ORIGINAL ARTICLE Hattori Chart Based Evaluation of Body Composition and its Relation to Body Mass Index in a Group of Sri Lankan Children V. P. Wickramasinghe Received: 11 December 2010 /Accepted: 15 November 2011 /Published online: 7 December 2011 # Dr. K C Chaudhuri Foundation 2011 Abstract Objective To assess the relationship between fat free mass (FFM), fat mass (FM), body mass index (BMI) and percentage fat mass (%FM) using Hattori chart in a group of Sri Lankan children. Methods In this cross sectional descriptive study involving 5–15 y old children, data from 4 different school surveys were pooled together. Height and weight were measured and BMI calculated. Total body water (TBW) was assessed using a height and weight based equation. Thus FFM and FM were assessed based on 2 C body composition model. Fat mass index (FMI) and Fat free mass index (FFMI) were calculated and plotted on Hattori chart. Results 4278 individuals (1297 boys and 2981 girls) were studied. Individual values clearly showed that Sri Lankan children had a low FFMI and a high FMI. Individuals with similar BMI had their %FM distributed in a wide range. Even children categorized as wasted had high levels of % FM in their body. Mean FMI and FFMI for each age was plotted, and it showed that most of the weight gain is due to accumulation of fat in the body. Conclusions This study shows that Sri Lankan children have a higher %FM from a younger age even when they are classified as wasted. As they grow older, the changes that occur in FM are more than FFM. This chart analysis clearly shows that BMI is not a good index to measure %FM in individuals of this population. Keywords Fat mass . BMI . Hattori chart . Sri Lankan children Introduction Body composition has shown to vary with ethnicity. Subcutaneous fat distribution in 7–15-y-old American children of European origin was seen to be different from children of African origin despite having similar weights and dietary habits [1]. Quite similar results were noted when Caribbean island children of African origin were compared with European children [2]. Body fat distribution of 12–17y-old American girls was assessed. Girls of Asian and Mexican origins had more centrally distributed fat than their European and African counterparts. Central to peripheral skin fold thickness (SFT) ratio is larger in Asians [3]. Racial differences in the relationship between BMI and fat mass (FM) are also noted. Asians have a low BMI value but high FM compared to white Caucasians [4]. When compared with American Caucasians, at any given BMI, Europeans had 3.8% higher FM when standardized to age and gender. This meta-analysis concluded that BMI based obesity cutoff should be different for different populations [5]. In another study, involving a group of 5–11 y old New Zealand children of European, Maori, Pacific Island and Indian origin, showed that compared with children of European origin, at any given BMI value, Indian children had 4.3% more %FM, while Pacific Island children averaged 1.7% less %FM [6]. This variation in body composition has been observed across different ethnic groups and therefore the ability of BMI to diagnose obesity and overweight accurately, V. P. Wickramasinghe (*) Department of Pediatrics, University of Colombo, Kynsey Road, Colombo, Sri Lanka e-mail: pujithaw@yahoo.com Indian J Pediatr (May 2012) 79(5):632–639 DOI 10.1007/s12098-011-0615-6