Abstract
ObjectivesBMI percentiles have been routinely and historically used to identify elevated adiposity. This paper aimed to investigate the optimal Centers for Disease Control and Prevention (CDC) body mass index (BMI) percentile that predicts elevated visceral adipose tissue (VAT), fat mass and cardiometabolic risk in a biracial sample of children and adolescents.Participants and MethodsThis cross-sectional analysis included 369 white and African American children (5–18 y). BMI was calculated using height and weight and converted to BMI percentiles based on CDC growth charts. Receiver operating characteristic curve analysis identified the optimal (balance of sensitivity and specificity) BMI percentile to predict the upper quartile of age-adjusted VAT (measured by magnetic resonance imaging), age-adjusted fat mass (measured by dual energy x-ray absorptiometry) and elevated cardiometabolic risk (≥ 2 of high glucose, triglycerides and blood pressure and low high density lipoprotein cholesterol) for each race-by-sex group.ResultsThe optimal CDC BMI percentile to predict those in the top quartile of age-adjusted VAT, age-adjusted fat mass and elevated cardiometabolic risk were the 96th, the 96th and the 94th percentiles, respectively, for the sample as a whole. Sensitivity and specificity was satisfactory (> 0.70) for VAT and fat mass. Compared to age-adjusted VAT and age-adjusted fat mass, there was a lower overall accuracy of the optimal percentile in identifying those with elevated cardiometabolic risk.ConclusionsThe present findings support the utility of the 95th CDC BMI percentile as a useful threshold for the prediction of elevated levels of VAT, fat mass and cardiometabolic risk in children and adolescents.The study is registered at clinicaltrials.gov as NCT01595100.
Highlights
Body mass index (BMI) is routinely used in surveillance and as a screening tool to identify those with excess adiposity.[1]
Age- and sexspecific BMI percentiles, such as those based on the US Centers for Disease Control and Prevention (CDC) growth reference curves,[3] are typically used for the identification of obesity-related health risks in children and adolescents
According to these reference data, for children and adolescents aged 2–19 years, a BMI between the 85th and 94th percentiles places them in the overweight category, whereas those X95th percentile are classified as obese.[4]
Summary
Body mass index (BMI) is routinely used in surveillance and as a screening tool to identify those with excess adiposity.[1]. It is important that BMI is adjusted for age or that the BMI of children of the same age and sex are compared.[2] Age- and sexspecific BMI percentiles, such as those based on the US Centers for Disease Control and Prevention (CDC) growth reference curves,[3] are typically used for the identification of obesity-related health risks in children and adolescents. According to these reference data, for children and adolescents aged 2–19 years, a BMI between the 85th and 94th (inclusive) percentiles places them in the overweight category, whereas those X95th percentile are classified as obese.[4]. Several studies have investigated the health implications of being X85th and X95th percentiles,[5,6] whereas others have aimed to identify an optimal age-specific BMI or BMI percentile to predict children at elevated cardiovascular risk.[7,8,9,10,11]
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