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British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum
T J Cole1, J V Freeman, M A Preece
1MRC Dunn Nutrition Centre, Cambridge, UK. Tim.Cole@mrc-dunn.cam.ac.uk
Insights
This study updated the British growth reference using anthropometric data from over 37,000 children. The new reference simplifies growth assessment by converting measurements into standard deviation scores (SDS).
Area of Science:
- Pediatrics
- Anthropometry
- Biostatistics
Background:
- Accurate growth references are crucial for monitoring child development.
- Existing British growth references required updating to reflect current population data.
- Standardized anthropometric measurements are essential for clinical and public health assessments.
Purpose of the Study:
- To develop an updated British growth reference for weight, height, body mass index, and head circumference.
- To utilize advanced statistical methods (LMS) for precise centile estimation.
- To provide a tool that simplifies the interpretation of child growth data.
Main Methods:
- Analysis of anthropometric data from 17 surveys across England, Scotland, and Wales (n=37,700 children).
- Application of the LMS method (L, M, S curves) using maximum penalized likelihood estimation.
- Development of a two-stage fitting procedure for age trends and simulation for confidence intervals.
Main Results:
- Generated age- and sex-specific centile curves for key anthropometric measurements.
- The updated reference converts measurements to standard deviation scores (SDS) approximating a normal distribution.
- SDS values demonstrated near-zero mean and median, with standard deviations close to one, simplifying interpretation.
Conclusions:
- The updated British growth reference provides a robust tool for assessing child growth.
- The use of standard deviation scores (SDS) greatly simplifies the interpretation of anthropometric data.
- This updated reference supports improved monitoring of child health and development across the UK.
Abstract:
To update the British growth reference, anthropometric data for weight, height, body mass index (weight/height2) and head circumference from 17 distinct surveys representative of England, Scotland and Wales (37,700 children, age range 23 weeks gestation to 23 years) were analysed by maximum penalized likelihood using the LMS method. This estimates the measurement centiles in terms of three age-sex-specific cubic spline curves: the L curve (Box-Cox power to remove skewness), M curve (median) and S curve (coefficient of variation). A two-stage fitting procedure was developed to model the age trends in median weight and height, and simulation was used to estimate confidence intervals for the fitted centiles. The reference converts measurements to standard deviation scores (SDS) that are very close to Normally distributed - the means, medians and skewness for the four measurements are effectively zero overall, with standard deviations very close to one and only slight evidence of positive kurtosis beyond+/-2 SDS. The ability to express anthropometry as SDS greatly simplifies growth assessment.