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Revista Brasileira de Epidemiologia

Print version ISSN 1415-790X


LEAL, Danielle Biazzi; ASSIS, Maria Alice Altenburg de; CONDE, Wolney Lisboa  and  BELLISLE, France. Performance of references based on body mass index for detecting excess body fatness in schoolchildren aged 7 to10 years. Rev. bras. epidemiol. [online]. 2014, vol.17, n.2, pp.517-530. ISSN 1415-790X.


To compare the sensitivity and specificity of body mass index (BMI)-based classification systems and to determine the optimal cut-offs for predicting excess body fatness in schoolchildren.


2795 schoolchildren aged 7 - 10 years were examined. Excess body fatness was defined as the standardized residuals of the sum of three skinfold thickness ranking at or above the 90th percentile. The international BMI-based system recommended by the World Health Organization (WHO-2007) was evaluated on the basis of its sensitivity and specificity for detecting excess body fatness and compared with a national BMI reference (Brazil-2006). Likelihood ratios analysis was used to select the optimal cut-offs in each curve.


The two classification systems presented high sensitivity (92.5 - 98.6%) and moderate specificity (75.9 - 85.0%) for both sexes. The optimal BMI cut-offs improved specificity with no marked loss of sensitivity. Using the proposed BMI cut-offs, the post-test probability of predicting excess body fatness for children classified as non-overweight decreased from 10 (pre-test probability) to 1.4% in girls and to 1.1% in boys. For overweight children, this probability increased to more than 46.0%.


The results showed that both the WHO-2007 and Brazil-2006 classification systems can be used as screening instruments for excess body fatness, and that one of the limitations of using the BMI-for-age references could be improved by refining the existing cut-offs.

Keywords : Body Mass Index; Adiposity; Children; Sensitivity; Specificity; Likelihood ratio analysis.

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