Different correlation of body mass index with body fatness and obesity-related biomarker according to age, sex and race-ethnicity

Abstract

The relationship between body mass index (BMI) and body fatness could differ according to age, sex, and race-ethnicity. We aimed to evaluate in which contexts BMI could be a good measure for body fatness compared to dual-energy X-ray absorptiometry (DXA) derived measures. The study population included 18,061 participants (9141 men and 8920 women) aged 18 and older who tested DXA from the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2006, and 8107 men and 10,754 women with DXA data from Korea NHANES from 2008 to 2011 to represent the Asian population. We calculated Pearson correlation coefficients between BMI and DXA derived fat mass index (FMI) and percentage body fat (PBF) depending on age, sex, and race-ethnicity. The correlation between BMI, FMI and PBF and obesity-related biomarkers was also estimated among the subgroup with both DXA and information on each biomarker. BMI was strongly correlated with FMI (r = 0.944 in men and 0.976 in women), PBF (r = 0.735 in men and 0.799 in women), and truncal fat mass (r = 0.914 in men and 0.941 in women) with correlations stronger in women than in men except for with waist-height ratio (r = 0.921 in men and 0.911 in women). The correlation between BMI and DXA derived adiposity weakened with age in both sexes. BMI was less correlated with FMI (r = 0.840 in men and 0.912 in women), PBF (r = 0.645 in men and 0.681 in women), and truncal fat mass (r = 0.836 in men and 0.884 in women) in Korean compared to other race-ethnicities. Among obesity-related biomarkers, insulin was the most strongly correlated to body adiposity indices in both sexes and strength of these correlations generally decreased with age. BMI predicted obesity-related biomarkers as well as FMI and truncal fat mass and superior to PBF. BMI could be a good measure for body fatness, particularly among young age groups, women, the US population, but less so in Korean populations. The lower correlation between BMI and body fatness in older compared to younger age groups could be related to increasing PBF and decreasing lean body mass.

Figure 1

Pearson correlation coefficients between body mass index and DXA derived body adiposity (fat mass index and percentage body fat) by sex and age for each race-ethnicity. The bar graphs of (A–H) show coefficients between body mass index (BMI) and fat mass index (FMI) and percentage body fat (PBF) in (A) and (B) Whites; (C) and (D) Blacks; (E) and (F) Mexican-Americans, and (G) and (H) Koreans.

Figure 2

Pearson correlation coefficients between obesity-related biomarkers and body adiposity indices (body mass index, fat mass index and percentage body fat) by age in men. The bar graphs of panel A show coefficients between obesity-related biomarkers (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], C-reactive protein [CRP], hemoglobinA1c [HbA1c], fasting blood glucose [FBG] and insulin) and body mass index (BMI), fat mass index (FMI), and percentage body fat (PBF) in National Health and Nutrition Examination Survey (NHANES) and panel B shows the correlations in Korea NHANES. CRP was not available in Korea NHANES.

Figure 3

Pearson correlation coefficients between obesity-related biomarkers and body adiposity indices (body mass index, fat mass index and percentage body fat) by age in women. The bar graphs of panel A show coefficients between obesity-related biomarkers (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], C-reactive protein [CRP], hemoglobinA1c [HbA1c], fasting blood glucose [FBG] and insulin) and body mass index (BMI), fat mass index (FMI), and percentage body fat (PBF) in National Health and Nutrition Examination Survey (NHANES) and panel B shows the correlations in Korea NHANES. CRP was not available in Korea NHANES.