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In their recent paper, Michels et al. (1) set out to critically assess the use of body mass index in epidemiologic research. They conclude that body mass index alone will often not suffice to adequately describe the relation between body stature and health outcomes. The authors demonstrate their point in 13-year-old adolescent girls from the Pediatric Task Force database, where they find that body height is, in addition to body mass index, independently and significantly associated with systolic blood pressure. I would like to comment on some of the interpretations contained in this paper. The report adds to a longstanding discussion of the role of body stature as a determinant of blood pressure at young age (2). There is consent that the influence of body height diminishes or even disappears after puberty and that body mass index remains the predominant anthropometric determinant of blood pressure in young adults (3, 4). Furthermore, study evidence suggests that the body height of adolescents is the strongest correlate of developmental age or biologic maturity (5). On the other hand, at a given chronologic age in adolescence, there is substantial variation in biologic maturity that, in turn, is a major determinant of blood pressure levels (5, 6). Thus, one might suspect that such variability in maturation is captured in statistical analyses by body height if additional adjustment for scores of maturity, for example, the Tanner score (5), is not provided. Although the inclusion of body height in these analyses is appropriate, in the sense that it accounts, as a marker, for the impact of maturity on blood pressure, the interpretation of the results may be less straightforward than the authors seem to assume.

RE: "DOES BODY MASS INDEX ADEQUATELY CAPTURE THE RELATION OF BODY COMPOSITION AND BODYSIZE TO HEALTH OUTCOMES?"