Review

International Journal of Obesity (2010) 34, 791–799; doi:10.1038/ijo.2010.5; published online 2 February 2010

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

D O Okorodudu1, M F Jumean2, V M Montori3, A Romero-Corral2, V K Somers2, P J Erwin4 and F Lopez-Jimenez2

  1. 1University of Missouri School of Medicine, Columbia, MO, USA
  2. 2Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN, USA
  3. 3Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN, USA
  4. 4Mayo Clinic Libraries, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN, USA

Correspondence: Dr F Lopez-Jimenez, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Gonda 5-368, Rochester, MN 55905, USA. E-mail: lopez@mayo.edu

Received 18 August 2009; Revised 21 December 2009; Accepted 26 December 2009; Published online 2 February 2010.

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Abstract

Objective:

 

We performed a systematic review and meta-analysis of studies that assessed the performance of body mass index (BMI) to detect body adiposity.

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, 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 3341 potentially relevant abstracts, and 25 articles met our predefined inclusion criteria. These studies evaluated 32 different samples totaling 31968 patients. Commonly used BMI cutoffs to diagnose obesity showed a pooled sensitivity to detect high adiposity of 0.50 (95% confidence interval (CI): 0.43–0.57) and a pooled specificity of 0.90 (CI: 0.86–0.94). Positive LR was 5.88 (CI: 4.24–8.15), I 2=97.8%; the negative LR was 0.43 (CI: 0.37–0.50), I 2=98.5%; and the DOR was 17.91 (CI: 12.56–25.53), I 2=91.7%. Analysis of studies that used BMI cutoffs greater than or equal to30 had a pooled sensitivity of 0.42 (CI: 0.31–0.43) and a pooled specificity of 0.97 (CI: 0.96–0.97). 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 half of the people with excess BF%.

Keywords:

adiposity; body composition; body mass index; BMI; fat mass

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