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Updated: Aug 6, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Body mass index percentiles versus body composition assessments: Challenges for disease risk classifications in
Jody L Clasey1,2, Elizabeth A Easley1,3, Margaret O Murphy2
1Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, United States.
Insights
Accurate identification of at-risk children is crucial. This study found that body composition measures, alongside Body Mass Index percentile (BMI%), improve the detection of children needing intervention, especially for girls.
Area of Science:
- Pediatric health and nutrition
- Body composition analysis
- Childhood obesity risk stratification
Background:
- Accurate identification of at-risk children is vital for timely intervention and improved health outcomes.
- Existing methods like Body Mass Index percentile (BMI%) may not fully capture actual body composition.
- Reliability of current guidelines needs assessment using validated body composition measures.
Purpose of the Study:
- To determine the relationship between BMI% classifications and actual body composition in children.
- To compare fat mass index (FMI) and fat-free mass index (FFMI) with BMI% for identifying at-risk children.
- To evaluate the reliability of normative reference values for body composition in children.
Main Methods:
- A cross-sectional study involved 1,064 children (537 boys).
- Body Fat Percentage (BF%), FMI, and FFMI were measured using rapid bioimpedance methods.
- These measures were compared against BMI% classifications, considering weight status and sex.
Main Results:
- BMI% generally correlated with body composition, but nearly 25% of children in healthy or overweight BMI% categories had high BF% or low FFMI.
- Higher-than-expected fatness and potential sarcopenia were observed relative to risk status.
- Inaccuracies in risk assessment were more common in girls, who consistently showed higher BF% at any given BMI%.
Conclusions:
- Concerns exist regarding the accuracy of BMI% in identifying actual health risks in children, including those classified as healthy weight or overweight.
- Integrating body composition measures (BF%, FMI, FFMI) with BMI% significantly enhances the sensitivity and accuracy of identifying children who could benefit from interventions.
- These comprehensive assessments can better guide clinical decision-making for disease risk stratification and intervention planning in pediatric populations.
Background:
Identifying at-risk children with optimal specificity and sensitivity to allow for the appropriate intervention strategies to be implemented is crucial to improving the health and well-being of children. We determined relationships of body mass indexes for age and sex percentile (BMI%) classifications to actual body composition using validated and convenient methodologies and compared fat and non-fat mass estimates to normative cut-off reference values to determine guideline reliability. We hypothesized that we would achieve an improved ability to identify at-risk children using simple, non-invasive body composition and index measures.
Methods:
Cross-sectional study of a volunteer convenience sample of 1,064 (537 boys) young children comparing Body Fat Percentage (BF%), Fat Mass Index (FMI), Fat-Free Mass Index (FFMI), determined via rapid bioimpedance methods vs. BMI% in children. Comparisons determined among weight classifications and boys vs. girls.
Results:
Amongst all subjects BMI% was generally correlated to body composition measures and indexes but nearly one quarter of children in the low-risk classifications (healthy weight or overweight BMI%) had higher BF% and/or lower FFMI than recommended standards. Substantial evidence of higher than expected fatness and or sarcopenia was found relative to risk status. Inaccuracies were more common in girls than boys and girls were found to have consistently higher BF% at any BMI%.
Conclusions:
The population studied raises concerns regarding actual risks for children of healthy or overweight categorized BMI% since many had higher than expected BF% and potential sarcopenia. When body composition and FMI and FFMI are used in conjunction with BMI% improved sensitivity, and accuracy of identifying children who may benefit from appropriate interventions results. These additional measures could help guide clinical decision making in settings of disease-risks stratifications and interventions.
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