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Fig. 7 | BMC Pediatrics

Fig. 7

From: Novel type of references for weight aligned for onset of puberty – using the QEPS growth model

Fig. 7

A guide for prospective use of the pubertal-age-adjusted reference for total weight (kg and kg0.5) and height (cm) for girls () and boys (♂). Individual age adjustment is made only from the height measurement at the chronological age (C-age) at which puberty started (see upper left traditional C-age-reference for girls and boys) [14], by using the height increase from the individual prepubertal growth curve (as drawn in upper left panel) through the individual measuring points. This occurs when secondary sex characteristics develop; early breast development stage, B2 in girls (red, upper left panel), or testicular volume increase to 4–6 ml in boys (blue, upper left panel). Height and weight according to C-age and P-age, ie the age adjusted to reflect the start of puberty are shown for an 8-year-old girl and a 13-year-old boy [14]. Height (cm) and weight (in kg or kg0.5) according to C-age at the onset of puberty, and to P-age, after adjustment for age at onset of the pubertal growth spurt are depicted as red dots (all panels), based only on age in the height references for each sex respectively. Corresponding heights and weights are then moved to puberty-adjusted age = zero, in the P-age-references shown in the lower panels (left panels for height and right for weight). Thereafter, all measured heights and weights are depicted at ages/times recalculated in relation to the specific onset of puberty in that individual, labelled on the x-axis as ‘Time from onset of growth spurt (years)’. Thus, changes in weight and height in the years preceding the pubertal growth spurt can be evaluated using the novel reference. Note, the weight increase precedes the height increase in relation to puberty

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