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Updated: Feb 18, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
The Use of Different International References to Assess Child Anthropometric Status in a Malaysian Population
Uttara Partap1, Elizabeth H Young1, Pascale Allotey2
1Department of Medicine, University of Cambridge, Cambridge, UK; Wellcome Trust Sanger Institute, Hinxton, United Kingdom.
Insights
Child BMI classification varies significantly between international references, impacting malnutrition prevalence estimates. Public health strategies must consider reference choice for accurate child health assessments.
Area of Science:
- Paediatric Endocrinology
- Public Health Nutrition
- Anthropometry
Background:
- Accurate assessment of child underweight, overweight, and obesity is crucial for public health.
- International Body Mass Index (BMI) references are used for classifying child anthropometric status.
- Discrepancies in classification may arise due to differing reference standards.
Purpose of the Study:
- To evaluate the prevalence of child underweight, overweight, and obesity in Malaysia.
- To compare classifications using three major international BMI references: WHO 2007, IOTF 2012, and CDC 2000.
- To assess the impact of reference selection on anthropometric status conclusions.
Main Methods:
- Analysis of data from 6414 Malaysian children aged 6-18 years.
- Classification of anthropometric status using WHO 2007, IOTF 2012, and CDC 2000 BMI references.
- Agreement assessment using Cohen's kappa statistic and prevalence estimation via mixed effects Poisson regression.
Main Results:
- Poor to moderate agreement was found between references for underweight classification; good agreement for overweight and obesity.
- Prevalence estimates for underweight, overweight, and obesity were inconsistent across the three references.
- The WHO 2007 reference yielded higher overweight/obesity prevalence, while the IOTF 2012 reference showed higher underweight prevalence.
Conclusions:
- The selection of a BMI reference significantly influences the assessment of child anthropometric status.
- Inconsistent prevalence estimates have critical implications for clinical management and public health interventions.
- Standardization or careful consideration of reference criteria is needed for global child health monitoring.
Objective:
To assess the prevalence of child underweight, overweight, and obesity in a Malaysian population according to 3 international references because classification of anthropometric status may differ according to the reference used to express body mass index (BMI).
Study Design:
We assessed data from 6414 children aged 6-18 years, collected by the South East Asia Community Observatory. Child underweight, overweight, and obesity were expressed according to 3 internationally used BMI references: World Health Organization 2007, International Obesity Task Force 2012, and Centers for Disease Control and Prevention 2000. We assessed agreement in classification of anthropometric status among the references using Cohen's kappa statistic and estimated underweight, overweight, and obesity prevalence according to each reference using mixed effects Poisson regression.
Results:
There was poor to moderate agreement between references when classifying underweight, but generally good agreement when classifying overweight and obesity. Underweight, overweight, and obesity prevalence estimates generated using the 3 references were notably inconsistent. Overweight and obesity prevalence estimates were higher using the World Health Organization reference vs the other 2, and underweight prevalence was up to 8.5% higher and obesity prevalence was about 4% lower when using the International Obesity Task Force reference.
Conclusions:
The choice of reference to express BMI may influence conclusions about child anthropometric status and malnutrition prevalence. This has implications regarding strategies for clinical management and public health interventions.
