Freedman David S, Zemel Babette S, Weber David R, Dietz William H
Retired from Centers for Disease Control and Prevention.
Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
J Pediatr. 2025 Feb;277:114375. doi: 10.1016/j.jpeds.2024.114375. Epub 2024 Oct 22.
To assess the screening ability of a high body mass index (BMI) for high adiposity among 8- to 19-year-olds.
This cross-sectional study included 6454 National Health and Nutrition Survey participants from 2011 through 2018. Fat and lean mass were measured with dual-energy X-ray absorptiometry. We expressed adiposity as fat mass index (FMI, kg ÷ m) and %fat.
Based on the Centers for Disease Control and Prevention 95th percentile, a high BMI correctly classified a high FMI for about 95% of participants in each racial and ethnic group. About 81% (Blacks) to 90% (Hispanics) of participants with a high BMI also had a high FMI. Further, children with a high BMI were 17 (Hispanics) to 46 (Blacks) times more likely to have a high FMI than those with a "normal" BMI. The screening ability of high BMI for high %fat was weaker because levels of %fat are influenced by both fat mass (numerator) and lean mass (denominator).
Despite differences in body composition, a high BMI is a very good screening tool for identifying high FMI not only among White 8- to 19-year-olds but also among Asians, Blacks, and Hispanics. Compared with %fat, FMI is likely a better adiposity metric among children and adolescents.
评估高体重指数（BMI）对8至19岁青少年高肥胖程度的筛查能力。
这项横断面研究纳入了2011年至2018年的6454名国家健康与营养调查参与者。采用双能X线吸收法测量脂肪量和去脂体重。我们将肥胖程度表示为脂肪量指数（FMI，千克÷米²）和体脂百分比。
根据疾病控制与预防中心的第95百分位数，高BMI能正确分类出各种族和族裔群体中约95%参与者的高FMI。BMI高的参与者中，约81%（黑人）至90%（西班牙裔）也有高FMI。此外，BMI高的儿童出现高FMI的可能性是BMI“正常”儿童的17倍（西班牙裔）至46倍（黑人）。高BMI对高体脂百分比的筛查能力较弱，因为体脂百分比受脂肪量（分子）和去脂体重（分母）两者影响。
尽管身体组成存在差异，但高BMI不仅是识别8至19岁白人青少年高FMI的良好筛查工具，也是识别亚洲人、黑人和西班牙裔青少年高FMI的良好筛查工具。与体脂百分比相比，FMI可能是儿童和青少年中更好的肥胖指标。
