Body Mass Index Percentile Values Research Articles

Body Mass Index Growth Curves for Birth to 24 Months Children in Ankara with RefCurv Software

It is important to monitor the development of infants and children during their growth period. Various anthropometric parameters of children are measured at regular intervals after birth, and their general health and nutrition and physiological needs are assessed based on these measurements. To construct the current body mass index (BMI) percentiles and compare them with the literature reports and World health organisation (WHO) data. Cross-sectional design. This study is a cross-sectional research on 1,345 boys and 1,364 girls of age ranging from 0 to 24 months; their BMIs were measured at the Başkent University Hospital from January 2018-December 2021. The BMI growth curves for either gender were constructed according to the LMS method by using RefCurv 0.4.2. software. The "gamlss" package was employed for the selection of model parameters in fitting the BMI growth curves, and the model performance was evaluated with reference to the generalized Akaike information criterion (GAIC). According to gender, smoothed BMI growth curves were constructed in the 3rd-97th percentiles. The model adequacy of the fitted growth curves was evaluated with the worm plot. The fit of the BMI model to the data was found to be sufficient, with 95% of the BMI values occurring between two elliptic curves. We examined the current BMI percentiles and growth curves of children aged 0-2 years living in Ankara and noted a slight increase in the BMI percentile values obtained by gender when compared to the WHO standards.

Nutritional Status of Younger Primary School Children in Urban and Rural Areas of Montenegro in Relation to Sex and Age During COVID-19 Pandemic: A National Study

Prevention and correction of overweight in children and adolescents is also very important for many reasons. According to previous research, the problem tends to vary according to sex, and different ages and the lifestyle in rural and urban areas has changed drastically in recent years and decades. Regarding the above-mentioned, the main goal of this research was to determine the nutritional status of young school children in urban and rural areas of Montenegro in relation to sex and age. The sample in this research has consisted of children aged 6 and 9 (younger school age). The total sample in this research is 800 male and female children who belong to the urban and rural areas of Montenegro. The sample of variables used in this study was: body mass index-percentile values (BMI), and waist circumference and body height ratio (WHtR) which were used as indicators to assess nutritional status. Based on obtained results it could be generally concluded that there are no statistically significant differences in nutritional status between primary school children from urban and rural areas of Montenegro, which is the opposite of what was expected based on previous research, but also which is very important since all subjects in the future can be treated as homogeneous groups when it comes to the impact of environment and lifestyle on the nutrition status of younger school children. On the other hand, it is important to emphasize that the main limitation of this research is that measurements were carried out in the middle of the COVID-19 pandemic, and the recommendation could be that after the end of the pandemic, special "COVID teams" should be formed, which would consist of experts from various fields of physical culture, sports, and medicine, all with the aim of influencing possible problems with nutritional status and physical activity of young school children caused by a pandemic.

Differences in sleep quality and body mass index in asthmatic children and healthy control group.

Childhood asthma has become a serious public health problem. Obesity has been determined to be one of the risk factors of asthma. We aimed to determine the difference in body mass index (BMI) and sleep quality in pediatric asthmatic individuals compared to their peers. Thirty children aged 8-17 years were followed up in the Pediatric Outpatient Clinic for asthma along with 30 healthy children. The BMI percentile values of the children were recorded. The Pittsburgh Sleep Quality Index was used to assess sleep quality. Each group in our study had 10 girls and 20 boys. The mean age was found to be 11.76 ± 2.69 years in asthma group and 11.33 ± 2.29 years in the healthy group. The asthma group were found to be more obese than the healthy group (P = 0.033). There was a significant difference between groups interested in a sport (P = 0.028) and sleep quality (P = 0.007). It was observed that the asthma group had more obesity and poorer sleep quality than the healthy group. Further, it was determined that in the asthma group, the level of interest in any sport was less than that in the healthy group. We think that high obesity in the asthma group reduces the effect of corticosteroids, and the continuity of nighttime cough symptoms causes deterioration in sleep quality. We conclude that participation in sports activities should be encouraged to reduce the level of obesity in asthmatic children.

Negative Association in Reported Dietary Energy Intake and Physique in Japanese Schoolchildren.

Appropriate dietary assessment and health education are necessary for children to achieve a healthy physique. To explore the relationship between habitual reported dietary energy intake (EI) and physique in elementary schoolchildren by sex and age, we conducted a longitudinal study, in the fiscal year 2011, that included all elementary schools in Omihachiman City, Shiga Prefecture, Japan. The study lasted for four consecutive years, ending in fiscal year 2014, and included 545 7-y-old schoolchildren in the target city. The subjects completed a brief self-administered diet history questionnaire with their guardians. The results of the study demonstrated a negative relationship between energy intake and the estimated energy requirement ratio and body mass index percentile values for both 7-, 9-, and 10-y-old boys and 7- to 10-y-old girls. These results suggest that there is a need to keep in consideration the under-reporting of obese children and over-reporting of lean children for dietary energy evaluation.

Serum omentin-1 levels in obese children.

Background Obesity is an important cause of morbidity, and it has an increasing frequency in childhood. Studies have reported that 33% of adults and 20-27% of children and adolescents are obese. Recently, it has been shown that the prevalence of obesity in the childhood group is higher than the past years. Omentin-1 is an adipokine which is synthesized from the visceral fat tissue but not synthesized in the subcutaneous fat tissue. Omentin-1 has been shown to increase insulin-mediated glucose uptake, especially in the adipose tissue. Studies have shown that plasma omentin-1 levels, which play an important role in the pathogenesis of insulin resistance, are significantly lowered in obese, polycystic ovary syndrome (PCOS) and diabetic patients. The aim of this study was to investigate the relationship between obesity and omentin-1 levels in children. Methods The study included obese children with a body mass index (BMI) greater than the 95th percentile and healthy children with a BMI lower than the 85th percentile. Obese and healthy individuals had similar age and sex distributions. Glucose, insulin, lipid profiles, thyroid panels and metabolic markers were evaluated. Results The levels of omentin-1 in obese children were significantly lower than in the control group (p<0.05). Results of Spearman's correlation analysis for all participants showed that omentin-1 levels were negatively related with triglycerides, total cholesterol, serum free thyroxine (FT4), insulin, homeostatic model assessment of insulin resistance (HOMA-IR), body weight, waist circumference (WC) and BMI percentile values. Conclusions Our findings indicate that serum omentin-1 levels are lower in obese children than in non-obese individuals. Omentin-1 can be used as a metabolic biomarker in children and adolescents.

The 2017 Korean National Growth Charts for children and adolescents: development, improvement, and prospects.

Growth charts are curves or tables that facilitate the visualization of anthropometric parameters, and are widely used as an important indicator when evaluating the growth status of children and adolescents. The latest version of the Korean National Growth Charts released in 2007 has raised concerns regarding the inclusion of data from both breastfed and formula-fed infants, higher body mass index (BMI) values in boys, and smaller 3rd percentile values in height-for-age charts. Thus, new growth charts have been developed to improve the previous version. The 2006 World Health Organization Child Growth Standards, regarded as the standard for breastfed infants and children, were introduced for children aged 0–35 months. For children and adolescents aged 3–18 years, these new growth charts include height-for-age, weight-for-age, BMI-for-age, weight-for-height, and head circumference-for-age charts, and were developed using data obtained in 1997 and 2005. Data sets and exclusion criteria were applied differently for the development of the different growth charts. BMI-for-age charts were adjusted to decrease the 95th percentile values of BMI. Criteria for obesity were simplified and defined as a BMI of ≥95th percentile for age and sex. The 3rd percentile values for height-for-age charts were also increased. Additional percentile lines (1st and 99th) and growth charts with standard deviation lines were introduced. 2017 Korean National Growth Charts are recommended for the evaluation of body size and growth of Korean children and adolescents for use in clinics and the public health sector in Korea.

Trends in the distribution of body mass index and waist circumference among South Korean adults, 1998-2014.

An increase in mean body mass index (BMI) or prevalence of obesity may be accompanied by changes in the population BMI distribution. This study aimed to examine how the distributions of BMI and waist circumference (WC) have changed in South Korea over a 16-year interval (1998-2014). Using the Korea National Health and Nutrition Examination Survey, we analyzed changes in mean, standard deviation (SD), 5th, and 95th percentile values of BMI and WC distributions for 46,343 (BMI) and 46,327 (WC) adults aged 25-64 years. For men, mean BMI increased at an annual rate of 0.060 units (95% CI: 0.047-0.073) with annual increases of 0.029 units in SD (95% CI: 0.019-0.039), 0.121 units in the 95th percentile (95% CI: 0.097-0.145) and 0.042 units in the 5th percentile (95% CI: 0.021-0.062). The 95th percentile and SD of the WC distribution increased, but not mean WC and the 5th percentile. For women, mean BMI decreased at an annual rate of 0.030 units (95% CI: 0.010-0.049) with a 0.030-unit increase in SD (95% CI: 0.012-0.048) and a 0.049-unit decrease in the 5th percentile (95% CI: 0.029-0.070). Mean WC also decreased with an increase in SD and a decrease in the 5th percentile. These findings suggest increasing dispersion in the distribution of BMI and WC derived from significant shifts in the upper tails for Korean men, but not women. Future research needs to identify the factors that underlie the increasing dispersion of obesity measures.

Relationships between physical activity, food choices, gender and BMI in Southern Californian teenagers.

Given the increased prevalence of pediatric obesity and risk of developing chronic disease, there has been great interest in preventing these conditions during childhood by focusing on healthy lifestyle habits, including nutritious eating and physical activity (PA). The purpose of this study was to determine the relationship between PA, body mass index (BMI) and food choices in adolescent males and females. This cross-sectional study, using a survey questionnaire, evaluated 1212 Southern Californian adolescents' self-reported PA, BMI and food frequency. Results revealed that even though males are more active than females, they have higher BMI percentile values (p < 0.05). Females consumed salad, vegetables and fruit more frequently than males (p < 0.05), where males consumed hamburgers, pizza, red meat, processed meat, eggs, fish, fruit juice, soda and whole milk more frequently than females (p < 0.05). Overweight/obese teens consumed red meat, processed meat and cheese more frequently than healthy weight teens (p < 0.05), yet there was no difference in PA between healthy and overweight/obese teens. These results demonstrate that higher levels of PA may not counteract an unhealthy diet. Even though PA provides numerous metabolic and health benefits, this study suggests that healthy food choices may have a protective effect against overweight and obesity. Healthy food choices, along with PA, should be advocated to improve adolescent health by encouraging maintenance of a healthy weight into adulthood.

A szérumkoleszterin-szint és a verbális memória kapcsolatának vizsgálata a testtömegindex tükrében

The objective of this study was to examine the relationship between verbal memory and total cholesterol (TC) levels related to body mass index (BMI) in healthy young women. Verbal memory was assessed using the Rey Auditory-Verbal Learning Test (RAVLT) while total serum cholesterol was measured by enzymatic colorimetric test. In order to analyze the potential significance of BMI subjects were divided into three groups according to their calculated BMI percentile values. No significant correlation was found when assessing the group as a whole. However a remarkable pattern of correlation emerged when assessing the BMI groups separately: a close-to-significant positive correlation was found for total learning score and TC in the low BMI group, no correlation emerged in the medium BMI group while a strong inverse correlation was found in the high BMI group. These findings indicate that the relationship between verbal memory and serum TC level is also influenced by BMI.

Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method

OBJECTIVE: To describe the percentile values for body mass index (BMI), waist circumference (WC) and waist-to-height (WHtR) of children from Colombo, Brazil, and compare them with data of children from other countries.METHODS: This was a cross-sectional study with a random sample of 2,035 children aged 6-11 years. Age- and sex-specific smoothed percentiles curves for BMI, WC and WHtR were created using the LMS method. Values of 10th, 50th and 90th percentiles from Brazilian children were compared with data from other countries.RESULTS: There was a trend of increasing BMI and WC with age in both sexes. WHtR remained constant with advancing age in boys and girls. Comparison of the growth pattern among countries showed clear differences. Southern Brazil boys and girls had elevated 90th percentile values for BMI, which was similar to German children and higher than the North American and World Health Organization percentile values. However, children from this study had intermediate values for WC and WHtR in comparison to children from other countries.CONCLUSIONS: Elevated BMI values were observed among southern Brazilian children, but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries. Interventions at different levels should be made to avoid a probable increase of nutritional disorders (especially general obesity) in the next years.

Índices antropométricos em escolares de um município no Sul do Brasil: análise descritiva utilizando o método LMS

ObjectiveTo describe the percentile values for body mass index (BMI), waist circumference (WC) and waist‐to‐height (WHtR) of children from Colombo, Brazil, and compare them with data of children from other countries. MethodsThis was a cross‐sectional study with a random sample of 2,035 children aged 6‐11 years. Age‐and sex‐specific smoothed percentiles curves for BMI, WC and WHtR were created using the LMS method. Values of 10th, 50th and 90th percentiles from Brazilian children were compared with data from other countries. ResultsThere was a trend of increasing BMI and WC with age in both sexes. WHtR remained constant with advancing age in boys and girls. Comparison of the growth pattern among countries showed clear differences. Southern Brazil boys and girls had elevated 90th percentile values for BMI, which was similar to German children and higher than the North American and World Health Organization percentile values. However, children from this study had intermediate values for WC and WHtR in comparison to children from other countries. ConclusionsElevated BMI values were observed among southern Brazilian children, but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries. Interventions at different levels should be made to avoid a probable increase of nutritional disorders (especially general obesity) in the next years.

Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method

ObjectiveTo describe the percentile values for body mass index (BMI), waist circumference (WC) and waist-to-height (WHtR) of children from Colombo, Brazil, and compare them with data of children from other countries. MethodsThis was a cross-sectional study with a random sample of 2,035 children aged 6–11 years. Age- and sex-specific smoothed percentiles curves for BMI, WC and WHtR were created using the LMS method. Values of 10th, 50th and 90th percentiles from Brazilian children were compared with data from other countries. ResultsThere was a trend of increasing BMI and WC with age in both sexes. WHtR remained constant with advancing age in boys and girls. Comparison of the growth pattern among countries showed clear differences. Southern Brazil boys and girls had elevated 90th percentile values for BMI, which was similar to German children and higher than the North American and World Health Organization percentile values. However, children from this study had intermediate values for WC and WHtR in comparison to children from other countries. ConclusionsElevated BMI values were observed among southern Brazilian children, but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries. Interventions at different levels should be made to avoid a probable increase of nutritional disorders (especially general obesity) in the next years.

Abstract 36: Adult Hypertension Risk is More than Quadrupled in Obese Children

There is a known association between adiposity and hypertension (HTN). However, whether and to what extent body mass index (BMI) predicts adult HTN has not been well examined longitudinally. In this study, we attempt to quantify the effects of childhood overweight and obesity on adult HTN in a prospective cohort. The original cohort was established in 1986, and consisted of 1117 healthy children (47% male), recruited from schools in Indianapolis, Indiana (mean age 12.1; SD 5.7 years). During the course of follow-up, blood pressure, height, and weight were measured semiannually with a mean of 8.4 visits per child (SD 7.2). BMI was calculated from recorded height and weight; weight status was determined by age and sex-adjusted BMI percentile values (BMI%). Subjects were classified as normal weight, overweight (BMI% ≥ 85% and &lt; 95%), or obese (BMI% ≥ 95%) based on either their mean BMI % or maximum BMI % during childhood. Evaluation based on mean childhood BMI % revealed that 765 (68%) were normal weight, 176 (16%) were overweight, and 176 (16%) were obese. The mean age of the subjects as of 2013 was 33.4 years (SD 3.9). From the cohort, we identified 119 adult cases of HTN through active follow up and medical chart review. In those with normal weight as children, 6% were hypertensive as adults. The rate of HTN was higher for those classified as overweight or obese as children (14% and 26% respectively, p = &lt;0.0001). Children classified as overweight or obese had double and quadruple the risk to have a diagnosis of HTN in adulthood, respectively, as compared to normal weight children [OR = 2.2 (95% CI = 1.3, 3.6), OR = 4.4 (95% CI = 2.8, 6.9) respectively]. Additional measures of adiposity were similarly associated with HTN in adulthood including waist circumference and tricep skinfold. This pattern was also seen when analyzed by maximum BMI%. However, the increased risk of HTN in adulthood for children classified as overweight or obese was not as great [OR = 1.3 (95% CI = 0.7, 2.3), OR = 3.7 = (2.4, 5.7) respectively]. In conclusion, the degree of adiposity in childhood significantly impacts the risk for HTN in adulthood. Childhood obesity is associated with a quadrupled risk of adult HTN. This has significant implications for early prevention of childhood obesity and public health.

The Tetrad BMI, Leptin, Leptin/Adiponectin (L/A) Ratio and CA 15‐3 are Reliable Biomarkers of Breast Cancer

Several studies have reported that leptin levels, the leptin/adiponectin (L/A) ratio and carbohydrate antigen (CA) 15-3 are especially elevated in breast cancer patients with high body mass index (BMI). The purpose of this study was to evaluate BMI, leptin, L/A ratio and CA 15-3 all together as reliable biomarkers for breast cancer. Serum levels of leptin, adiponectin and CA 15-3, as well as anthropometric and biochemical parameters were analysed in 88 female patients who participated in a mammography study. Predictive values of BMI, leptin, L/A ratio and CA 15-3 were determined with a 95% confidence interval. Women were diagnosed with either breast cancer (n = 40) or benign breast lesions (n = 48). Among anthropometric parameters, age (P ≤ 0.001), weight (P ≤ 0.05) and waist circumference (P ≤ 0.02) were higher in patients with breast cancer than in patients without this pathology. The 75th percentile values for BMI, leptin, L/A ratio and CA 15-3 were 29.24 kg/m(2), 26.65 ng/ml, 2.37 and 18.45 IU, respectively. The suggested odds ratio for breast cancer patients with the values that were above the 75th percentile of the tetrad was 6.7 (0.7505-60.0665 confidence interval). When the four variables were analysed together, a sensitivity of 83.3%, specificity of 80%, positive predictive value of 83.3% and negative predictive value of 80% were obtained. Results indicate that using the 75th percentile set points for BMI, leptin, L/A ratio and CA 15-3 together could offer a reliable approach to determine which women are at high risk for developing breast cancer.

BMI percentile curves for Japanese men and women aged 20–79 years who underwent a health check-up in 1980 and 2005

To establish body mass index (BMI) percentile curves for adults and to compare these in 1980 with those in 2005 among Japanese men and women. Participants included 8080 community residents aged 20-79 years who had a health check-up in 1980 and 5616 community residents aged 20-79 years who had a health check-up in 2005. Sex-specific percentile curves for BMI were constructed using the LMS method. We presented the 3rd, 5th, 15th, 25th, 50th, 75th, 85th, 95th, and 97th percentile curves. From 1980 to 2005, the BMI percentile values of men increased, especially the 95th and 97th percentile values in men aged 20-39 years. The BMI distribution of young men in 2005 was wider than that in 1980. From 1980 to 2005, the 50th percentile values of women in 2005 were lower than those in 1980. However, the 95th percentile values of women increased among women aged less than 50 years. We were able to confirm the existence of BMI percentile values depending on date, age, and sex by establishing BMI percentile curves.

Nutritional status of children with an intellectual disability

The aim of this study was to determine the nutritional status of economically disadvantaged 7- to 18-year-old children with mild or moderate intellectual disability in Turkey. The research was conducted in Izmir. Children with mild or moderate intellectual disability with poor socioeconomic status and their families who applied to the Counseling Research Center between May 15, 2010 and June 15, 2010 constituted the sample. The sample consisted of 70 families. The data were collected by filling out questionnaires through face-to-face interviews, and height and weight measurements were also taken. Body mass index (BMI) was calculated. BMI percentile values were determined according to the curves used for Turkish children. Of the children, 70% (n=49) had normal weight, 5.7% (n=4) were underweight, 17.1% (n=12) were overweight, and 7.1% (n=5) were obese. Of the children, 61.4% consumed milk and milk products, 2.9% meat products, 34.3% eggs, 58.6% dry legumes, 61.4% vegetables, 62.9% fruits, 98.6% bread and cereal food group, 100% oil, and 11.4% oil seeds every day. A total of 42.9% (n=30) of the mothers stated that they use foods as a reward. In this study, we found that children did not consume enough animal protein sources, such as meat, fish, and chicken. Multifaceted studies should be undertaken to prevent obesity in children with intellectual disabilities. Planning social aids to the nutrition of economically disadvantaged children may be beneficial for the health of those children.

Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults

Background:Body mass index (BMI), waist circumference (WC), and the waist-stature ratio (WSR) are considered to be possible proxies for adiposity.Objective: The objective was to investigate the relations between BMI, WC, WSR, and percentage body fat (measured by dual-energy X-ray absorptiometry) in adults in a large nationally representative US population sample from the National Health and Nutrition Examination Survey (NHANES).Design: BMI, WC, and WSR were compared with percentage body fat in a sample of 12,901 adults.Results: WC, WSR, and BMI were significantly more correlated with each other than with percentage body fat (P < 0.0001 for all sex-age groups). Percentage body fat tended to be significantly more correlated with WC than with BMI in men but significantly more correlated with BMI than with WC in women (P < 0.0001 except in the oldest age group). WSR tended to be slightly more correlated with percentage body fat than was WC. Percentile values of BMI, WC, and WSR are shown that correspond to percentiles of percentage body fat increments of 5 percentage points. More than 90% of the sample could be categorized to within one category of percentage body fat by each measure.Conclusions: BMI, WC, and WSR perform similarly as indicators of body fatness and are more closely related to each other than with percentage body fat. These variables may be an inaccurate measure of percentage body fat for an individual, but they correspond fairly well overall with percentage body fat within sex-age groups and distinguish categories of percentage body fat.

Height‐specific body mass index reference curves for Japanese children and adolescents 5−17 years of age

Body mass index (BMI) reference values in consideration of height variation have not previously been reported. This study established height-specific BMI reference curves for Japanese children and adolescents aged from 5 to 17 years. The 2001 nationwide survey data were utilized for the study. First, the range of variation in BMI corresponding to height (mean +/- 2SD) at each age was compared with the range of variation in BMI corresponding to age (from minimum to maximum) at every cm height. Second, various age groups were combined, and percentile values of BMI (3rd, 5th, 15th, 50th, 85th, 95th, and 97th) were calculated for every cm height, regardless of age, and height-specific BMI reference values (males 100-179 cm, females 100-169 cm) were prepared. Variation in BMI due to variation in height at each age was significantly (P <0.05) greater than variation in BMI due to age at every cm height [males, 12.7 +/- 0.4 vs 9.2 +/- 0.4; females, 11.7 +/- 0.8 vs 8.8 +/- 0.3 (mean +/- SE)]. Although the use of standard values established in consideration of age and height is desirable for BMI-based guidelines for determining childhood overweight and obesity, to simplify the procedure for practical use, it is necessary to establish standard values by height, not by age. Height-specific BMI reference curves are useful for BMI-based evaluation of childhood overweight and obesity in the school health service and follow-up of obese children until adulthood.

Body mass index percentiles among adolescent girls living in Edirne, Turkey.

Body mass index (BMI) is the simplest way to measure obesity; therefore, it is chosen by many authorities as a screening method for adolescent obesity. Body mass index is positively correlated with the complications of childhood and adolescent obesity, such as hypercholesterolemia, insulin resistance, hyper-tension and long-term development of cardiovascular diseases. The aim of the present study was to produce percentile curves for bodyweight, height and BMI in a representative sample of adolescent girls living in urban and rural areas of Edirne, Turkey, and to compare these percentile curves with curves from other countries. The present study was a cross-sectional study, including a representative sample of 1687 adolescent girls from rural and urban areas of Edirne, who were evaluated between May and July 2001. Bodyweight and height were measured using standard procedures. Body mass index (kg/m2) was calculated as the ratio of bodyweight to body height squared. Smoothed percentiles for these variables were calculated using polynominal regression models. Crude weight, height and BMI percentile values, as well as smoothed percentile curves are presented. Body mass index, weight and height reference curves for adolescent girls were produced. When we compared the BMI values of subjects in the present study with those of other countries, 85th and 95th percentiles of BMI in the present study were found to be generally lower than those for other ethnicities. Our findings show ethnic differences in BMI among adolescent girls. It will be usefull for each country to produce its own BMI percentiles.

Approaching healthy body mass index norms for children and adolescents from health-related physical fitness.

Current body mass index (BMI) norms for children and adolescents are developed from a reference population that includes obese and slim subjects. The validity of these norms is influenced by the observed secular increase in body weight and BMI. We hypothesized that the performance of children in health-related physical fitness tests would be negatively related to increased BMIs, and therefore fitness tests might be used as criteria for developing a more appropriate set of BMI norms. We evaluated the existing data from a nation-wide fitness survey for students in Taiwan (444 652 boys and 433 555 girls) to examine the relationship between BMI and fitness tests. The fitness tests used included: an 800/1600-m run/walk; a standing long jump; bent-leg curl-ups; and a sit-and-reach test. The BMI percentiles developed from the subgroup whose test scores were better than the 'poor' quartile in all four tests were compared with those of the whole population and linked to the adult criteria for overweight and obesity. The BMIs were significantly related to the results of fitness testing. A total of 43% of students had scores better than the poorest quartile in all of their tests. The upper BMI percentile curves of this fitter subgroup were lower than those of the total population. The 85th and 95th BMI percentile values of the fitter 18-year-old-students (23.7 and 25.5 kg m(-2) for boys; 22.6 and 24.6 kg m(-2) for girls) linked well with the adult cut-off points of 23 and 25 kg m(-2), which have been recommended as the Asian criteria for adult overweight and obesity. Hence, the BMI norms for children and adolescents could be created from selected subgroups that have better physical fitness. We expect that the new norms based on this approach will be used not only to assess the current status of obesity or overweight, but also to encourage activity and exercise.