Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children

Background/Objectives: Body mass index (BMI) (weight per height 2 ) 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 height 5 ) 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 ; P