Diagnostic Accuracy of Body Mass Index in Defining Childhood Obesity: Analysis of Cross-Sectional Data from Ghanaian Children

Adom, Theodosia; Kengne, André Pascal; Villiers, Anniza de; Boatin, Rose; Puoane, Thandi

doi:10.3390/ijerph17010036

Cited by 9 publications

(6 citation statements)

References 32 publications

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“…Based on WHtR as reference, pBMI was less sensitive (54.0%) to identifying obesity but was highly specific (97.5%) in discriminating non-obese adolescents in the population. This finding corroborates previous studies that have shown low sensitivity of pBMI in screening obesity in Ghanaian children when percentage of body fat was used as reference [ 41 ].…”

Section: Discussionsupporting

confidence: 92%

Assessment of Anthropometric Indices for Optimal Cut-Offs for Obesity Screening in a South African Adolescent Population

Engwa

Schmid‐Zalaudek

Chungag³

et al. 2021

Biology

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The assessment of obesity in sub-Saharan Africa relies on cut-offs established from western populations. This study assessed anthropometric indices to determine optimal cut-off values for obesity screening in the South African adolescent population. A cross-sectional study involving 1144 (796 females and 348 males) adolescents aged 11–17 years from the Eastern Cape Province of South African was conducted. Anthropometric parameters were measured. Receiver operating characteristic (ROC) analysis was performed to assess the sensitivity and specificity of obesity screening tools and establish cut-offs. The optimal cut-offs for obesity in the cohort using waist-to-height ratio (WHtR) as reference were: neck circumference (NC) = 30.6 cm, mid-upper arm circumference (MUAC) = 25.9 cm, waist circumference (WC) = 75.1 cm, hip circumference (HC) = 92.15 cm and body mass index percentile (pBMI) = p85.2th. The new pBMI cut-off value at p85.2th improved the sensitivity of the test by approximately 30% compared to the CDC recommended BMI percentile (pBMIr) of p95.0th. When pBMI was used as reference, the optimal cut-offs in the cohort were: WHtR = 0.481, NC = 30.95 cm, MUAC = 27.95 cm, WC = 76.1 cm and HC = 95.75 cm. The WHtR optimal cut-off of 0.481 was close to the recommended cut-off value of 0.5. The predicted prevalence of obesity obtained using cut-offs from ROC analysis was higher than those from recommended references. All cut-off values for the various anthropometric measures generally increased with age for all percentile ranges. This study reveals a lower pBMI cut-off value, different from the CDC recommended cut-off, for screening obesity in a South African adolescent population. The study has established that the optimal pBMI cut-off for obesity screening may be ethnic-specific.

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Section: Discussionsupporting

confidence: 92%

Assessment of Anthropometric Indices for Optimal Cut-Offs for Obesity Screening in a South African Adolescent Population

Engwa

Schmid‐Zalaudek

Chungag³

et al. 2021

Biology

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“…The IOTF and WGOC cut-offs, recommended for Asian and Chinese populations, respectively, were included. Although many studies used different BMI-based cut-offs such as WHO, IOTF and WGOC to describe the prevalence of childhood obesity, a small number of articles have carried out comparative studies among three or four sets of BMI cut-offs and drawn different conclusions for racial/ethnic groups (24)(25)(26)(27)(28)(29) . However, few studies made in-depth work on the performances of various BMI cut-offs and examine whether they differ by sex and age groups.…”

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confidence: 99%

Comparison of different BMI cut-offs to screen for child and adolescent obesity in urban China

Qian

Tan²,

et al. 2020

Public Health Nutr.

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Objectives: To determine which set of BMI cut-offs is the most appropriate to define child and adolescent obesity in urban China. Design: A cross-sectional study was carried out between 1 November and 31 December in 2017. Setting: Community Healthcare Center in Minhang District, Shanghai, China. Participants: A total of 12 426 children and adolescents aged 7–17 years were selected by cluster random sampling. Bioelectrical impedance analysis was the gold standard to measure body composition. Results: Comparisons of three sets of BMI cut-offs by sensitivity and κ value revealed that the Working Group on Obesity in China (WGOC) (sensitivity 39·9–84·0 %; κ 0·51–0·79) and WHO (sensitivity 25·5–74·5 %; κ 0·35–0·78) cut-offs were not superior to the International Obesity Task Force (IOTF) (sensitivity 47·9–92·4 %; κ 0·58–0·85) cut-offs across all subgroups. The WGOC and WHO cut-offs yielded higher misclassification rates, in the worst case, categorising 11·2 % of girls with high adiposity as normal and 44·4 % of them as overweight, while the IOTF cut-offs categorised 2·3 % as normal and 30·7 % as overweight. Individuals who were classified by the IOTF cut-offs as overweight had the lowest ratios of high adiposity (4·2–41·6 %) than by the BMI cut-offs for each subgroup. Among pubertal girls, none of the BMI-based cut-offs indicated excellent agreement with body fat percentage, and κ value of the WHO cut-offs (0·35 (95 % CI 0·29, 0·41)) was lower than the other two sets of BMI cut-offs (all P < 0·001). Conclusions: The IOTF cut-offs for Asian should be recommended for child obesity screening in urban China. Pubertal individuals need a more accurate indicator of obesity screening.

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“…The IOTF sample did not have any data from African countries, which was applied in the MULT BMI reference, making the MULT BMI reference the one with the most ethnically diverse sample (Cole et al, 2000). Regarding the applicability of IOTF BMI reference in Africans, a study using the deuterium dilution method to assess nutritional status in school-aged children from Ghana showed that IOTF growth charts did not achieve optimal rates for detecting obesity, presenting high rates of misclassification for the Ghanaians (Adom et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the use of older data collected from 1963 to 1974 and only from one population (United States) made the WHO 2007 growth charts for school‐aged children (from 5 years old) inaccurate for worldwide use (de Oliveira et al, 2022). Asian and African countries such as China, Pakistan, Iran, and Ghana have found greater divergences when comparing their growth patterns to the ones from WHO 2007, and studies conducted in European countries such as Slovakia, Italy, Poland and Portugal indicate the use of the IOTF BMI reference instead of the WHO growth reference for BMI (2007), as it screened overweight and obesity conditions better in their populations (Adom et al, 2020; Iftikhar et al, 2018; Ma et al, 2010; Minghelli et al, 2014; Mohammadi et al, 2020; Valerio et al, 2017; Woźniacka et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

MULT: A new BMI reference to assess nutritional status of multi‐ethnic children and adolescents

Oliveira

Araújo

Severo

et al. 2023

American J Hum Biol

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ObjectivesTo develop a new Body Mass Index (BMI) reference (MULT) based on longitudinal data of multi‐ethnic populations and to compare it to international BMI references.MethodsThe MULT BMI reference was constructed through the LMS method and the Generalized Additive Models for Location Scale and Shape (GAMLSS), with 81 310 observations of 17 505 subjects aged 0–22 years old, from the United Kingdom, Ethiopia, Peru, India, Vietnam, Brazil, and Portugal. Outlier values were removed based on weight z‐scores (population level) and based on BMI z‐scores using the linear mixed effects model (individual level). The MULT M, S and L curves were compared to the ones of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and Dutch Growth Study (DUTCH). The MULT BMI percentile cutoffs for overweight and obesity were calculated using the adult BMI values of 25 and 30 kg/m2 at 17, 18, 19, and 20 years old.ResultsMULT presented the lowest mean BMI values for the ages 102–240 months for boys and 114–220 months for girls. MULT S values were similar to the WHO and IOTF for children under 60 months of age and the highest during puberty, while the L curve showed to be more symmetric than the other BMI references.ConclusionThe MULT BMI reference was constructed based on recent data of populations from 10 countries, being a good option to assess the nutritional status of multi‐ethnic populations.

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Diagnostic Accuracy of Body Mass Index in Defining Childhood Obesity: Analysis of Cross-Sectional Data from Ghanaian Children

Cited by 9 publications

References 32 publications

Assessment of Anthropometric Indices for Optimal Cut-Offs for Obesity Screening in a South African Adolescent Population

Assessment of Anthropometric Indices for Optimal Cut-Offs for Obesity Screening in a South African Adolescent Population

Comparison of different BMI cut-offs to screen for child and adolescent obesity in urban China

MULT: A new BMI reference to assess nutritional status of multi‐ethnic children and adolescents

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