Validation of a BMI cut-off point to predict an adverse cardiometabolic profile with adiposity measurements by dual-energy X-ray absorptiometry in Guatemalan children

Objective To identify a body fat percentage (%BF) threshold related to an adverse cardiometabolic profile and its surrogate BMI cut-off point. Design Cross-sectional study. Setting Two public schools in poor urban areas on the outskirts of Guatemala City. Subjects A convenience sample of ninety-three healthy, prepubertal, Ladino children (aged 7-12 years). Results Spearman correlations of cardiometabolic parameters were higher with %BF than with BMI-for-age Z-score. BMI-for-age Z-score and %BF were highly correlated (r=0·84). The %BF threshold that maximized sensitivity and specificity for predicting an adverse cardiometabolic profile (elevated homeostasis model assessment-insulin resistance index and/or total cholesterol:HDL-cholesterol ratio) according to receiver operating characteristic curve analysis was 36 %. The BMI-for-age Z-score cut-off point that maximized the prediction of BF ≥ 36 % by the same procedure was 1·5. The area under the curve (AUC) for %BF and for BMI data showed excellent accuracy to predict an adverse cardiometabolic profile (AUC 0·93 (sd 0·04)) and excess adiposity (AUC 0·95 (sd 0·02)). Conclusions Since BMI standards have limitations in screening for adiposity, specific cut-off points based on ethnic-/sex- and age-specific %BF thresholds are needed to better predict an adverse cardiometabolic profile.