How well does the body adiposity index capture adiposity change in midlife women?: The SWAN fat patterning study

Abstract

OBJECTIVES The body adiposity index (BAI) is a proposed alternative to the body mass index (BMI) that has shown good cross-sectional agreement with percent body fat (%BF) in validation studies. The objective of this study was to examine the ability of BAI to track adiposity change over time in a biracial sample of midlife women. METHODS African-American (n=159) and Caucasian (n=206) women, aged 42–60 years, at the Chicago site of the Study of Women’s Health Across the Nation were followed from 2002–2008. BAI and BMI were calculated from measurements taken at annual assessments. %BF was quantified using whole-body dual-energy X-ray absorptiometry. Difference scores (BAIΔ, BMIΔ, and %BFΔ) quantified adiposity change over a mean of 1.6 (SD=0.7) years. Lin’s concordance correlation (ρc) and Bland-Altman limits-of-agreement assessed agreement between BAI and %BF. RESULTS In examining adiposity change, BAIΔ showed poor agreement with %BFΔ in the overall sample (ρc=.41), African-American women (ρc=.36), and Caucasian women (ρc=.43). BAIΔ estimated %BFΔ with minimal bias (+0.4%) but low precision (±6.3%BF limits-of-agreement). %BFΔ had weaker correlations with BAIΔ (r’s=.38 to .48) than with BMIΔ (r’s=.48 to .59). BAI and BMI showed similar cross-sectional associations with %BF in the overall sample and within each race (r’s>.74). CONCLUSIONS We conclude that BAI is less accurate than BMI in tracking adiposity change in midlife women, and would not be a suitable replacement for BMI in most research applications involving adiposity change.

Predictive Validity of the Body Adiposity Index in Overweight and Obese Adults Using Dual-Energy X-ray Absorptiometry

“…For example, previous studies in different populations [15,28,29,30,31]—such as European Americans [9,32,33], Mexican Americans [9,34], African Americans [28], and Latin Americans [12,15,16]—which have showed that BAI overestimates BF% at lower levels of adiposity. Similar to our findings, these studies showed that BAI underestimates BF% at higher levels of adiposity (Table 4) [15,31,32,35,36]. …”

Validity of body adiposity index in predicting body fat in Brazilians adults

“…BAI's ability to predict body fat has been analyzed in the literature, especially in relation to BMI. Some studies have shown that BAI is a better predictor of body fat when compared with BMI (Chang, Simonsick, Ferrucci, & Cooper, ; Dhaliwal, Welborn, Goh, & Howat, ; Godoy‐Matos et al, ; Johnson, Chumlea, Czerwinski, & Demerath, ; Silva et al, ; Sun et al, ;), while others have found a similar or higher capacity of BMI as a predictor of body fat when compared with BAI (Appelhans et al, ; Barreira et al, ; Freedman et al, ; Gibson, Atalayer, Flancbaum, & Geliebter, ; Lopez et al, ; Schulze & Stefan, ; Vinknes et al, ). In the present study, despite the strong correlation with DXA in men ( r = 0.72) and in women ( r = 0.78), BAI was not shown to be a better indicator of body fat than BMI.…”

Body Mass Index and Waist Circumference Rather Than Body Adiposity Index Are Better Surrogates for Body Adiposity in a Chinese Population

“…Suchanek and colleagues 32 reported that BMI is a better surrogate for body fat mass than BAI in a white population. Furthermore, a prospective investigation found that BAI was less accurate than BMI in tracking adiposity change in 159 African American and 206 white midlife women and would not be a suitable replacement for BMI in most research applications involving adiposity change 37 . BAI was also not a good index for %Bfat in athletic women 33 and has limitations for use in clinical settings for overweight/obese postmenopausal white women, 27 as well as morbidly obese patients 34 .…”