The relevance of body mass index in forensic age assessment of living individuals: an age-adjusted linear regression analysis using multivariable fractional polynomials.

In forensic age assessment of living individuals, developmental stages of skeletal maturation and tooth mineralization are examined and compared with a reference population. It is of interest which factors can affect the development of these features. We investigated the effect of body mass index (BMI) on the developmental stages of the medial epiphysis of the clavicle, the distal epiphysis of the radius, the distal epiphysis of the femur, the proximal epiphysis of the tibia, and the left lower third molar in a total of 581 volunteers, 294 females and 287 males aged 12-24 years, using 3 T MRI. BMI values in the cohort ranged from 13.71 kg/m in a 12-year-old female to 35.15 kg/m in an 18-year-old female. The effect of BMI on the development of the characteristics was investigated using linear regression models with multivariable fractional polynomials. In the univariable analysis, BMI was associated with all feature systems (beta between 0.10 and 0.44; p < 0.001). When accounting for the physiological increase of BMI with increasing age, the effect of BMI was lower and in the majority of the models no longer clinically relevant. Betas decreased to values between 0.00 and 0.05. When adding feature variables to a model already including age, r values increased only minimally. For an overall bone ossification score combining all characteristics, the adjusted ß was 0.11 (p = 0.021) and 0.08 (p = 0.23) for females and males, respectively. Low ß and r values (0.00 (adjusted)-0.16 (crude)) were present in both models for third molar development already in the unadjusted analyses. In conclusion, our study found no to little effect of BMI on osseous development in young adults. Teeth development in both sexes was completely independent of BMI. Therefore, dental methods should be part of every age assessment.