Author + information
- Bartosz Hudzik, MD, PhD⁎ (, )
- Piotr Rozentryt, MD, PhD,
- Andrzej Lekston, MD, PhD and
- Lech Poloński, MD, PhD
- ↵⁎Third Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Curie-Sklodowska 9, 41-800 Zabrze, Poland
We read with interest the paper by Gupta et al. (1). Adipose tissue is a major source of hormones and cytokines implicated in systemic inflammatory reactions, metabolic abnormalities, hypertension, and insulin resistance (2,3). The investigators use body mass index (BMI) to classify adiposity status. However, it is useful to re-evaluate how body fat is determined. Numerous studies have produced evidence that BMI has limited ability to accurately predict body composition.
So how fat is fat? BMI is the most commonly used measure to determine adiposity status in everyday clinical practice. It is a safe, convenient, and popular method. However, the index is an indirect surrogate of body fat, which is not able to distinguish lean body mass from fat mass. There is growing body of evidence that BMI may misclassify weight status in many patients (4–6). It tends to overestimate normal weight and underestimate overweight or obesity.
Dual-energy X-ray (DXA) absorptiometry is considered by many to be a gold standard for assessing body composition (direct measurement of total body fat and lean soft tissue mass). It provides a more accurate indication of body fat percentage, which is one of the fundamental links between obesity and its associated disease risk.
There are reports that those with elevated body fat percentage are at increased risk of developing cardiometabolic disease despite having a normal BMI (7).
When using BMI to determine adiposity status of our patients in clinical practice, it is important to keep in mind the possibility of misclassification that may lead to withholding or overusing preventive or therapeutic interventions.
- American College of Cardiology Foundation
- Gupta N.K.,
- de Lemos J.A.,
- Ayers C.R.,
- Abdullah S.,
- McGuire D.K.,
- Khera A.
- De Lorenzo A.,
- Bianchi A.,
- Maroni P.,
- et al.