Objective: The aim of this study was to compare the accuracy of body fat patterns and single measures in assessing body fat and to clarify the use of indices based on waist circumference as measures of adiposity in children. Methods: This study included 2,531 7-year-old children from the Generation XXI birth cohort (Porto, Portugal). Anthropometrics were obtained by trained personnel and whole-body dual-energy x-ray absorptiometry (DXA) scans were performed. Results: Principal component analysis identified two body fat patterns. Pattern 1 (BMI, fat mass index from tetra-polar bioelectric impedance, and waist-to-height ratio) showed strong correlations with DXA fat mass index (r = 0.85; P < 0.001), and pattern 2 (waist-to-hip, waist-to-thigh, and waist-to-weight ratios) showed moderate correlations with DXA central fat (r = 0.35; P < 0.001). Compared with single measures, body fat patterns showed similar correlations with DXA-derived measures. Conclusions: Compared with single anthropometric indices, body fat patterns seem to add little value for estimating body fat in children. Waist-to-height ratio seems to be a proxy for total fat, while waist-to-hip, waist-to-thigh, and waist-to-weight ratios seem to be proxies for central fat. Further studies should address the predictive ability of waist-to-weight ratio to identify children at risk of developing cardiometabolic disease, as this was the first time describing its potential usefulness.Generation XXI was funded by FEDER through the Operational Programme Competitiveness and Internationalization and with national funding from the Foundation for Science and Technology, FCT (Portuguese Ministry of Science, Technology and Higher Education) (POCI-01-0145-FEDER-021177), under the project PTDC/SAU-EPI/121532/2010 and Unidade de Investigação em Epidemiologia, Instituto de Saúde Pública da Universidade do Porto Epidemiology Research Unit (EPIUnit) (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). SS received a grant from the Foundation for Science and Technology (SFRH/BD/81123/2011). AO receives funds from the FCT Investigator Programme (IF/01350/2015), with FEDER funds through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology, FCT, cofunded by the FCT and the POPH/FSE Program. The funders had no role in the design, analysis, or writing of this article
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