Accuracy of body mass index (BMI) thresholds for predicting excess body fat in girls from five ethnicities.

The association between body mass index (BMI) and body fat in young people differs among ethnic groups. Consequently, BMI thresholds for defining childhood overweight may not represent an equivalent level of adiposity in multiethnic populations. The objectives of this study were to characterise the relationships between BMI and percentage body fat (%BF) and to determine the appropriateness of universal BMI standards for predicting excess fatness in girls from five ethnic groups. The BMI and %BF of 1,676 European, Maori, Pacific Island, East Asian, and South Asian girls aged 5-16 years were determined using anthropometric and bioimpedance measurements. Receiver operating characteristic (ROC) curves were prepared to assess the sensitivity and specificity of the International Obesity Taskforce (IOTF) and Centers for Disease Control and Prevention (CDC) BMI thresholds for detecting %BF >85th percentile. Compared with European girls, South and East Asians averaged 4.2% and 1.3% more %BF at a fixed BMI and age, whereas Pacific Islanders averaged 1.8% less %BF. Areas under the ROC curves ranged from 89.9% to 92.4%, suggesting that BMI is an acceptable screening tool for identifying excess adiposity. However, the IOTF and CDC thresholds showed low sensitivity for predicting excess %BF in South and East Asian girls, with low specificity in Pacific Island and Maori girls. The development of an ethnic-specific definition of overweight improved diagnostic performance. We conclude that BMI can be an acceptable proxy measure of excess fatness in girls from diverse ethnicities, especially when ethnic-specific BMI reference points are implemented.