Shorter than average adults are at a higher risk for obesity and are also more susceptible to diabetes and CVD, independent of BMI. In contrast, taller children have a higher risk of obesity. We hypothesised that short stature is related to adverse body composition and that the association between stature and obesity differs between generations. In a cross-sectional German database of 213 804 adults and 12 411 children and adolescents, the prevalence of overweight and obesity was compared between percentiles of height. The association between stature and percentage of fat mass (%FM), lean BMI (LBMI; kg/m 2 ) or waist:hip ratio (in children only) was analysed within BMI groups. In adults, the prevalence of BMI . 30 kg/m 2 gradually increased with decreasing percentile of height whereas in children and adolescents, a positive association between height and weight status was observed. Short-stature women and girls had a 0·8 -3·2 % lower %FM than tall subjects (P,0·05), whereas no trend for %FM was observed in males. When compared with tall subjects, LBMI was 0·2 -0·6 kg/m 2 lower in short-stature men, as well as obese women (P,0·05). There was a non-significant trend for a lower LBMI and a higher waist:hip ratio in shorter children. In conclusion, short stature is associated with an increased risk of obesity in adults. Cardiometabolic risk in short stature is not explained by an adverse body composition.
Stature: Body mass index: Obesity: Fat mass: Lean body massA number of studies have established a positive association between short stature in adulthood and the prevalence of obesity (1 -4) , cardiovascular risk or disease (5 -11) , insulin resistance (2,9,12) and glucose intolerance (13 -22) . The relationship between short stature and cardiometabolic risk might be due to obesity and socio-economic factors. However, even after accounting for BMI, lifestyle and socio-economic status, short height or leg length was independently associated with a greater likelihood of insulin resistance, type 2 diabetes (3) and CHD (7,9) . BMI was also shown to be a less sensitive tool for the detection of high-risk cases in short-stature subjects when compared with taller subjects, because short stature modifies the relationship between BMI and obesity-associated co-morbidities (23) . Mortality risk is known to increase with increasing percentage of fat mass (%FM) as well as decreasing lean mass (normalised by height as lean BMI (LBMI); kg/m 2 ) (24,25) . Because BMI is only an indirect parameter of body composition, differences in body composition, for example, a higher %FM and a lower LBMI per BMI might contribute to the higher metabolic and cardiovascular risk in short stature. The first evidence for a higher body fat mass per BMI in short stature came from data obtained from a small Mexican population with short stature who were compared with taller subjects, matched for sex, age and BMI (26) . However, there are a lack of population data.In children, BMI is known to moderately correlate with height (27 -29) , a fact that ...