Childhood overweight and obesity, a worldwide problem, is generally identified using BMI (body mass index). However, this application of BMI has been little investigated in children below 5 years of age due to a lack of appropriate methods to assess body composition. Therefore, we used air displacement plethysmography (ADP) to study 4.4-year old boys and girls since this method is accurate in young children if they accept the requirements of the measurement. The purpose was to analyze the relationship between BMI and body fat in these children. Body composition was assessed in 76 (43 boys, 33 girls) of the 84 children brought to the measurement session. Boys and girls contained and % body fat, respectively. BMI-based cut-offs for overweight could not effectively identify children with a high body fat content. There was a significant ( ) but weak ( ) correlation between BMI and body fat (%). In conclusion, requirements associated with a successful assessment of body composition by means of ADP were accepted by most 4-year-olds. Furthermore, BMI-based cut-offs for overweight did not effectively identify children with a high body fatness and BMI explained only a small proportion of the variation in body fat (%) in this age group. 1. Introduction Childhood overweight and obesity is a growing problem worldwide which, according to the WHO, represents one of the most serious challenges to human health in this century [1]. Globally as many as 42 million children under the age of five were overweight in 2010 [1]. Thus early childhood obesity-prevention interventions represent a rapidly growing research area [2]. For example, Manios [3] has described how a team of 15 partners across the EU are working to develop such a program for children aged 4–6 years. In the USA, Fitzgibbon et al. [4] conducted a pilot intervention study to prevent obesity in 3–5-year-old Latino children, and Taveras et al. [5] tested an intervention in primary care pediatrics including children aged 2–6 years in an attempt to reduce their overweight and obesity. Identification of overweight and obesity in young children is generally based on the BMI (body mass index) of boys and girls from several countries with age- and sex-specific cut-off values for these conditions [6]. However, obesity is characterized by excessive body fat accumulation, and in adults the body fat content for any particular BMI-value is quite variable [7]. Published data suggest that BMI is an inaccurate estimate of body fatness of individuals also in pediatric populations [8]. However, the relationship between BMI and
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