Indirect estimates of body composition are useful for groups but unreliable in individuals

OBJECTIVE: To assess the usefulness of the body mass index (BMI) in identifying individuals classified as overweight or obese based on estimates of body fat percentage (BF%) obtained by the deuterium dilution (BF%(DD)) method. In addition, to assess the accuracy of bioelectrical impedance analysis (BIA) and skinfold thickness (SFT) measurements in the estimation of body composition of Australians at the individual and group level. DESIGN: Cross-sectional study. SUBJECTS: One hundred and seventeen healthy Australian volunteers of European descent, comprising of 51 males and 66 females, ranging in age from 19 to 77 y. MEASUREMENTS: BMI was calculated from body weight and height. Fat-free mass (FFM) was estimated from measures of total body water (TBW) using deuterium dilution (FFMDD). SFT using the equations of Durnin and Womersley (Br J Nutr 1974; 32: 77 - 97) (FFMSFT), and BIA using the equations of Luhaski at al (J Appl Physiol 1986; 60: 1327 - 1332) (FFMLU), Segal et al (Am J Clin Nutr 1988; 47: 7 - 14) (FFMSe) and Heitmann (Eur J Clin Nutr 1990; 44: 831 - 837) (FFMHe). Estimates of fat mass (FM) were calculated as the difference between body weight and FFM, while BF% was calculated by expressing FM as a percentage of body weight. RESULTS: BMI had poor sensitivity and positive predictive value in identifying individuals as being overweight/obese as classified by BF%(DD). Furthermore, estimates of FFM (and hence FM) from BIA or SFT could not be used interchangeably with DD, without the risk of considerable error at the individual level. At the group level errors were relatively smaller, though statistically significant. While FFMSFT could be corrected by the addition of the bias (1.2 kg in males and 0.8 kg in females), no simple correction was possible with BIA estimates of FFM for any of the equations used. However, an accurate prediction of FFMDD was possible from the combination of FFMHe, biceps SFT and mid-arm circumference in both males and females. The bias of this prediction was small ( < 0.15 kg), statistically non-significant in both sexes, and unrelated to the mean FFM obtained by the two methods. The revision of Heitmann's estimate of FFM using anthropometric variables described in this study had the best sensitivity (79%), specificity (96%) and positive predictive value (92%) in identifying overweight/obese individuals in comparison to the other equations tested. CONCLUSION: BMI was a poor surrogate for body fatness in both males and females. The currently recommended equations for the prediction of body composition from SFT and BIA provided inaccurate estimates of FFM both at the individual and group level as compared to estimates from DD. However, Heitmann's equations, when combined with measures of the biceps SFT and mid-arm circumference, provided better estimates of FFM both at the individual and group level.