title: Limitations of body mass index for counseling individuals with unilateral lower extremity amputation.
abstract: BACKGROUND
  Body composition is important for health screening, but appropriate methods for unilateral lower extremity amputees have not been validated.
  
  
  OBJECTIVE
  To compare body mass index adjusted using Amputee Coalition equations (body mass index-Amputee Coalition) to dual-energy X-ray absorptiometry in unilateral lower limb amputees.
  
  
  METHODS
  Cross-sectional, experimental.
  
  
  METHODS
  Thirty-eight men and women with lower limb amputations (transfemoral, transtibial, hip disarticulation, Symes) participated. Body mass index (mass/height2) was compared to body mass index corrected for limb loss (body mass index-Amputee Coalition). Accuracy of classification and extrapolation of percent body fat with body mass index was compared to dual-energy X-ray absorptiometry.
  
  
  RESULTS
  Body mass index-Amputee Coalition increased body mass index (by ~ 1.1 kg/m2) but underestimated and mis-classified 60% of obese and overestimated 100% of lean individuals according to dual-energy X-ray absorptiometry. Estimated mean percent body fat (95% confidence interval) from body mass index-Amputee Coalition (28.3% (24.9%, 31.7%)) was similar to dual-energy X-ray absorptiometry percent body fat (29.5% (25.2%, 33.7%)) but both were significantly higher ( p < 0.05) than percent body fat estimated from uncorrected body mass index (23.6% (20.4%, 26.8%)). However, total errors for body mass index and body mass index-Amputee Coalition converted to percent body fat were unacceptably large (standard error of the estimate = 6.8%, 6.2% body fat) and the discrepancy between both methods and dual-energy X-ray absorptiometry was inversely related ( r = -0.59 and r = -0.66, p < 0.05) to the individual's level of body fatness.
  
  
  CONCLUSIONS
  Body mass index (despite correction) underestimates health risk for obese patients and overestimates lean, muscular individuals with lower limb amputation. Clinical relevance Clinical recommendations for an ideal body mass based on body mass index-Amputee Coalition should not be relied upon in lower extremity amputees. This is of particular concern for obese lower extremity amputees whose health risk might be significantly underestimated based on body mass index despite a "correction" formula for limb loss.
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Alexandra P
authors.initials: AP
authors.lastname: Frost
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Norman Giest
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Ruta
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Teresa K
authors.initials: TK
authors.lastname: Snow
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Mindy
authors.initials: M
authors.lastname: Millard-Stafford
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D001823:Body Composition; D015992:Body Mass Index; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009765:Obesity; D018579:Patient Selection; D017755:Prosthesis Fitting / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Body fat; body composition; dual-energy X-ray absorptiometry; obesity