Related Experiment Video
Updated: May 15, 2026

Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
BMI may underestimate the socioeconomic gradient in true obesity
G van den Berg1, M van Eijsden, T G M Vrijkotte
1Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands. g.vandenberg@vumc.nl
Background:
Body mass index (BMI) does not make a distinction between fat mass and lean mass. In children, high fat mass appears to be associated with low maternal education, as well as low lean mass because maternal education is associated with physical activity. Therefore, BMI might underestimate true obesity in children of low-educated mothers.
Objective:
To investigate the associations of maternal education with fat mass index (FMI), lean mass index (LMI) and BMI.
Methods:
In total, 1965 Dutch children from a prospective cohort, aged 5.7 years (standard deviation 0.5), had available data on body composition based on bioelectrical impedance analysis.
Results:
Maternal education was not associated with BMI after adjustment for confounders. In contrast, children of low-educated mothers had a higher FMI (β 0.28 95% confidence interval [CI] 0.07; 0.49) and a lower LMI (β -0.18 95% CI -0.33; -0.03) compared with children of high-educated mothers.
Conclusions:
This suggests that BMI underestimates the educational gradient of childhood obesity.
Related Concept Videos
Obesity
Drug Dosing: Obese Patients
Pharmacokinetics in Obese Patients: Drug Absorption and Distribution
Bias in Epidemiological Studies
Regression Toward the Mean
Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion
