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BMI-for-Age and Weight-for-Length in Children 0 to 2 Years
Kayla R Furlong1, Laura N Anderson2, Huiying Kang3
1Child Health and Evaluative Sciences, Research Institute, and.
Insights
Body Mass Index-for-age (BIA) shows strong agreement with weight-for-length in infants and toddlers. This growth indicator is reliable from birth, even with routine data collection.
Area of Science:
- Pediatrics
- Growth Monitoring
- Nutritional Assessment
Background:
- Accurate growth assessment in children under two is crucial for early identification of potential health issues.
- Weight-for-length has been a standard measure, but Body Mass Index-for-age (BMI-for-age) is increasingly considered for a broader age range.
- Understanding the agreement between these measures is vital for consistent clinical practice.
Purpose of the Study:
- To evaluate the concordance between weight-for-length and BMI-for-age in children aged 0 to <2 years.
- To identify factors influencing the agreement between these growth metrics.
- To compare the agreement using research-collected versus routinely collected data.
Main Methods:
- A cross-sectional study analyzed data from 1632 healthy, term-born children aged 0 to <2 years.
- Measurements of length and weight were collected during both research and routine clinical visits.
- BMI-for-age z-scores were compared against weight-for-length z-scores using correlation and Bland-Altman analysis.
Main Results:
- A strong correlation (r = 0.986) and good agreement were found between weight-for-length and BMI-for-age.
- A low misclassification rate (6.3%) was observed, primarily near percentile cutoffs.
- Agreement remained high and consistent between research-collected and routinely collected data.
Conclusions:
- BMI-for-age demonstrates high agreement with weight-for-length and low misclassification in young children.
- BMI-for-age is a potentially suitable growth indicator from birth through early childhood.
- Further research is warranted to explore the association of BMI-for-age in this age group with long-term health outcomes.
Objectives:
To determine the agreement between weight-for-length and BMI-for-age in children 0 to <2 years by using research-collected data, examine factors that may affect agreement, and determine if agreement differs between research- and routinely collected data.
Methods:
Cross-sectional data on healthy, term-born children (n = 1632) aged 0 to <2 years attending the TARGet Kids! practice-based research network in Toronto, Canada (December 2008-October 2014) were collected. Multiple visits for each child were included. Length (cm) and weight (kg) measurements were obtained by trained research assistants during research visits, and by nonresearch staff during all other visits. BMI-for-age z-scores were compared with weight-for-length z-scores (the criterion measure).
Results:
The correlation between weight-for-length and BMI-for-age was strong (r = 0.986, P < .0001) and Bland-Altman plots revealed good agreement (difference = -0.08, SD = 0.20, P = .91). A small proportion (6.3%) of observations were misclassified and most misclassifications occurred near the percentile cutoffs. There were no differences by age and sex. Agreement was similar between research- and routinely collected data (r = 0.99, P < .001; mean difference -0.84, SD = 0.20, P = .67).
Conclusions:
Weight-for-length and BMI-for-age demonstrated high agreement with low misclassification. BMI-for-age may be an appropriate indicator of growth in the first 2 years of life and has the potential to be used from birth to adulthood. Additional investigation is needed to determine if BMI-for-age in children <2 years is associated with future health outcomes.
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