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Receiver operating characteristic analysis of body mass index to detect increased risk of functional morbidity in Vietnamese rural adults

European Journal of Clinical Nutrition volume 58, pages 1594–1603 (2004)Cite this article

Abstract

Objective: To assess the performance of low BMI, and define optimal BMI cut-off values in order to detect fever-associated adult morbidity.

Design: A cohort study of adults between 18 and 60 y in rural Vietnam, whose BMI and health status were assessed at baseline, and who were then monitored for illness events for 4 months. Nonparametric receiver operating characteristic (ROC) analysis was used to evaluate the performance of low BMI to detect the average number of restricted-days due to illness and to determine optimal cut-off values.

Setting: A rural commune in the Red River Delta, northern Vietnam.

Subjects: The study included 693 men and 739 women aged 18–60-y.

Results: At baseline, 21% of the study participants had a BMI<18.5 kg/m2. As BMI progressively decreased, the percentage of participants experiencing morbidity with fever increased. The areas under the ROC curves for BMI were significantly greater than 0.5 for all levels of monthly average restricted-days of illness (MARDI) with fever, with best performance for >5 days/month. Excluding participants with acute or chronic disease at baseline improved the performance of BMI to detect MARDI with fever of >5 days (area under ROC curve 0.95; 95% CI 0.92, 0.99). With increasing levels of MARDI with fever, BMI cut-offs fell to 17.9 kg/m2 when MARDI with fever was >5 days.

Conclusions: The ROC analysis demonstrates that low BMI performs well as a risk indicator of MARDI with fever of >5 days with an optimal BMI cut-off value of 17.9 kg/m2.

Sponsorship: Wellcome Trust Research Training Fellowship in Population Health.

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Acknowledgements

We are indebted to Dr Huy Vu D for revising the comorbidity questionnaire and assisting with interviewer training. We gratefully acknowledge the assistance of the staff of the National Institute of Nutrition, the Bavi Preventive Health Centre, and the Minh Quang People Committee in data collection. Support for this research was provided by the Wellcome Trust through a Research Training Fellowship in Population Health to the National Institute of Nutrition, Hanoi, Vietnam, and the University of Newcastle, Newcastle, Australia.

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Authors and Affiliations

  1. Department of Education and Information, National Institute of Nutrition, Ministry of Health, Hanoi, Vietnam

    T T Do

  2. Centre for Clinical Epidemiology and Biostatistics, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia

    M J Dibley & C D'Este

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  1. T T Do
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  2. M J Dibley
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  3. C D'Este
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Contributions

Guarantor: Michael J Dibley.

Contributors: DTT designed the study, organized and monitored the collection of data, conducted data analysis and prepared the manuscript; MJD contributed to the design of the study, advised about data collection methods, and contributed to the analysis of data and preparation of the manuscript; CD'E provided advice about the design, especially the sampling strategy, and the analysis of data. No author has any financial or personal relationships with the organization sponsoring this research.

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Correspondence to T T Do.

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Do, T., Dibley, M. & D'Este, C. Receiver operating characteristic analysis of body mass index to detect increased risk of functional morbidity in Vietnamese rural adults. Eur J Clin Nutr 58, 1594–1603 (2004). https://doi.org/10.1038/sj.ejcn.1602010

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