Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children: a systematic review and meta-analysis

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 677-696-Obesity Physiology & Epidemiology
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-687
Asma Javed*1, Marwan Jumean2, Dale Okorodudu3, Seema Kumar1 and Francisco Lopez Jiminez1
1Mayo Clinic, Rochester, MN, 2Tufts Medical Center, Boston, MA, 3Duke University Medical Center, Durham, NC
Objective: We performed a systematic review and meta-analysis of studies that assessed the performance of body mass index (BMI) to detect body adiposity in children up to 19 years of age.

Design: Data sources were MEDLINE, EMBASE, Cochrane, Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, and SCOPUS. To be included, studies must have assessed the performance of BMI to measure body adiposity in children and teenagers up to the age of 19 years, provided standard values of diagnostic performance, and used a body composition technique as the reference standard for body fat percent (BF%) measurement. We obtained pooled summary statistics for sensitivity, specificity, positive and negative likelihood ratios (LRs), and diagnostic odds ratio (DOR). The inconsistency statistic (I2) assessed potential heterogeneity.

Results: The search strategy yielded 1412 potentially relevant abstracts, and 37 articles met our predefined inclusion criteria. The studies evaluated a total of 53,521 patients, with a mean age ranging from 4 to 18 years old. Gender-specific data were present in 34 of the 37 studies, which include 18,429 males and 22,781 females. Commonly used BMI cutoffs to diagnose obesity showed a pooled sensitivity to detect high adiposity of 0.70 (95% confidence interval (CI) 0.69 – 0.71) and a pooled specificity of 0.93 (CI 0.93 – 0.93). LR+ was 11.14 (CI 9.25 – 13.41), I2 96.6%; LR- was 0.26 (CI 0.21-0.31), I2 97.6%; and DOR 54.61 (CI 42.41 – 70.32), I2 87.3%. In males, BMI showed a pooled sensitivity of 0.71 (CI0.69 – 0.73), and a pooled specificity of 0.95 (CI 0.95 – 0.96). LR + was 13.53 (10.74 – 17.05), I2 84.5%; LR- was 0.33 (CI 0.25 – 0.44), I2 96.5%; and DOR was 53.18 (36.64 – 77.21), I2 78.4%. As for females, BMI showed a pooled sensitivity of 0.64 (CI 0.62 – 0.68), a pooled specificity of 0.95 (CI 0.94 – 0.95), LR + of 14.74 (CI 10.77 – 20.16), I2 95.1%; LR- of 0.28 (CI 0.22 – 0.35), I2 97.6%; and a DOR of 68.19 (48.8 – 95.30), I2 76.2%.

Cutoff values and regional origin of the studies can only partially explain the heterogeneity seen in pooled DOR estimates.

Conclusion: Commonly used BMI cutoff values to diagnose obesity have high specificity, but low sensitivity to identify adiposity, as they fail to identify over a quarter of children with excess BF%.

Nothing to Disclose: AJ, MJ, DO, SK, FL

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm