References for growth and pubertal development from birth to 21 years in Flanders, Belgium

Due to the secular trend in length and height, growth references need to be updated regularly. Reference charts that were until recently used in Belgium are based on samples collected more than 30 years ago, and references for body mass index (BMI) and pubertal development have not been established before.

To establish contemporary cross-sectional reference charts for height, weight, BMI, head circumference, and pubertal development from birth to 21 years of age, based on a representative sample of children from Flanders, Belgium.

15 989 healthy subjects of Belgian origin, 0-25 years of age, were measured in 2002-2004. Growth curves were fitted with the LMS method, and percentiles for the pubertal development were estimated with generalized additive models on status quo data from 8690 subjects aged 6-22 years of age.

A positive secular trend in height and weight is observed in children above 5 years of age. Adult median height has increased by 1.2 cm/decade in boys and 0.8 cm/decade in girls; median weight by 0.9 kg/decade in boys, and 1.0 kg/decade in girls, and the weight distribution became more skewed. The BMI curve is comparable to that of other populations, except for higher percentiles. This reflects the increasing prevalence of overweight and obesity. Median age at menarche (13.0 years) has not advanced any more over the past 50 years. Median ages at menarche and B2 in girls and G2 or T4 in boys are comparable to other West European estimates, but approximately 10% enter G2/T4 before 9 years of age.

The ongoing secular trend in height and weight makes growth charts previously used in Belgium obsolete. New representative charts for growth and pubertal development are introduced. For weight monitoring, it is advised that the now-available BMI growth charts are used.