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Cited by 49Obesity, Physical Activity, DietBody Composition Measurement TechniquesCancer Risks and Factors

Distance and percentage distance from median BMI as alternatives to BMI z score

Open access
Freedman, David S., Woo, Jessica G., Ogden, Cynthia L., Xu, Ji H., Cole, Tim J.·2020·British Journal of Nutrition
DOI 10.1017/s0007114519002046PMC PMC7035962
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Abstract

BMI z (BMIz) score based on the Centers for Disease Control and Prevention growth charts is widely used, but it is inaccurate above the 97th percentile. We explored the performance of alternative metrics based on the absolute distance or % distance of a child’s BMI from the median BMI for sex and age. We used longitudinal data from 5628 children who were first examined <12 years to compare the tracking of three BMI metrics: distance from median, % distance from median and % distance from median on a log scale. We also explored the effects of adjusting these metrics for age differences in the distribution of BMI. The intraclass correlation coefficient (ICC) was used to compare tracking of the metrics. Metrics based on % distance (whether on the original or log scale) yielded higher ICCs compared with distance from median. The ICCs of the age-adjusted metrics were higher than that of the unadjusted metrics, particularly among children who were (1) overweight or had obesity, (2) younger and (3) followed for >3 years. The ICCs of the age-adjusted metrics were also higher compared with that of BMIz among children who were overweight or obese. Unlike BMIz, these alternative metrics do not have an upper limit and can be used for assessing BMI in all children, even those with very high BMIs. The age-adjusted % from median (on a log or linear scale) works well for all ages, while unadjusted % from median is better limited to older children or short follow-up periods.

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  • BMI is relatively simple to measure in adults and functionally sums a variety of complex body indicators.

    “BMI is relatively simple to measure in adults [4,5,6,7,8,9] and functionally sums a variety of complex body indicators.”

    From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [9]

    In Subjects and Methods > BMI Metrics (page unavailable), the paper describes calculating BMI from measured height and weight, supporting the point that it is relatively simple to obtain. The study sample comprises children aged 2–17, however, so it does not establish the claim specifically for adults. The citation is attached to the measurement clause, not the subsequent claim about body indicators. (LLM, conf=0.82)

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Cited by

Sorted by citations

Authors
Freedman, D. S., Woo, J. G., Ogden, C. L., Xu, J. H., & Cole, T. J.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • Louisiana State University Health Sciences Center New Orleans (US)
  • University College London (GB)
Corresponding author
Freedman, David S.
ORCID
Venue
British Journal of Nutrition
Publisher
Cambridge University Press (CUP)
Published
2019-08-23
Volume
124
Issue
5
Pages
493-500
ISSN
  • 0007-1145 (ISSN-L)
  • 1475-2662
DOI
10.1017/s0007114519002046
PMC
PMC7035962
OpenAlex
W2969212872
Cited by
49
References
2
Citations by year
2026: 4 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 11 · 2021: 10 · 2020: 8
FWCI
6.68
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • British Journal Of Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Louisiana State University
  • National Institutes of Health (CC999999)
  • Centers for Disease Control and Prevention
  • Medical Research Council (MR/R010692/1)
  • National Institute on Aging (R01AG016592)
  • National Heart, Lung, and Blood Institute (R01HL121230, HL 38 844, AG-16592)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
BMI z-score, childhood obesity, overweight children, CDC growth charts
MeSH terms
Adolescent, Anthropometry, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Reference Values, United States, Body Mass Index, Young Adult

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