title: Sensitivity and Specificity of Body Mass Index as a Marker of Obesity in Elderly Patients on Hemodialysis.
abstract: OBJECTIVE
  Diagnosing obesity by body mass index (BMI) may not be reliable in elderly individuals due to the changes in body composition. We aimed to analyze the accuracy of BMI thresholds by World Health Organization (WHO) and Nutrition Screening Initiative (NSI) to diagnose obesity in elderly patients on hemodialysis (HD).
  
  
  METHODS
  Multicenter cross-sectional study.
  
  
  METHODS
  Six dialysis facilities.
  
  
  METHODS
  169 elderly on chronic HD (70.4 ± 7.1 years; 63.9% men).
  
  
  METHODS
  Total body fat percentage (BF%) was assessed by the sum of skinfold thicknesses and abdominal fat by waist circumference (WC). Both were used as reference to test the specificity and sensitivity of BMI thresholds (WHO: ≥30 kg/m(2); NSI: >27 kg/m(2)).
  
  
  RESULTS
  The prevalence of obesity according to NSI-BMI, WHO-BMI, BF%, and WC thresholds were 31%, 13%, 27%, and 29.6% in men, respectively, and 36%, 15%, 13%, and 75% in women. Compared to BF%, the sensitivity of NSI-BMI was moderate (65.5%) for men and high (100%) for women, whereas that of WHO-BMI was low (31%) for men and high (87.5%) for women. Compared with WC, NSI-BMI had good (75%) sensitivity for men and moderate (47.8%) for women, whereas WHO-BMI had moderate (43.8%) sensitivity for men and low (19.6%) for women. The best agreement with BF% was observed for NSI-BMI in men (kappa = 0.46) and for WHO-BMI in women (kappa = 0.80). For WC, the best agreement was for WHO-BMI for men (kappa = 0.63) and NSI-BMI for women (kappa = 0.31).
  
  
  CONCLUSIONS
  BMI thresholds do not accurately diagnose adiposity in elderly on HD. Therefore, using BMI may lead to misclassifications in this segment population.
authors.affiliation: Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil; Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Juliana
authors.initials: J
authors.lastname: Rodrigues
authors.affiliation: Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Santin
authors.affiliation: Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil; Department of Social Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: Flávia Santos
authors.initials: FS
authors.lastname: Barbosa Brito
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Carrero
authors.affiliation: Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Lilian
authors.initials: L
authors.lastname: Cuppari
authors.affiliation: Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil; Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil. Electronic address: carla.avesani@gmail.com.
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Avesani
mesh_terms: D015502:Absorptiometry, Photon; D000273:Adipose Tissue; D050154:Adiposity; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D006435:Renal Dialysis; D012680:Sensitivity and Specificity; D012885:Skinfold Thickness; D055105:Waist Circumference