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Background The body mass index (BMI) is a simple and widely utilized screening tool for obesity in children and adults. The purpose of this investigation was to evaluate if BMI could predict total fat mass (TFM) and percent body fat (%FAT) in a sample of overweight and obese children. Methods In this observational study, body composition was measured by dual energy x-ray absorptiometry (DXA) in 663 male and female overweight and obese children at baseline within a multidisciplinary, pediatric fitness clinic at an academic medical center. Univariate and multivariate regression analyses were conducted to evaluate whether BMI z-score (BMIz) predicts TFM or %FAT. Results The BMIz, sex and age of subjects were identified as significant predictors for both TFM and %FAT. In subjects younger than 9 years, the BMIz was a weak to moderate predictor for both TFM (R 2  = 0.03 for males and 0.26 for females) and %FAT (R 2  = 0.22 for males and 0.38 for females). For subjects between 9 and 18 years, the BMIz was a strong predictor for TFM (R 2 between 0.57 and 0.73) while BMIz remained only moderately predictive for %FAT (R 2 between 0.22 and 0.42). Conclusions These findings advance the understanding of the utility and limitations of BMI in children and adolescents. In youth (9-18y), BMIz is a strong predictor for TFM, but a weaker predictor of relative body fat (%FAT). In children younger than 9y, BMIz is only a weak to moderate predictor for both TFM and %FAT. This study cautions the use of BMIz as a predictor of %FAT in children younger than 9 years.

Background The age and sex standardized body mass index (BMIz) is a simple and widely utilized screening tool for obesity in children and adolescents. The purpose of this study was to evaluate the relationship between the BMIz trajectory versus the percent body fat (%FAT) trajectory, and if BMIz could predict significant changes in %FAT in a sample of obese children and adolescents. Methods In this longitudinal observational study, body composition was measured by dual energy x-ray absorptiometry (DXA) in obese children within a multidisciplinary pediatric fitness clinic at an academic medical center over a 3-year time period. Regression analyses were conducted to evaluate the association between changes in BMIz and changes in %FAT. Results Baseline assessment was obtained from 515 participants. The reduction observed in BMIz (2.20 to 2.08, p  < 0.0001) correlated with the reduction in %FAT (38.5 to 35.8%, p  < 0.05) in the first two years. The overall correlation between the slope in BMIz reduction versus %FAT reduction was moderate ( r  = 0.36, p < 0.0001) over the 3-year follow-up period. The sensitivity of BMIz changes for predicting a decrease in %FAT was acceptable (70, 95% CI: 61–78%), however the specificity was poor (42, 95% CI: 31–54%). Conclusions These findings advance the understanding of the utility and limitations of BMIz in children and adolescents. While BMIz may be sensitive to changes in adiposity, it is a weak predictor of these changes in total body fat (%FAT) due to the poor specificity. Therefore, clinicians must exercise caution when monitoring changes in a growing child’s body composition to avoid misclassifying or missing substantial change when utilizing BMIz alone.

This research presents the first validation of a multiracial, gender-neutral body figure scale [BFS] to measure body figure awareness [BFA] within a pediatric sample with obesity, racial/ethnic diversity and a wide age range from 9 to 18 years. The present results suggest that the modified Collins BFS [mCBFS] is a valid self-report tool as compared to the original Collins BFS (τ = .83, p < 0.001) and has good construct validity (%FAT: τ = 0.39, p < 0.001 and BMI-for-age percentiles: τ = 0.52, p < 0.001). This research was also the first to examine BFA alongside a measure of WPA. The majority of the sample were found to have misperceived both their weight and body figure. These observations were more apparent when examined by sex and race/ethnicity. Outcomes of this research provide a framework for more constructive conversations about weight using a validated assessment of WPA and the novel body figure scale [mCBFS] to measure BFA in both the primary care and specialty care settings.

Background. High folate intake (≥400μg) among older persons has been associated with adverse health outcomes. Such intakes likely produce elevated serum folate concentrations, as shown in earlier National Health and Nutrition Examination Survey (NHANES) analyses. Objective. To examine folate intake and circulating folate concentrations of persons ≥45 years in NHANES 2003-2004 stratified by gender, supplement use (folate containing, non-folate containing supplements, or none) and four race-ethnicity groups: non-Hispanic white (NHW), non-Hispanic black (NHB), Mexican American (MA) and Other race-ethnicity groups (Other). Design. Cross-sectional, secondary analysis of folate intake, supplement use, and biochemical concentrations from adults in the NHANES 2003-2004. Results. NHB and NHW men consumed less refined, non-whole grains than Other males (p=0.008) and less legumes than MA and Other (p=0.019). MA women consumed more grains (p=0.007) than NHW and NHB women, and more legumes than Other (p=0.006). NHB men had the lowest mean red blood cell (RBC) folate concentrations (p<0.001) and the lowest mean serum folate concentrations (p=0.003) of all race-ethnicity groups. NHW women had the highest mean serum folate concentration (p=0.001). Female folate containing supplement users consumed more food folate than non-supplement users (p=0.012). All supplement users are at risk of high serum folate concentrations. Those most likely to have elevated RBC folate concentrations are those whom are older (≥65), female, NHW, and/or supplements users. Conclusion. These findings highlight the need to better understand the effects of chronic exposure to elevated folate intakes—in particular, among older, NHW, women who use supplements.