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Background: Several concerns have been raised by World Health Organization (WHO) expert groups regarding the adequacy of currently existing growth references, including those currently supported by WHO. As part of a concerted action of the European Union, new references were developed that were based on a well-defined sample of the European population and were compared with existing references.

Methods: During the longitudinal, observational multicenter study, anthropometric measurements using standardized methodology were performed in 2245 children between 1 and 36 months of age, and sex-and age-specific growth references for recumbent length, weight, mid-upper arm, thigh, and calf circumferences were developed.

Results: The validity of the curve-fitting programs was demonstrated by comparing the selected sex-specific percentile distributions for all indices with the smoothed references. Comparison with the National Center for Health Statistics (NCHS)-WHO references for length and weight for age indicated that the -2 z-score value of the WHO reference as cutoff value shows that a substantial part of the children with suspected failure to thrive should be classified as normal. The references also indicate that the mid-upper arm circumference is age and sex dependent and that a single cutoff value for children less than 5 years of age should no longer be used. Mid-parental height was the best single predictor of recumbent length until 36 months of age.

Conclusions: The Euro-Growth references that were developed reflect growth of a well-defined, large cohort of healthy infants and can be used for international comparisons.

(C) 2000 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,