Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children.
Body mass index (BMI) (weight per height2) is the most widely used marker of childhood obesity and total body fatness (BF). However, its validity is limited, especially in children of South Asian and Black African origins. We aimed to quantify BMI adjustments needed for UK children of Black African and South Asian origins so that adjusted BMI related to BF in the same way as for White European children.



We used data from four recent UK studies that made deuterium dilution BF measurements in UK children of White European, South Asian and Black African origins. A height-standardized fat mass index (FMI) was derived to represent BF. Linear regression models were then fitted, separately for boys and girls, to quantify ethnic differences in BMI-FMI relationships and to provide ethnic-specific BMI adjustments.



We restricted analyses to 4-12 year olds, to whom a single consistent FMI (fat mass per height5) could be applied. BMI consistently underestimated BF in South Asians, requiring positive BMI adjustments of +1.12 kg m-2(95% confidence interval (CI): 0.83, 1.41 kg m-2; P<0.0001) for boys and +1.07 kg m-2(95% CI: 0.74, 1.39 kg m-2; P<0.0001) for girls of all age groups and FMI levels. BMI overestimated BF in Black Africans, requiring negative BMI adjustments for Black African children. However, these were complex because there were statistically significant interactions between Black African ethnicity and FMI (P=0.004 boys; P=0.003 girls) and also between FMI and age group (P<0.0001 for boys and girls). BMI adjustments therefore varied by age group and FMI level (and indirectly BMI); the largest adjustments were in younger children with higher unadjusted BMI and the smallest in older children with lower unadjusted BMI.



BMI underestimated BF in South Asians and overestimated BF in Black Africans. Ethnic-specific adjustments, increasing BMI in South Asians and reducing BMI in Black Africans, can improve the accuracy of BF assessment in these children.
Population Health Research Institute, St George's, University of London, London, UK.
M T
MT
Hudda
Population Health Research Institute, St George's, University of London, London, UK.
C M
CM
Nightingale
Population Health Research Institute, St George's, University of London, London, UK.
A S
AS
Donin
Childhood Nutrition Research Centre, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK.
M S
MS
Fewtrell
College of Sustainability Sciences and Humanities, Department of Natural Science and Public Health, Zayed University, Dubai, UAE.
D
D
Haroun
Respiratory, Critical Care and Anaesthesia section of III Programme (Portex Unit), UCL Great Ormond Street Institute of Child Health, London, UK.
S
S
Lum
Childhood Nutrition Research Centre, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK.
J E
JE
Williams
Population Health Research Institute, St George's, University of London, London, UK.
C G
CG
Owen
Population Health Research Institute, St George's, University of London, London, UK.
A R
AR
Rudnicka
Childhood Nutrition Research Centre, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK.
J C K
JCK
Wells
Population Health Research Institute, St George's, University of London, London, UK.
D G
DG
Cook
Population Health Research Institute, St George's, University of London, London, UK.
P H
PH
Whincup
D000273:Adipose Tissue; D050154:Adiposity / Q000208:ethnology*; D044466:Asian People; D044383:Black People; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000175:diagnosis / Q000517:prevention & control*; D012015:Reference Standards; D015203:Reproducibility of Results; D006113:United Kingdom