Population differences in the relationship between height, weight, and adiposity: an application of Burton's model

The study of human variation in adiposity and lean mass is important for understanding core processes in human evolution, and is increasingly a public health concern as the "obesity epidemic" expands globally. The dominant measure of population differences in adiposity is Body Mass Index (BMI), which suffers from systematic biases across populations due to variation in the relationship between true body fat, height and weight. Here we develop simplified corrections for such anthropometric-based measures of adiposity that can take into account this population variation. These corrections derive from a recent model proposed by Burton that assumes humans accrue mass in two ways-growth in height that adds bone and muscle, and growth in body fat and the ancillary fat-free mass (FFM) needed to support this additional body fat. We analyze two ethnically diverse datasets with dual X-ray absorptiometry-measured (DXA) fat mass, assessing the fit of Burton's model and deriving novel corrections based on estimated musculoskeletal slenderness. The resulting model provides excellent fit to fat mass within populations (average R2 = 0.92 for women and R2 = 0.83 for men). World populations differ dramatically in musculoskeletal slenderness (up to a difference of 4.4 kg/m2), as do men and women (differences of 3.3-4.5 kg/m2), leading to clear population corrections. These findings point to a conceptually straightforward tool for estimating true differences in adiposity across populations, and suggest an alternative to BMI that provides a more accurate and theoretically based estimate of body fat than that traditionally derived from height and weight measures.