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

Background: Since no growth standards for adoles- cents exist and a single reference applicable everywhere is still in debate, it is recognized that the best reference should be derived from the growth pattern of the healthy population that will use it. In 2007 a study developed ref- erences for body mass index for 12th to 18th y Bolivian school adolescent (BAP).
Objectives: To compare nutritional status outcomes applying BMI references from the BAP , the Center for Disease Control and Prevention CDC 2000, the Interna- tional Task Force (IOTF), and the 2007 WHO, to deter- mine appropriateness of use in Bolivian adolescents.
Subjects/methods: References were applied in 3306 adolescents, 45.0% male, 55% female, 12th to 18th 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 valida- tion of international references where appropriate until a standard is released.