title: Nutritional status in sick children and adolescents is not accurately reflected by BMI-SDS.
abstract: OBJECTIVE
  Nutritional status provides helpful information of disease severity and treatment effectiveness. Body mass index standard deviation scores (BMI-SDS) provide an approximation of body composition and thus are frequently used to classify nutritional status of sick children and adolescents. However, the accuracy of estimating body composition in this population using BMI-SDS has not been assessed. Thus, this study aims to evaluate the accuracy of nutritional status classification in sick infants and adolescents using BMI-SDS, upon comparison to classification using percentage body fat (%BF) reference charts.
  
  
  METHODS
  BMI-SDS was calculated from anthropometric measurements and %BF was measured using dual-energy x-ray absorptiometry (DXA) for 393 sick children and adolescents (5 months-18 years). Subjects were classified by nutritional status (underweight, normal weight, overweight, and obese), using 2 methods: (1) BMI-SDS, based on age- and gender-specific percentiles, and (2) %BF reference charts (standard). Linear regression and a correlation analysis were conducted to compare agreement between both methods of nutritional status classification. %BF reference value comparisons were also made between 3 independent sources based on German, Canadian, and American study populations.
  
  
  RESULTS
  Correlation between nutritional status classification by BMI-SDS and %BF agreed moderately (r (2) = 0.75, 0.76 in boys and girls, respectively). The misclassification of nutritional status in sick children and adolescents using BMI-SDS was 27% when using German %BF references. Similar rates observed when using Canadian and American %BF references (24% and 23%, respectively).
  
  
  CONCLUSIONS
  Using BMI-SDS to determine nutritional status in a sick population is not considered an appropriate clinical tool for identifying individual underweight or overweight children or adolescents. However, BMI-SDS may be appropriate for longitudinal measurements or for screening purposes in large field studies. When accurate nutritional status classification of a sick patient is needed for clinical purposes, nutritional status will be assessed more accurately using methods that accurately measure %BF, such as DXA.
authors.affiliation: a Department of Neonatology and Pediatric Intensive Care , University Children's Hospital , Greifswald , GERMANY.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fusch
authors.forename: Preeya
authors.initials: P
authors.lastname: Raja
authors.forename: Nguyen Quang
authors.initials: NQ
authors.lastname: Dung
authors.forename: Nadina
authors.initials: N
authors.lastname: Karaolis-Danckert
authors.forename: Ronald
authors.initials: R
authors.lastname: Barr
authors.forename: Christoph
authors.initials: C
authors.lastname: Fusch
mesh_terms: D000293:Adolescent; D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D012016:Reference Values