European Heart Journal Advance Access first published online on July 10, 2007
This version published online on July 17, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm243
Diagnostic performance of body mass index to detect obesity in patients with coronary artery disease
1 Division of Cardiovascular Diseases, Department of Internal Medicine, Gonda 5-368, 200 First Street SW, Rochester, MN 55905, USA
2 Endocrine Research Unit, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN, USA
3 Department of Medicine, Atherosclerosis Research Unit, Karolinska Insititutet, Stockholm, Sweden
Received 26 January 2007; revised 30 April 2007; accepted 22 May 2007.
* Corresponding author. Tel: +1 507 284 8087; fax: +1 507 266 7929. E-mail address: lopez{at}mayo.edu
Background: Emerging evidence suggests that a mildly elevated body mass index (BMI), is related to improved survival and fewer cardiovascular events in patients with coronary artery disease (CAD). We hypothesize that these results are related to the poor diagnostic performance of BMI to detect adiposity, especially in the intermediate BMI ranges.
Methods and Results: A cross-sectional study of 95 patients with CAD referred to phase II cardiac rehabilitation. Body fat (BF)% was estimated by air displacement plethysmography. Height, weight, BMI and waist circumference were measured the same day. We calculated the correlation between BMI and both, BF% and lean mass and assessed the diagnostic performance of BMI to detect obesity defined as a BF% >25% in men and >35% in women. Although BMI had a good correlation with BF% (
= 0.66, P < 0.0001), it also had a good correlation with lean mass ( = 0.41, P < 0.0001), and BMI failed to discriminate between both (P-value = 0.72). A BMI 
30 kg/m2 had a good specificity (95%; 95% CI, 83–100) but a poor sensitivity (43%; 95% CI, 32–54) while a BMI 25 kg/m2 had a good sensitivity (91%; 95% CI, 84–97) but a poor specificity (65%; 95% CI, 42–88) to detect BF%-obesity.
Conclusions: In patients with CAD, BMI does not discriminate between BF% and lean mass, and a BMI < 30 kg/m2 is a poor index to diagnose obesity. These findings may explain the controversial findings that link mild elevations of BMI to better survival and fewer cardiovascular events in patients with CAD. Body composition techniques to accurately diagnose obesity in patients with CAD might be necessary.
Key Words: Obesity • Body fat • Body mass index • Diagnostic performance • Cardiovascular risk factor
The originally published version of this paper was incorrect. In Table 4, the negative predictive value and positive predictive value in the first row should read 59 and 97 respectively, instead of 5995 and 9795.
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