Editorial

Three
Stanley

limitations
M Garn, P/iD, William

of the body
R Leonard, MA, and

mass
Victor

index1
MD
Downloaded from ajcn.nutrition.org at Universidade Federal de Mato Grosso on July 18, 2013

M Hawthorne,

Although the wt/ht2 or Body Mass Index (BMI) has attained growing popularity in the past few years (1), the two components of this index and their relative weighting suggest possible limitations on its use. Since stature (ie, standing height) is one component, the BMI may be stature dependent over at least part of the age range. Again, the use of stature as a divisor suggests that the BMI may also be a!fected by relative leg length or relative sitting height. Finally, the use of weight as the numerator suggests that the BMI-like weight itself-may reflect both lean tissue and fat tissue to a comparable degree. If we turn first to the extensive data of the first National Health and Nutrition Examination Survey (NHANES I), readily available on tape and familiar to most readers of this journal (2), the BMI is indeed stature dependent but in different directions at different points in the life cycle. For NHANES I, correlations between stature and the BMI approximate 0.30 for children, shift during adolescence, and become negative in adult years (Table 1). The massive data of the National Collaborative Perinatal Project (NCPP) confirm these trends; correlations between stature and the BMI again approximate 0.30 for children but average -0. 12 for 40 000 3rd and 4th decade women. Thus the assumption that the BMI is independent ofstature is not quite true for adults and especially not true for children. Anthropometric data included in NHANES I also reveal the extent to which BMI reflects body proportions or more specifically sitting height relative to standing height (Table 2). At all ages considered (ages 5-50) the correlation between BMI and relative sitting height (sitting height/stature) is at least 0.15 and generally exceeds 0.20. With n = 596 for adolescent
996 Am J Clin Mar l986;44:996-7. Printed

males to n = 3858 for young adult women, all ofthese values of r are statistically significant. However, the point in question is the magnitudes of the correlations and their implications. Children, adolescents, or adults with short legs for their height have higher BMI values, which indicates the extent to which BMI is also a measure of body build or body
proportions.

When the BMI is further explored in relation to frame size, Lean Body Mass, and fatness, again on an age-specific basis, it is seen to relate to all three. With use of data from the Tecumseh (Michigan) Community Health Survey to include the radiogrammetricallydetermined bony chest breadth (3) as in Table 3, the correlations approximate 0.5 overall. For the same subjects arranged by age intervals, correlations with the triceps skinfold approximate 0.7, as shown in the table. If we further estimate Lean Body Mass by subtracting estimated fat weight from total body weight (4), correlations with BMI then approximate 0.65 for males aged 30-50. Accordingly, it is clear that BMI reflects both the weight of lean tissue and the weight offat tissue and for some age groups, at least, it may be a better measure of amount oflean than of relative fatness. Under these circumstances and with sampies of considerable size (up to and exceeding 40 000), it is clear that the BMI is not quite independent ofstature, especially at the younger ages. Moreover, the BMI is influenced by

the Center for Human Growth and DevelopThe University of Michigan, 300 North Ingalls Building, Ann Arbor, MI and the Department of EpideI

From

ment,

miology, School of Public Health, The Michigan, Ann Arbor, MI. Received May 5, 1986. Accepted for publication July 1, 1986.

University

of

in USA. 1986 American

Society for Clinical

Nutrition

EDITORIAL TABLE 1 Relationship TABLE 3 Relationship subcutaneous

997

between
M

stature

and BMI in NHANES

Fem r n

between bony fat and BMI

chest

breadth

and BMI and

AeGroup

,i

Bony chest besadth

Age ii

Tri n

skinfod r

5-10 11-15 16-19 20-35 36-50

S

1112 897 596 1706 1485

0.32 0.24 0.04

-0.02
-0.05

1165 895 614 3766 2513

0.27 0.17 -0.08 -0.08 -0.08

Males

Age corrected

values of r.

5-10 11-15 16-18 20-30 30-40 40-50 50-60

310 373 173 141 81 61

22

0.51 0.65 0.53 0.48 0.57 0.51

0.67

685 533 253 249 145 116

40

0.60 0.72 0.72 0.68 0.67 0.56

0.71

Downloaded from ajcn.nutrition.org at Universidade Federal de Mato Grosso on July 18, 2013

body proportions (relative leglength or relative sitting height) such that shorter-legged mdividuals have BMI values higher by as much as 5 units. Finally, BMI (like weight) is influenced nearly to an equal degree by both the lean and the fat compartments of the human body. It is as much a measure of Lean Body Mass as it is a measure of fatness or obesity. While these comments apply specifically to the BMI calculated as weight (kg) did by stature (m2), they also apply to the ht/Vwt ratio and similar indices that express weight for height. Thus, family-line resemblances in BMI, which approximate 0.20-0.25 for parents and subadult children, may reflect similarities in body build and proportions and in lean or fat-free mass as much as familial resemblances in fatness. Similarly, resemblances in BMI between older parents and their adult children may or may not reveal whether fatness is biologically inherited. Relative leg length, frame size, and amount of lean tissue
TABLE 2 Effect of rela tive sitti ng hei ght
Males AgeGmup n r
,

Females

5-10 331 0.52 709 0.60 11-15 343 0.63 502 0.81 16-18 153 0.55 247 0.74 20-30 132 0.56 218 0.80 30-40 92 0.41 147 0.73 40-SO 73 0.51 108 0.78 50-60 21 0.37 43 0.76 Age corrected values of r. All data from Tecumsch, Community Health Survey examination round

Michigan 2.

are also
semble

involved, and older parents their adult children in these

may rerespects

aswell(5).

References 1. Keys A, Fidanza F, Karvonen HL Indices ofrelative weight MJ, Kimura

and obesity.

N, Taylor J Chronic

on BMI in N HANES
Females

Dis l97225:329-43. 2. Landis JR, Lepkowski JM, Ekiund SA, Stehouwer SA. A statistical methodology foranalyzingdata from a complex survey: the first national health and nutrition examination survey. Hyattsville, MD: Department ofHealth and Human Services, 1982. [DHHS publication no (PHS) 82-2366.]

3. Garn SM, Pesick SD, Hawthorne VM. The bony chest

r

5-10 11-15 16-19 20-35 36-50

*

1112 898 596 1743

0.19 0.23 0.19 0.21

1166 895 614 3858

0.19 0.25 0.26

1483

0.21

2527

0.17 0.15

Sitting height/stature.

breadth as a frame size standard in nutritional assessment. Am J Clin Nutr l983;37:3l5-8. 4. Garn SM, LaVelle M. Family-line origins ofthe lowfat and low-lean child or adolescent. In: Cohen SA, ed. The underweight infant, child and adolescent East Norwalk: Appleton.Century-Crofts, !985:15-29. 5. Stunkard AJ, S#{248}rensen IA, Hanis C, et al. An adoption study ofhuman obesity. N Engi J Med 1986,314:193-8.