International BMI-for-age references underestimate thinness and overestimate overweigth and obesity in Bolivian adolescents

Background: Since no growth standards for adolescents exist and a single reference applicable everywhere is still in debate, it is recognized that the best reference should he derived from the growth pattern of the healthy population that will use it. In 2007 a study developed references for body mass index for 12(th) to 18(th) y Bolivian school adolescent (BAP). Objectives: To compare nutritional status outcomes applying BM I references from the BAP, the Center for Disease Control and Prevention CDC 2000, the International Task Force (IOTE), and the 2007 WHO, to determine appropriateness of use in Bolivian adolescents. Subjects/methods: References were applied in 3306 adolescents, 45.0% male, 55% female, 12(th) to 18(th) y selected from a nationally representative sample. Results: Main findings reveal that the CDC and the 2007 WHO underestimate underweight (p < 0.001) and the three international references overestimate overweight (p<0.001) with variation between ages and gender. Conclusions: Bolivian health providers are advised to replace CDC, OITF and 2007WHO references for the use of BAP in Bolivia which reflects its healthy adolescent population growth pattern. International references may lead to incorrect conclusions when applied on Bolivian adolescents. They could deflect efforts from population which need prompt intervention and mislead treatments and budget to unnecessary ones. We recommend validation of international references where appropriate until a standard is released