Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e487-e495 (doi:10.1542/peds.2005-0572)

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Do Changes in Body Mass Index Percentile Reflect Changes in Body Composition in Children? Data From the Fels Longitudinal Study

Ellen W. Demerath, PhD^a, Christine M. Schubert, PhD^a, L. Michele Maynard, PhD^b, Shumei S. Sun, PhD^a, W. Cameron Chumlea, PhD^a, Arthur Pickoff, MD^c, Stefan A. Czerwinski, PhD^a, Bradford Towne, PhD^a and Roger M. Siervogel, PhD^a

^a Lifespan Health Research Center, Wright State University School of Medicine, Dayton, Ohio
^b National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
^c Department of Pediatrics, Children's Medical Center, Dayton, Ohio

OBJECTIVE. Our aim was to examine the degree to which changes in BMI percentile reflect changes in body fat and lean body mass during childhood and how age and gender affect these relationships.

METHODS. This analysis used serial data on 494 white boys and girls who were aged 8 to 18 years and participating in the Fels Longitudinal Study (total 2319 observations). Total body fat (TBF), total body fat-free mass (FFM), and percentage of body fat (%BF) were determined by hydrodensitometry, and then BMI was partitioned into its fat and fat-free components: fat mass index (FMI) and FFM index (FFMI). We calculated predicted changes () in FMI, FFMI, and %BF for each 10-unit increase in BMI percentile using mixed-effects models.

RESULTS. FFMI had a linear relationship with BMI percentile, whereas FMI and %BF tended to increase dramatically only at higher BMI percentiles. Gender and age had significant effects on the relationship between BMI percentile and FFMI, FMI, and %BF. Predicted %BF for boys 13 to 18 years of age was negative, suggesting loss of relative fatness for each 10-unit increase in BMI percentile.

CONCLUSIONS. In this longitudinal study of white children, FFMI consistently increased with BMI percentile, whereas FMI and %BF had more complicated relationships with BMI percentile depending on gender, age, and whether BMI percentile was high or low. Our results suggest that BMI percentile changes may not accurately reflect changes in adiposity in children over time, particularly among male adolescents and children of lower BMI.

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Key Words: BMI • fat-free mass • body composition • total body fat • obesity • percentage of body fat • longitudinal study • childhood • adolescence • gender differences

Abbreviations: TBF—total body fat • %BF—percentage of body fat • FFM—fat-free mass • FMI—fat mass index • FFMI—fat-free mass index

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Accepted Aug 18, 2005.

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