ArticleEuropean journal of pediatrics2026
Adiposity heterogeneity and overlap across BMI-defined weight-status categories in adolescents.
Article in European journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Body mass index (BMI) is widely used to classify weight status but does not fully capture heterogeneity in adiposity within and between BMI-defined weight-status categories. This study characterised adiposity across weight-status categories in adolescents, focusing on adiposity heterogeneity, distributional overlap, and sex differences. The sample comprised 5740 Polish adolescents (50.8% boys), aged 10-18 years, from the cross-sectional ADOPOLNOR study. Body composition was assessed using bioelectrical impedance analysis. Participants were classified as underweight (UNW), normal weight without obesity (NWNO), normal-weight obesity (NWO), or overweight/obesity (OVOB). Adiposity was evaluated using fat mass percentage (FM%), fat mass index (FMI), and fat-to-muscle mass ratio (FMR). Group differences were assessed using non-parametric tests, with effect sizes (r) reported for pairwise comparisons. Density plots visualised adiposity distributions, and overlap coefficients (OVL) quantified overlap between adjacent weight-status categories. Median values of all three adiposity indicators increased from UNW to OVOB in both sexes (p < 0.001). However, distributional overlap was non-uniform, being lowest between NWNO and NWO (OVL 0.16-0.33) and substantial between NWO and OVOB (OVL 0.54-0.71). Girls had higher adiposity than boys across all weight-status categories, with the largest sex differences in NWNO (FM%, r = 0.49; FMI, r = 0.44; FMR, r = 0.47). Sex differences in overlap were evident for some category transitions, although overall patterns were similar between sexes.
conclusionBMI provides a framework for classifying weight status, but substantial heterogeneity within weight-status categories and considerable overlap between adjacent categories support the complementary use of body-composition measures for characterising adolescent adiposity. WHAT IS KNOWN: • BMI is widely used to classify weight status in adolescents but serves only as a proxy for adiposity. • Consequently, BMI-defined weight-status categories may not fully capture differences in body fatness among adolescents. WHAT IS NEW: • Adiposity is heterogeneous within BMI-defined weight-status categories. • Distributional overlap between adjacent categories provides additional insight into the extent to which BMI-defined weight-status categories differ in adiposity.
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