Development of tanner stage-age adjusted CDC height curves for research and clinical applications

Background and Objective: Variations in normal pubertal development, pubertal disorders, and race/ethnicity can lead to differences in growth patterns and timing that are not captured by the Centers for Disease Control and Prevention (CDC) height-for-chronological age (CA_Height) charts. Therefore, we sought to develop new Tanner stage-adjusted height-for-age (TSA_Height) charts accounting for these differences. Study Design: Population-based Tanner staging and anthropometric data for 13 358 children age 8 to 18 years from 3 large US national surveys: National Health Examination Surveys (NHES cycle III); the Hispanic Health and Nutrition Examination Surveys (HHANES) and the third National Health and Nutrition Examination Surveys (NHANES III) were analyzed. TSA_Height semi-parametric models with additive age splines were used to develop smoothed TSA_Height curves accounting for maturation stage and calendar age. Results: As expected, the TSA_Height curves did not track along the respective percentile curves for the CDC 2000 CA_Height curves. We generated race/ethnicity-nonspecific and race/ethnicity-specific TSA_Height charts stratified by sex and plotted against the CDC 2000 CA_Height curves to account for the pubertal status differences between these models. An online calculator to adjust height for pubertal status was created. Conclusions: TSA_Height charts provide a much-needed tool to assess and manage linear growth for US children over the course of puberty. These tools may be useful in clinical management of children with pubertal timing variations.