Document Type


Source of Publication

International Journal of Obesity

Publication Date



© 2017 Macmillan Publishers Limited, part of Springer Nature. BACKGROUND/OBJECTIVES: 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. METHODS: 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. RESULTS: 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; Po0.0001) 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. CONCLUSIONS: 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.




Nature Publishing Group





First Page


Last Page



Education | Medicine and Health Sciences


deuterium, adolescent, African, Article, body fat, body height, body mass, body weight, child, ethnic difference, European, female, human, male, priority journal, South Asian, United Kingdom, adipose tissue, Asian continental ancestry group, Black person, childhood obesity, ethnology, meta analysis, obesity, preschool child, reproducibility, standard, validation study, Adipose Tissue, Adiposity, African Continental Ancestry Group, Asian Continental Ancestry Group, Body Mass Index, Child, Child, Preschool, Female, Humans, Male, Pediatric Obesity, Reference Standards, Reproducibility of Results, United Kingdom

Scopus ID


Indexed in Scopus


Open Access


Open Access Type

Hybrid: This publication is openly available in a subscription-based journal/series