Importance of Growth for Health and Development

65th Nestlé Nutrition Institute Workshop, Pediatric Program, Kuala Lumpur, March 2009

Editor(s): Lucas A. (London) 
Makrides M. (Adelaide, S.A.) 
Ziegler E.E. (Iowa City, Iowa) 
Table of Contents
Vol. 65, No. , 2010
Section title: Physical Growth and Body Composition

The 2000 Centers for Disease Control and Prevention Growth Charts: Several Insights after 8 Years

Ogden C.L. · Wei R. · Curtin L.R. · Flegal K.M.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


This paper explores three issues related to the 2000 Centers for Disease Control and Prevention growth charts. First, it clarifies the methods that were used to create the charts as it has become apparent that the smoothing techniques have been somewhat misunderstood. The techniques included smoothing-selected percentiles between and including the 3rd and 97th percentiles and then approximating these smoothed curves using a procedure to provide the transformation parameters, lambda, mu, and sigma. Only the selected percentiles were used in this process due to small sample sizes beyond these percentiles. Second, given the concern that the infant charts were created with relatively few data points in the first few months of life, it compares the original observed percentiles with percentiles that include newly available US national data for the first few months of life. Third, it discusses the issues that arise if a 99th percentile is extrapolated based on the lambda, mu, and sigma parameters. The 99th percentile of the body mass index-for-age chart has been recommended to identify extremely obese children, yet the 97th percentile is the highest available percentile on the Centers for Disease Control and Prevention growth charts.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al: CDC growth charts United States. Adv Data 2000;8:1-27
  2. Grummer-Strawn LM, Ogden CL, Mei Z, et al: Scientific and practical issues in the development of the US childhood growth reference. (eds) Martorell R, Haschke F: Nutrition and Growth Nestle Nutrition Workshop Series, Basel, Karger, 2001;
  3. Hamill PV, Drizd TA, Johnson CL, et al: Physical growth National Center for Health Statistics percentiles. Am J Clin Nutr 1979;32:607-629
  4. Hamill PV, Drizd TA, Johnson CL, et al: NCHS growth curves for children birth-18 years. United States. Vital Health Stat 11 1977;165:1-74
  5. Dibley MJ, Staehling N, Nieburg P, Trowbridge FL: Interpretation of Z-score anthropometric indicators derived from the international growth reference. Am J Clin Nutr 1987;46:749-762
  6. Dibley MJ, Goldsby JB, Staehling NW, Trowbridge FL: Development of normalized curves for the international growth reference historical and technical considerations. Am J Clin Nutr 1987;46:736-748
  7. Ogden CL, Kuczmarski RJ, Flegal KM, et al: Centers for Disease Control and Prevention 2000 growth charts for the United States improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002;109:45-60
  8. Victora CG, Morris SS, Barros FC, et al: The NCHS reference and the growth of breast- and bottle-fed infants. J Nutr 1998;128:1134-1138
  9. de Onis M, Garza C, Habicht JP: Time for a new growth reference. Pediatrics 1997;100:E8
  10. National Center for Health Statistics Plan and operation of the Third National Health and Nutrition Examination Survey: 1988-94; (eds) Hyattsville MD: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1994 (Vital and health statistics; series 1, No 32); DHHS publication No (PHS) 94-1308
  11. Roche AF: Executive Summary of the NCHS Growth Chart Workshop. 1992;http://www.cdc/gov/nchs/data/misc/growork.pdf
  12. Roche AF: Executive Summary of Workshop to Consider Low Birthweight in Relation to the Revision of the NCHS Growth Charts for Infancy (Birth-3 Years). 1994;
  13. Roche AF: Executive Summary of Workshop to Consider Secular Trends and Possible Pooling of Data in Relation to the Revision of the NCHS Growth Charts. 1995; nchs/data/misc/poolwork.pdf.
  15. Kuczmarski RJ, Ogden CL, Guo SS, et al: 2000 CDC Growth Charts for the United States methods and development. Vital Health Stat 11 2002;246:1-190
  16. Cole TJ: The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990;44:45-60
  17. Cole TJ, Green PJ: Smoothing reference centile curves the LMS method and penalized likelihood. Stat Med 1992;11:1305-1319
  20. Martin JA, Hamilton BE, Sutton PD, et al: Births final data for 2005. Natl Vital Stat Rep 2007;56:1-103
  21. Guo SS, Roche AF, Chumlea WC, et al: Statistical effects of varying sample sizes on the precision of percentile estimates. Am J Hum Biol 2000;12:64-74
  22. Barlow SE: Expert Committee Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity summary report. Pediatrics 2007;120:(suppl 4)S164-S192
  23. Krebs NF, Himes JH, Jacobson D, et al: Assessment of child and adolescent overweight and obesity. Pediatrics 2007;120:(4)S193-S228
  24. Freedman DS, Mei Z, Srinivasan SR, et al: Cardiovascular risk factors and excess adiposity among overweight children and adolescents the Bogalusa Heart Study. J Pediatr 2007;150:12-17.e2
  25. World Health Organization WHO Child Growth Standards Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age Methods and Development: Geneva, World Health Organization, 2006;
  26. Rigby RA, Stasinopoulos DM: Using the Box-Cox t distribution in GAMLSS to model skewness and kurtosis. Stat Modelling 2006;6:209-229

Pay-per-View Options
Direct payment This item at the regular price: USD 33.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 23.00