Body mass index as a measure of adiposity among children and adolescents: A validation study

Objectives: To test the hypothesis that in a healthy pediatric population body mass index (BMI) (kilograms per meter square) is a valid measure of fatness that is independent of age for both sexes, Methods: Total body fat (TBF) (in kilograms) and percent of body weight as fat (PBF) were estimated by dual energy x-ray absorptiometry (DXA) in 198 healthy Italian children and adolescents between 5 and 19 years of age. We developed multiple regression analysis models with TBF and percent body fat as dependent variables and BMI, age, and interaction terms as independent variables. Separate analyses were conducted for boys and girls. Results: BMI was strongly associated with TBF (R-2 = 0.85 and 0.89 for boys and girls, respectively) and PBF (R-2 = 0.63 and 0.69 for boys and girls, respectively). Confidence limits an BMI-fatness association were wide, with individuals of similar BMI showing large differences in TBF and in PBF. Age was a significant covariate in all regression models. Addition of nonlinear terms for BMI did not substantially increase the R-2 for TBF and PBF models in Lays and girls. Conclusion: Our results support the use of BMI as a fatness measure in groups of children and adolescents, although interpretation should be cautious when comparing BMI across groups that differ in age or when predicting a specific individual's TBF or PBF.