm (Nagahara et al., 2011; Saari et al., 2011).

We established weight-for-length/height growth curves using a nationally

representative sample of children and adolescents who were born and

raised in optimal or near-optimal circumstances in China. In the

methodology we used the international LMS method to smooth

weight-for-length/height curves. In addition, in consideration of nonlinear

growth with age during puberty (Cole et al., 2012; Mumm et al., 2014),

the growth curves were established separately before and after average

spermarcheal/menarcheal ages for each sex to reduce the impact of

pubertal maturity on the shape of the curve.

Some differences were observed between this study, WHO and

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CDC2000, and these generally occurred at the outer (upper and lower)

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percentiles and were more evident in the older ages. We inferred that

these differences may attribute to the disparity of racial/ethnic groups.

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Further, larger differences may appear in adolescence among racial/ethnic
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groups due to various ages of onset of maturity of individuals. The

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differences of weight-for-height among various racial/ethnic groups

implied international or non-native weight-for-height references should

be used with caution in clinical evaluation of individuals and

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population-based studies, especially for older children.

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Considering the variable timing of pubertal growth spurt,

weight-for-age may not be a satisfactory indicator of tissue and body

fatness because a child who is heavy for age may also be tall for age.

Weight-for-height was more likely to reflect body mass loss or gain and

lowered the influence of the timing of pubertal development. Mei and

colleagues (2002) reported the performance of weight-for-height was

similar to that of BMI-for-age in screening underweight and overweight

in children between 2 and 19 years. It proves that weight-for-height is

still useful for older children and post-pubertal adolescents, only with its

complicated interpretation for body composition at this age. The

weight-for-height references for older children and adolescents are still

used in some countries (Deurenberg-Yap et al., 2009; Jlusson et al.,

2007; Rerksuppaphol & Rerksuppaphol, 2013; Sun et al., 2014). Our

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results also exhibited significant statistical correlation in prevalence

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estimates of wasting, overweight and obesity between WFH and BMI

criteria. However, in recent years there seems to have been an ascendancy

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of BMI criteria in the screening of malnutrition as BMI has been
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recommended as a consistent measure across age groups in children,

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adolescents and adults. From the perspective of outpatient services for

pediatricians, a clinically useful assessment not only reflects excess body

fat but should also be very simple to use. For this reason, the
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weight-for-height may be easily adopted by directly plotting in charts

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without calculation. Therefore, instead of arbitrarily abandoning it, more

attention should be paid to practical application in preliminary screening

of clinic outpatients and field investigations and the association of

weight-for-height with other indicators.

Our study presents a set of smoothed weight-for-length/height

growth curves which may be useful to continuously evaluate the

performance of growth and nutrition in infants through to post-pubertal

adolescents. We also observed similar screening performance of

weight-for-height and BMI-for-age in prevalence estimates of wasting,

overweight and obesity, suggesting weight-for-height is still a valuable

indicator for the assessment of physical proportion and the surveillance of

malnutrition, especially for pediatric outpatients and emergency screening.

Future studies should focus on the construction of weight-for-height

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growth curves conditioned on the developmental stage of puberty and the

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efficiency of assessing body size and malnutrition in clinical services and

public health.
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DISCLOSURE STATEMENT
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The authors declared no conflict of interest.

ACKNOWLEDGMENTS
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We thank all staffs participating in the NSPGDC and the CNSSCH in

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2005 for their carefully measuring and collecting data in the fields. We

thank Prof. Chengye Ji (Institute of Child and Adolescent Health, School

of Public Health, Peking University) for allowing us access to the 9

provinces/municipalities data of the 5th CNSSCH and for providing

insight comments for constructing the China growth reference values. We

thank Prof. Jie Mi (Department of Epidemiology, Capital Institute of

Pediatrics) for providing the test population for comparing prevalence

estimates of malnutrition between WFH and BMI criteria.

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TABLE 1. Observed weight-for-length/height (kg) for Chinese boys and girls, 0 to 19
years, presented as sample sizes, median, mean and SD
Length/height Boys Girls
(cm) N Median Mean SD N Median Mean SD
44- 8 2.6 2.6 0.2 17 2.7 2.8 0.3
46- 108 2.9 2.9 0.3 193 2.8 2.9 0.3
48- 417 3.1 3.1 0.3 547 3.1 3.1 0.3
50- 768 3.4 3.4 0.3 690 3.4 3.4 0.4
52- 370 3.9 3.9 0.5 413 4.1 4.1 0.5
54- 450 4.7 4.7 0.5 647 4.6 4.6 0.4
56- 710 5.2 5.2 0.5 816 5.1 5.1 0.5
58- 825 5.8 5.8 0.6 981 5.6 5.7 0.5
60- 1091 6.4 6.4 0.6 1148 6.3 6.3 0.6
62- 1241 7.0 7.0 0.7 1486 6.8 6.8 0.6
64- 1346 7.5 7.5 0.7 1501 7.3 7.3 0.6

D
66- 1485 8.0 8.0 0.7 1446 7.8 7.8 0.7
68- 1334 8.5 8.5 0.7 1230 8.2 8.2 0.7
70-
72-
74-
1277
1215
1167
8.9
9.3
9.7
9.0
9.4
9.7
0.8
0.8
0.8
TE
1178
1145
1066
8.6
9.0
9.4
8.7
9.1
9.5
0.7
0.8
0.8
EP
76- 1037 10.1 10.1 0.9 1014 9.8 9.8 0.8
78- 1049 10.5 10.6 0.9 1000 10.1 10.2 0.8
80- 1180 10.9 11.0 0.9 1141 10.5 10.6 0.9
82- 1074 11.3 11.4 0.9 1022 11.0 11.0 0.9
C

84- 998 11.8 11.8 0.9 990 11.4 11.4 0.9

86- 888 12.2 12.3 1.0 841 11.8 11.8 1.0
AC

88- 780 12.7 12.7 1.0 775 12.2 12.3 1.0

90- 845 13.0 13.1 1.1 791 12.8 12.8 1.0
92- 795 13.6 13.7 1.1 755 13.3 13.4 1.1
94- 855 14.0 14.0 1.0 878 13.9 13.9 1.1
ST

96- 835 14.6 14.6 1.1 850 14.4 14.4 1.2

98- 901 15.1 15.2 1.2 955 15.1 15.1 1.2
100- 883 15.7 15.8 1.2 921 15.5 15.6 1.3
JU

102- 932 16.3 16.4 1.3 853 16.1 16.2 1.4

104- 920 16.9 17.1 1.4 894 16.6 16.8 1.4
106- 855 17.6 17.7 1.5 899 17.4 17.4 1.5
108- 904 18.1 18.2 1.5 932 17.9 18.0 1.5
110- 937 18.8 19.0 1.6 960 18.5 18.6 1.7
112- 915 19.5 19.7 2.3 889 19.2 19.3 1.7
114- 901 20.2 20.5 1.9 888 19.9 20.0 1.9
116- 869 21.0 21.3 2.1 839 20.6 20.8 2.1
118- 788 21.9 22.1 2.2 778 21.1 21.4 2.2
120- 701 22.6 22.9 2.4 713 22.2 22.3 2.2
 122- 596 23.7 24.1 3.0 498 23.0 23.4 2.5
124- 503 24.4 25.0 3.0 451 23.9 24.2 2.6
126- 422 25.4 26.2 3.5 412 24.6 25.0 2.9
128- 361 26.3 26.9 3.6 344 25.3 25.8 2.9
130- 350 27.6 28.6 4.4 329 26.5 27.0 3.6
132- 344 29.5 30.2 4.4 300 27.6 28.2 3.6
134- 327 30.5 31.2 4.4 302 28.2 28.8 3.8
136- 314 31.7 32.5 5.1 309 29.8 30.6 4.4
138- 351 32.8 34.1 5.9 280 31.2 32.3 5.0
140- 325 34.2 35.2 5.4 287 32.4 33.0 4.8
142- 320 35.8 36.9 6.2 264 33.5 34.8 5.6
144- 310 37.6 38.5 6.4 289 35.3 36.7 6.1
146- 302 39.2 40.4 7.0 344 38.6 39.0 6.2
148- 276 40.0 41.0 6.3 403 39.6 41.0 6.2
150- 272 42.9 43.8 7.4 601 43.4 43.7 6.4
152- 272 43.8 44.9 7.7 841 45.2 45.6 7.0

D
154- 245 45.0 46.8 8.3 1092 46.5 47.3 6.7
156- 238 47.0 48.4 8.0 1333 48.0 48.6 6.5
158-
160-
162-
292
376
523
49.1
51.8
52.5
50.5
52.9
54.0
8.8
8.7
8.6
TE
1436
1511
1223
49.3
50.8
51.8
50.4
51.7
52.8
7.0
6.8
7.1
EP
164- 676 55.2 56.1 8.5 968 53.4 54.5 7.4
166- 887 56.9 58.2 8.9 654 54.8 55.8 7.3
168- 1086 58.0 59.3 9.0 392 56.0 57.5 8.1
170- 1151 59.1 61.1 9.3 217 57.7 58.5 8.2
C

172- 1138 61.3 62.9 9.8 109 60.0 61.2 8.4

174- 988 62.2 64.4 10.0 39 59.8 63.0 11.9
AC

176- 775 65.0 66.7 10.4 - - - -

178- 562 66.0 67.6 9.9 - - - -
180- 362 67.0 68.9 10.8 - - - -
182- 235 69.3 72.3 12.5 - - - -
ST

184-186 119 71.3 72.9 11.2 - - - -

N, number. SD, standard deviation. -, no data available. Data from the length range
JU

(below 3 years of age) was merged directly with data from the height range (from 3
years onwards). The number of subjects was 116 for boys height > 186 cm and 45 for
girls height > 176 cm.
TABLE 2. Comparisons of prevalence estimates (%) of wasting, overweight and

obesity based on weight-for-height and BMI

Age Wasting 2 Wasting 1 Overweight Obesity

Sampl
(years CC BM WF
e BMI WFH BMI WFH BMI WFH
) I H
Boys
0.9 15.6 18.17 5.75*
3-5 644 1.09 0.93 4.50 3.88* 6.68
2 8 * *
0.8 1.54 15.1 14.02 15.7 16.76 12.2 5.72*
6-11 4737 1.88
8 * 6 * 7 * 0 *
0.8 1.49 12.9 16.2 5.70*
12-18 5319 1.20 13.44 16.96 8.48
9 * 2 2 *
10700 0.8 13.4 15.9 16.94 10.0 5.71*
3-18 1.50 1.48 13.12
9 0 9 * 2 *

D
Girls
0.9 7.30* 16.9 7.45*
3-5 644 0.62 0.62 9.16 16.15 6.06

6-11 4467
4
0.8
8
2.17 2.01
12.5
6
*
13.63
*
TE 3
15.9
2
14.86
*
10.1
0
*
5.91*
*
EP
0.8 1.62 11.2 10.10 15.8 17.32 8.24*
12-18 5605 1.89 6.58
5 * 2 * 3 * *
10716 0.8 1.73 11.6 15.9
3-18 1.93 11.40 16.23 8.02 7.22*
6 * 6 3
C

BMI, body mass index. WFH, weight-for-height. CC, correlation coefficient between
AC

BMI and WFH. The test data was collected as part of the the BCAMSS in 2004, with
21,416 children and adolescents from 3 to 18 years. The definitions of wasting 2,
wasting 1, overweight and obesity were based on the cut-off points of -2, -1, +1 and
+2 Z-scores for the WFH and BMI, respectively. Wasting 1 not including wasting 2,
ST

and overweight not including obesity. T-test for significance between WFH and BMI,
*p<0.05, **p<0.01.
JU
 D
TE
Fig. 1. Geographical distribution of the 9 cities (Shaded their corresponding provinces)
EP
in China.
C
AC
ST
JU
JU
ST
AC
C
EP
TE
D
 D
TE
EP

Fig. 2. Smoothed weight-for-length Z-score curves for Chinese boys and girls
C

between length 46 and 110 cm.

AC
ST
JU
JU
ST
AC
C
EP
TE
D
 D
TE
EP

Fig. 3. Smoothed weight-for-height Z-score curves for Chinese boys and girls
C

between height 70 and 180 cm.

AC
ST
JU
JU
ST
AC
C
EP
TE
D
 D
TE
EP

Fig. 4. Comparisons of P3, P50 and P97 of weight-for-length curves among this study,
C

WHO and CDC2000.

AC
ST
JU
JU
ST
AC
C
EP
TE
D
 D
TE
EP

Fig. 5. Comparisons of P3, P50 and P97 of weight-for-height curves among this study,
C

WHO and CDC2000.

AC
ST
JU