Guest guest Posted March 4, 2011 Report Share Posted March 4, 2011 This does seem more useful than BMI but wouldn't hip circumfrence miss the very apple - build people, those who don't have much hip storage. The ethnic populations it has been tested with tend to have more caboose action than whites or Asians. (I am a pear and relate more to J Lo. than J An.) " Muffin top " problems in low rise jeans led to tops with a gathered lower waist-line to cover up the overflow. Fashion found a way to fix its own faux pas. R Vajda, R.D. ________________________________ To: RD-USA <rd-usa > Sent: Fri, March 4, 2011 4:08:09 PM Subject: New Obesity Index Proposed, But Further Work Needed US researchers have developed a new index of adiposity that they say is a more accurate measure of body fat than the traditionally used body-mass index (BMI); the latter is calculated by dividing weight by height [1]. Using measurements of hip circumference and height, the new body adiposity index (BAI) can be used to reflect percentage of body fat for adult men and women of differing ethnicities, without numerical correction or assessment of weight, say *Dr N Bergman* (University of Southern California, Los Angeles) and colleagues in their paper published online March 3, 2011 in *Obesity*. However, they note that further work will be needed to extend and confirm their findings--tested in Mexican Americans and African Americans--to whites and other ethnic groups and to assess the role of the new index in children. And " it remains to be seen if the BAI is a more useful predictor of health outcome, in both males and females, than other indexes of body adiposity, including the BMI itself. " *Height and Hip Size Most Strongly Relate to Percentage Adiposity * " We were interested in determining whether we could find an index of body adiposity that at least in some ways may be better than the BMI, which has been around since the 1840s " and is not a very accurate measure of adiposity in individual patients, Bergman explained to* heartwire *. BMI is particularly inaccurate in people with elevated lean body mass, such as athletes, and in children, and it cannot be generalized among different ethnic groups, he and his colleagues note. Bergman et al are not the first to propose an alternative to BMI. Waist circumference is widely thought to be a better indicator of cardiovascular risk than BMI, although some studies have shown them to be equally predictive. Other examples include the waist-to-hip ratio (WHR) and the waist-to-hip-to-height index, which have both been forwarded as potentially better measures of obesity than BMI. But critics have said that it is difficult and time-consuming to get very accurate measurements of waist and hip circumference and height and that BMI has remained popular because it is simple and fast. In their study, Bergman and colleagues used a large database, *BetaGene*, which consisted of relatives of Mexican Americans with gestational diabetes, to determine whether there might be a better index. They chose the Mexican American population because of its prevalence in Los Angeles, observing, " Most of the world population is nonwhite. " " We looked at which variables most strongly related to percent adiposity, and they were height and hip size. Because these variables were uncorrelated, we proposed a new index, the BAI, based upon these measures alone, " Bergman explains. *BAI Will Be Easy to Calculate* " We showed that the BAI, calculated as (hip circumference/height1.5)–18, was a good predictor of percent fat and worked for men and women, " he continues. The BAI also yielded the percentage of fat itself, rather than just a correlate (or index) of it, which is what the BMI does, he notes. The BAI was validated against the " gold standard " of dual-energy X-ray absorption (DEXA). " It will be very easy for a physician or a nurse practitioner to work out this index for individual patients, using a calculator, a computer program, or an iPhone app, " Bergman says. The researchers then went on to corroborate their findings in another population, the *Triglyceride and Cardiovascular Risk in African Americans*(TARA) study, and found that the behavior of the BAI was quite similar between the blacks in that population and the Hispanics in BetaGene. " Thus, we believe that we have presented evidence of accuracy at least in two ethnic populations, and further work on the generalizability of BAI to other groups is under way, " they state. It will also be important to see whether the index can reliably forecast percentage of adiposity in children and predict risk of cardiovascular disease, they note. medscape.com -- Ortiz, MS, RD *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> Check out my blog: mixture of deals and nutrition Made my own " funny but real " movie: Me interviewing a " potential " Dietetic student <http://www.xtranormal.com/watch/11216383/> *Healthy Diet at any Age: We are NOT just looking * *at the years people have behind them but also the * *quality of the years ahead of them.* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2011 Report Share Posted March 4, 2011 This does seem more useful than BMI but wouldn't hip circumfrence miss the very apple - build people, those who don't have much hip storage. The ethnic populations it has been tested with tend to have more caboose action than whites or Asians. (I am a pear and relate more to J Lo. than J An.) " Muffin top " problems in low rise jeans led to tops with a gathered lower waist-line to cover up the overflow. Fashion found a way to fix its own faux pas. R Vajda, R.D. ________________________________ To: RD-USA <rd-usa > Sent: Fri, March 4, 2011 4:08:09 PM Subject: New Obesity Index Proposed, But Further Work Needed US researchers have developed a new index of adiposity that they say is a more accurate measure of body fat than the traditionally used body-mass index (BMI); the latter is calculated by dividing weight by height [1]. Using measurements of hip circumference and height, the new body adiposity index (BAI) can be used to reflect percentage of body fat for adult men and women of differing ethnicities, without numerical correction or assessment of weight, say *Dr N Bergman* (University of Southern California, Los Angeles) and colleagues in their paper published online March 3, 2011 in *Obesity*. However, they note that further work will be needed to extend and confirm their findings--tested in Mexican Americans and African Americans--to whites and other ethnic groups and to assess the role of the new index in children. And " it remains to be seen if the BAI is a more useful predictor of health outcome, in both males and females, than other indexes of body adiposity, including the BMI itself. " *Height and Hip Size Most Strongly Relate to Percentage Adiposity * " We were interested in determining whether we could find an index of body adiposity that at least in some ways may be better than the BMI, which has been around since the 1840s " and is not a very accurate measure of adiposity in individual patients, Bergman explained to* heartwire *. BMI is particularly inaccurate in people with elevated lean body mass, such as athletes, and in children, and it cannot be generalized among different ethnic groups, he and his colleagues note. Bergman et al are not the first to propose an alternative to BMI. Waist circumference is widely thought to be a better indicator of cardiovascular risk than BMI, although some studies have shown them to be equally predictive. Other examples include the waist-to-hip ratio (WHR) and the waist-to-hip-to-height index, which have both been forwarded as potentially better measures of obesity than BMI. But critics have said that it is difficult and time-consuming to get very accurate measurements of waist and hip circumference and height and that BMI has remained popular because it is simple and fast. In their study, Bergman and colleagues used a large database, *BetaGene*, which consisted of relatives of Mexican Americans with gestational diabetes, to determine whether there might be a better index. They chose the Mexican American population because of its prevalence in Los Angeles, observing, " Most of the world population is nonwhite. " " We looked at which variables most strongly related to percent adiposity, and they were height and hip size. Because these variables were uncorrelated, we proposed a new index, the BAI, based upon these measures alone, " Bergman explains. *BAI Will Be Easy to Calculate* " We showed that the BAI, calculated as (hip circumference/height1.5)–18, was a good predictor of percent fat and worked for men and women, " he continues. The BAI also yielded the percentage of fat itself, rather than just a correlate (or index) of it, which is what the BMI does, he notes. The BAI was validated against the " gold standard " of dual-energy X-ray absorption (DEXA). " It will be very easy for a physician or a nurse practitioner to work out this index for individual patients, using a calculator, a computer program, or an iPhone app, " Bergman says. The researchers then went on to corroborate their findings in another population, the *Triglyceride and Cardiovascular Risk in African Americans*(TARA) study, and found that the behavior of the BAI was quite similar between the blacks in that population and the Hispanics in BetaGene. " Thus, we believe that we have presented evidence of accuracy at least in two ethnic populations, and further work on the generalizability of BAI to other groups is under way, " they state. It will also be important to see whether the index can reliably forecast percentage of adiposity in children and predict risk of cardiovascular disease, they note. medscape.com -- Ortiz, MS, RD *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> Check out my blog: mixture of deals and nutrition Made my own " funny but real " movie: Me interviewing a " potential " Dietetic student <http://www.xtranormal.com/watch/11216383/> *Healthy Diet at any Age: We are NOT just looking * *at the years people have behind them but also the * *quality of the years ahead of them.* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2011 Report Share Posted March 4, 2011 Exactly what I was thinking re: waist circumference would seem to be a better indicator.... On Fri, Mar 4, 2011 at 8:05 PM, Vajda wrote: > > > This does seem more useful than BMI but wouldn't hip circumfrence miss the > very > apple - build people, those who don't have much hip storage. The ethnic > populations it has been tested with tend to have more caboose action than > whites > or Asians. (I am a pear and relate more to J Lo. than J An.) > > " Muffin top " problems in low rise jeans led to tops with a gathered lower > waist-line to cover up the overflow. Fashion found a way to fix its own > faux > pas. > > R Vajda, R.D. > > > ________________________________ > > To: RD-USA <rd-usa > > Sent: Fri, March 4, 2011 4:08:09 PM > Subject: New Obesity Index Proposed, But Further Work Needed > > > US researchers have developed a new index of adiposity that they say is a > more accurate measure of body fat than the traditionally used body-mass > index (BMI); the latter is calculated by dividing weight by height [1]. > > Using measurements of hip circumference and height, the new body adiposity > index (BAI) can be used to reflect percentage of body fat for adult men and > women of differing ethnicities, without numerical correction or assessment > of weight, say *Dr N Bergman* (University of Southern California, > Los Angeles) and colleagues in their paper published online March 3, 2011 > in > *Obesity*. > > However, they note that further work will be needed to extend and confirm > their findings--tested in Mexican Americans and African Americans--to > whites > and other ethnic groups and to assess the role of the new index in > children. > And " it remains to be seen if the BAI is a more useful predictor of health > outcome, in both males and females, than other indexes of body adiposity, > including the BMI itself. " > > *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > > " We were interested in determining whether we could find an index of body > adiposity that at least in some ways may be better than the BMI, which has > been around since the 1840s " and is not a very accurate measure of > adiposity > in individual patients, Bergman explained to* heartwire *. BMI is > particularly inaccurate in people with elevated lean body mass, such as > athletes, and in children, and it cannot be generalized among different > ethnic groups, he and his colleagues note. > > Bergman et al are not the first to propose an alternative to BMI. Waist > circumference is widely thought to be a better indicator of cardiovascular > risk than BMI, although some studies have shown them to be equally > predictive. Other examples include the waist-to-hip ratio (WHR) and the > waist-to-hip-to-height index, which have both been forwarded as potentially > better measures of obesity than BMI. But critics have said that it is > difficult and time-consuming to get very accurate measurements of waist and > hip circumference and height and that BMI has remained popular because it > is > simple and fast. > > In their study, Bergman and colleagues used a large database, *BetaGene*, > which consisted of relatives of Mexican Americans with gestational > diabetes, > to determine whether there might be a better index. They chose the Mexican > American population because of its prevalence in Los Angeles, observing, > " Most of the world population is nonwhite. " > > " We looked at which variables most strongly related to percent adiposity, > and they were height and hip size. Because these variables were > uncorrelated, we proposed a new index, the BAI, based upon these measures > alone, " Bergman explains. > > *BAI Will Be Easy to Calculate* > > " We showed that the BAI, calculated as (hip circumference/height1.5)–18, > was > a good predictor of percent fat and worked for men and women, " he > continues. The BAI also yielded the percentage of fat itself, rather than > just a correlate (or index) of it, which is what the BMI does, he notes. > The > BAI was validated against the " gold standard " of dual-energy X-ray > absorption (DEXA). > > " It will be very easy for a physician or a nurse practitioner to work out > this index for individual patients, using a calculator, a computer program, > or an iPhone app, " Bergman says. > > The researchers then went on to corroborate their findings in another > population, the *Triglyceride and Cardiovascular Risk in African > Americans*(TARA) study, and found that the behavior of the BAI was > quite similar > between the blacks in that population and the Hispanics in BetaGene. > > " Thus, we believe that we have presented evidence of accuracy at least in > two ethnic populations, and further work on the generalizability of BAI to > other groups is under way, " they state. It will also be important to see > whether the index can reliably forecast percentage of adiposity in children > and predict risk of cardiovascular disease, they note. > > medscape.com > -- > Ortiz, MS, RD > *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > Check out my blog: mixture of deals and nutrition > Made my own " funny but real " movie: Me interviewing a " potential " Dietetic > student <http://www.xtranormal.com/watch/11216383/> > > *Healthy Diet at any Age: We are NOT just looking > > * > > *at the years people have behind them but also the > * > > *quality of the years ahead of them.* > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2011 Report Share Posted March 4, 2011 Exactly what I was thinking re: waist circumference would seem to be a better indicator.... On Fri, Mar 4, 2011 at 8:05 PM, Vajda wrote: > > > This does seem more useful than BMI but wouldn't hip circumfrence miss the > very > apple - build people, those who don't have much hip storage. The ethnic > populations it has been tested with tend to have more caboose action than > whites > or Asians. (I am a pear and relate more to J Lo. than J An.) > > " Muffin top " problems in low rise jeans led to tops with a gathered lower > waist-line to cover up the overflow. Fashion found a way to fix its own > faux > pas. > > R Vajda, R.D. > > > ________________________________ > > To: RD-USA <rd-usa > > Sent: Fri, March 4, 2011 4:08:09 PM > Subject: New Obesity Index Proposed, But Further Work Needed > > > US researchers have developed a new index of adiposity that they say is a > more accurate measure of body fat than the traditionally used body-mass > index (BMI); the latter is calculated by dividing weight by height [1]. > > Using measurements of hip circumference and height, the new body adiposity > index (BAI) can be used to reflect percentage of body fat for adult men and > women of differing ethnicities, without numerical correction or assessment > of weight, say *Dr N Bergman* (University of Southern California, > Los Angeles) and colleagues in their paper published online March 3, 2011 > in > *Obesity*. > > However, they note that further work will be needed to extend and confirm > their findings--tested in Mexican Americans and African Americans--to > whites > and other ethnic groups and to assess the role of the new index in > children. > And " it remains to be seen if the BAI is a more useful predictor of health > outcome, in both males and females, than other indexes of body adiposity, > including the BMI itself. " > > *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > > " We were interested in determining whether we could find an index of body > adiposity that at least in some ways may be better than the BMI, which has > been around since the 1840s " and is not a very accurate measure of > adiposity > in individual patients, Bergman explained to* heartwire *. BMI is > particularly inaccurate in people with elevated lean body mass, such as > athletes, and in children, and it cannot be generalized among different > ethnic groups, he and his colleagues note. > > Bergman et al are not the first to propose an alternative to BMI. Waist > circumference is widely thought to be a better indicator of cardiovascular > risk than BMI, although some studies have shown them to be equally > predictive. Other examples include the waist-to-hip ratio (WHR) and the > waist-to-hip-to-height index, which have both been forwarded as potentially > better measures of obesity than BMI. But critics have said that it is > difficult and time-consuming to get very accurate measurements of waist and > hip circumference and height and that BMI has remained popular because it > is > simple and fast. > > In their study, Bergman and colleagues used a large database, *BetaGene*, > which consisted of relatives of Mexican Americans with gestational > diabetes, > to determine whether there might be a better index. They chose the Mexican > American population because of its prevalence in Los Angeles, observing, > " Most of the world population is nonwhite. " > > " We looked at which variables most strongly related to percent adiposity, > and they were height and hip size. Because these variables were > uncorrelated, we proposed a new index, the BAI, based upon these measures > alone, " Bergman explains. > > *BAI Will Be Easy to Calculate* > > " We showed that the BAI, calculated as (hip circumference/height1.5)–18, > was > a good predictor of percent fat and worked for men and women, " he > continues. The BAI also yielded the percentage of fat itself, rather than > just a correlate (or index) of it, which is what the BMI does, he notes. > The > BAI was validated against the " gold standard " of dual-energy X-ray > absorption (DEXA). > > " It will be very easy for a physician or a nurse practitioner to work out > this index for individual patients, using a calculator, a computer program, > or an iPhone app, " Bergman says. > > The researchers then went on to corroborate their findings in another > population, the *Triglyceride and Cardiovascular Risk in African > Americans*(TARA) study, and found that the behavior of the BAI was > quite similar > between the blacks in that population and the Hispanics in BetaGene. > > " Thus, we believe that we have presented evidence of accuracy at least in > two ethnic populations, and further work on the generalizability of BAI to > other groups is under way, " they state. It will also be important to see > whether the index can reliably forecast percentage of adiposity in children > and predict risk of cardiovascular disease, they note. > > medscape.com > -- > Ortiz, MS, RD > *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > Check out my blog: mixture of deals and nutrition > Made my own " funny but real " movie: Me interviewing a " potential " Dietetic > student <http://www.xtranormal.com/watch/11216383/> > > *Healthy Diet at any Age: We are NOT just looking > > * > > *at the years people have behind them but also the > * > > *quality of the years ahead of them.* > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 I am glad to hear there is work towards new index.However, this one may work only for ambulating clients/outpt settings. Hospitalized pt...how will I measure them when they are bad bound. Someone might say " the RN would have to do that on the initial screening " but I have hard time getting the Ht & Wt on admission, hip circ...? I don't see it happen. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) To: rd-usa From: jennyvajda@... Date: Fri, 4 Mar 2011 17:05:49 -0800 Subject: Re: New Obesity Index Proposed, But Further Work Needed This does seem more useful than BMI but wouldn't hip circumfrence miss the very apple - build people, those who don't have much hip storage. The ethnic populations it has been tested with tend to have more caboose action than whites or Asians. (I am a pear and relate more to J Lo. than J An.) " Muffin top " problems in low rise jeans led to tops with a gathered lower waist-line to cover up the overflow. Fashion found a way to fix its own faux pas. R Vajda, R.D. ________________________________ To: RD-USA <rd-usa > Sent: Fri, March 4, 2011 4:08:09 PM Subject: New Obesity Index Proposed, But Further Work Needed US researchers have developed a new index of adiposity that they say is a more accurate measure of body fat than the traditionally used body-mass index (BMI); the latter is calculated by dividing weight by height [1]. Using measurements of hip circumference and height, the new body adiposity index (BAI) can be used to reflect percentage of body fat for adult men and women of differing ethnicities, without numerical correction or assessment of weight, say *Dr N Bergman* (University of Southern California, Los Angeles) and colleagues in their paper published online March 3, 2011 in *Obesity*. However, they note that further work will be needed to extend and confirm their findings--tested in Mexican Americans and African Americans--to whites and other ethnic groups and to assess the role of the new index in children. And " it remains to be seen if the BAI is a more useful predictor of health outcome, in both males and females, than other indexes of body adiposity, including the BMI itself. " *Height and Hip Size Most Strongly Relate to Percentage Adiposity * " We were interested in determining whether we could find an index of body adiposity that at least in some ways may be better than the BMI, which has been around since the 1840s " and is not a very accurate measure of adiposity in individual patients, Bergman explained to* heartwire *. BMI is particularly inaccurate in people with elevated lean body mass, such as athletes, and in children, and it cannot be generalized among different ethnic groups, he and his colleagues note. Bergman et al are not the first to propose an alternative to BMI. Waist circumference is widely thought to be a better indicator of cardiovascular risk than BMI, although some studies have shown them to be equally predictive. Other examples include the waist-to-hip ratio (WHR) and the waist-to-hip-to-height index, which have both been forwarded as potentially better measures of obesity than BMI. But critics have said that it is difficult and time-consuming to get very accurate measurements of waist and hip circumference and height and that BMI has remained popular because it is simple and fast. In their study, Bergman and colleagues used a large database, *BetaGene*, which consisted of relatives of Mexican Americans with gestational diabetes, to determine whether there might be a better index. They chose the Mexican American population because of its prevalence in Los Angeles, observing, " Most of the world population is nonwhite. " " We looked at which variables most strongly related to percent adiposity, and they were height and hip size. Because these variables were uncorrelated, we proposed a new index, the BAI, based upon these measures alone, " Bergman explains. *BAI Will Be Easy to Calculate* " We showed that the BAI, calculated as (hip circumference/height1.5)–18, was a good predictor of percent fat and worked for men and women, " he continues. The BAI also yielded the percentage of fat itself, rather than just a correlate (or index) of it, which is what the BMI does, he notes. The BAI was validated against the " gold standard " of dual-energy X-ray absorption (DEXA). " It will be very easy for a physician or a nurse practitioner to work out this index for individual patients, using a calculator, a computer program, or an iPhone app, " Bergman says. The researchers then went on to corroborate their findings in another population, the *Triglyceride and Cardiovascular Risk in African Americans*(TARA) study, and found that the behavior of the BAI was quite similar between the blacks in that population and the Hispanics in BetaGene. " Thus, we believe that we have presented evidence of accuracy at least in two ethnic populations, and further work on the generalizability of BAI to other groups is under way, " they state. It will also be important to see whether the index can reliably forecast percentage of adiposity in children and predict risk of cardiovascular disease, they note. medscape.com -- Ortiz, MS, RD *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> Check out my blog: mixture of deals and nutrition Made my own " funny but real " movie: Me interviewing a " potential " Dietetic student <http://www.xtranormal.com/watch/11216383/> *Healthy Diet at any Age: We are NOT just looking * *at the years people have behind them but also the * *quality of the years ahead of them.* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 I am glad to hear there is work towards new index.However, this one may work only for ambulating clients/outpt settings. Hospitalized pt...how will I measure them when they are bad bound. Someone might say " the RN would have to do that on the initial screening " but I have hard time getting the Ht & Wt on admission, hip circ...? I don't see it happen. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) To: rd-usa From: jennyvajda@... Date: Fri, 4 Mar 2011 17:05:49 -0800 Subject: Re: New Obesity Index Proposed, But Further Work Needed This does seem more useful than BMI but wouldn't hip circumfrence miss the very apple - build people, those who don't have much hip storage. The ethnic populations it has been tested with tend to have more caboose action than whites or Asians. (I am a pear and relate more to J Lo. than J An.) " Muffin top " problems in low rise jeans led to tops with a gathered lower waist-line to cover up the overflow. Fashion found a way to fix its own faux pas. R Vajda, R.D. ________________________________ To: RD-USA <rd-usa > Sent: Fri, March 4, 2011 4:08:09 PM Subject: New Obesity Index Proposed, But Further Work Needed US researchers have developed a new index of adiposity that they say is a more accurate measure of body fat than the traditionally used body-mass index (BMI); the latter is calculated by dividing weight by height [1]. Using measurements of hip circumference and height, the new body adiposity index (BAI) can be used to reflect percentage of body fat for adult men and women of differing ethnicities, without numerical correction or assessment of weight, say *Dr N Bergman* (University of Southern California, Los Angeles) and colleagues in their paper published online March 3, 2011 in *Obesity*. However, they note that further work will be needed to extend and confirm their findings--tested in Mexican Americans and African Americans--to whites and other ethnic groups and to assess the role of the new index in children. And " it remains to be seen if the BAI is a more useful predictor of health outcome, in both males and females, than other indexes of body adiposity, including the BMI itself. " *Height and Hip Size Most Strongly Relate to Percentage Adiposity * " We were interested in determining whether we could find an index of body adiposity that at least in some ways may be better than the BMI, which has been around since the 1840s " and is not a very accurate measure of adiposity in individual patients, Bergman explained to* heartwire *. BMI is particularly inaccurate in people with elevated lean body mass, such as athletes, and in children, and it cannot be generalized among different ethnic groups, he and his colleagues note. Bergman et al are not the first to propose an alternative to BMI. Waist circumference is widely thought to be a better indicator of cardiovascular risk than BMI, although some studies have shown them to be equally predictive. Other examples include the waist-to-hip ratio (WHR) and the waist-to-hip-to-height index, which have both been forwarded as potentially better measures of obesity than BMI. But critics have said that it is difficult and time-consuming to get very accurate measurements of waist and hip circumference and height and that BMI has remained popular because it is simple and fast. In their study, Bergman and colleagues used a large database, *BetaGene*, which consisted of relatives of Mexican Americans with gestational diabetes, to determine whether there might be a better index. They chose the Mexican American population because of its prevalence in Los Angeles, observing, " Most of the world population is nonwhite. " " We looked at which variables most strongly related to percent adiposity, and they were height and hip size. Because these variables were uncorrelated, we proposed a new index, the BAI, based upon these measures alone, " Bergman explains. *BAI Will Be Easy to Calculate* " We showed that the BAI, calculated as (hip circumference/height1.5)–18, was a good predictor of percent fat and worked for men and women, " he continues. The BAI also yielded the percentage of fat itself, rather than just a correlate (or index) of it, which is what the BMI does, he notes. The BAI was validated against the " gold standard " of dual-energy X-ray absorption (DEXA). " It will be very easy for a physician or a nurse practitioner to work out this index for individual patients, using a calculator, a computer program, or an iPhone app, " Bergman says. The researchers then went on to corroborate their findings in another population, the *Triglyceride and Cardiovascular Risk in African Americans*(TARA) study, and found that the behavior of the BAI was quite similar between the blacks in that population and the Hispanics in BetaGene. " Thus, we believe that we have presented evidence of accuracy at least in two ethnic populations, and further work on the generalizability of BAI to other groups is under way, " they state. It will also be important to see whether the index can reliably forecast percentage of adiposity in children and predict risk of cardiovascular disease, they note. medscape.com -- Ortiz, MS, RD *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> Check out my blog: mixture of deals and nutrition Made my own " funny but real " movie: Me interviewing a " potential " Dietetic student <http://www.xtranormal.com/watch/11216383/> *Healthy Diet at any Age: We are NOT just looking * *at the years people have behind them but also the * *quality of the years ahead of them.* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 But there will always be exceptions - amputees, bed-bound like you said, etc. > > I am glad to hear there is work towards new index.However, this one may > work only for ambulating clients/outpt settings. Hospitalized pt...how will > I measure them when they are bad bound. Someone might say " the RN would > have to do that on the initial screening " but I have hard time getting the > Ht & Wt on admission, hip circ...? I don't see it happen. > > Merav Levi, RD, MS, CDNA dietitian, not the food police. > http://www.linkedin.com/in/meravlevi > > " Life is not measured by the number of breath you take, but by the moments > that take your breath away. " - Carlin " People don't forget the truth, > they just become better in lying " (Revolutionary Road) > > > > > To: rd-usa > From: jennyvajda@... > Date: Fri, 4 Mar 2011 17:05:49 -0800 > Subject: Re: New Obesity Index Proposed, But Further Work Needed > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This does seem more useful than BMI but wouldn't hip circumfrence miss > the very > > apple - build people, those who don't have much hip storage. The ethnic > > populations it has been tested with tend to have more caboose action than > whites > > or Asians. (I am a pear and relate more to J Lo. than J An.) > > > > " Muffin top " problems in low rise jeans led to tops with a gathered lower > > waist-line to cover up the overflow. Fashion found a way to fix its own > faux > > pas. > > > > R Vajda, R.D. > > > > > > ________________________________ > > > > To: RD-USA <rd-usa > > > Sent: Fri, March 4, 2011 4:08:09 PM > > Subject: New Obesity Index Proposed, But Further Work Needed > > > > US researchers have developed a new index of adiposity that they say is a > > more accurate measure of body fat than the traditionally used body-mass > > index (BMI); the latter is calculated by dividing weight by height [1]. > > > > Using measurements of hip circumference and height, the new body adiposity > > index (BAI) can be used to reflect percentage of body fat for adult men and > > women of differing ethnicities, without numerical correction or assessment > > of weight, say *Dr N Bergman* (University of Southern California, > > Los Angeles) and colleagues in their paper published online March 3, 2011 > in > > *Obesity*. > > > > However, they note that further work will be needed to extend and confirm > > their findings--tested in Mexican Americans and African Americans--to > whites > > and other ethnic groups and to assess the role of the new index in > children. > > And " it remains to be seen if the BAI is a more useful predictor of health > > outcome, in both males and females, than other indexes of body adiposity, > > including the BMI itself. " > > > > *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > > > > " We were interested in determining whether we could find an index of body > > adiposity that at least in some ways may be better than the BMI, which has > > been around since the 1840s " and is not a very accurate measure of > adiposity > > in individual patients, Bergman explained to* heartwire *. BMI is > > particularly inaccurate in people with elevated lean body mass, such as > > athletes, and in children, and it cannot be generalized among different > > ethnic groups, he and his colleagues note. > > > > Bergman et al are not the first to propose an alternative to BMI. Waist > > circumference is widely thought to be a better indicator of cardiovascular > > risk than BMI, although some studies have shown them to be equally > > predictive. Other examples include the waist-to-hip ratio (WHR) and the > > waist-to-hip-to-height index, which have both been forwarded as potentially > > better measures of obesity than BMI. But critics have said that it is > > difficult and time-consuming to get very accurate measurements of waist and > > hip circumference and height and that BMI has remained popular because it > is > > simple and fast. > > > > In their study, Bergman and colleagues used a large database, *BetaGene*, > > which consisted of relatives of Mexican Americans with gestational > diabetes, > > to determine whether there might be a better index. They chose the Mexican > > American population because of its prevalence in Los Angeles, observing, > > " Most of the world population is nonwhite. " > > > > " We looked at which variables most strongly related to percent adiposity, > > and they were height and hip size. Because these variables were > > uncorrelated, we proposed a new index, the BAI, based upon these measures > > alone, " Bergman explains. > > > > *BAI Will Be Easy to Calculate* > > > > " We showed that the BAI, calculated as (hip circumference/height1.5)–18, > was > > a good predictor of percent fat and worked for men and women, " he > > continues. The BAI also yielded the percentage of fat itself, rather than > > just a correlate (or index) of it, which is what the BMI does, he notes. > The > > BAI was validated against the " gold standard " of dual-energy X-ray > > absorption (DEXA). > > > > " It will be very easy for a physician or a nurse practitioner to work out > > this index for individual patients, using a calculator, a computer program, > > or an iPhone app, " Bergman says. > > > > The researchers then went on to corroborate their findings in another > > population, the *Triglyceride and Cardiovascular Risk in African > > Americans*(TARA) study, and found that the behavior of the BAI was > > quite similar > > between the blacks in that population and the Hispanics in BetaGene. > > > > " Thus, we believe that we have presented evidence of accuracy at least in > > two ethnic populations, and further work on the generalizability of BAI to > > other groups is under way, " they state. It will also be important to see > > whether the index can reliably forecast percentage of adiposity in children > > and predict risk of cardiovascular disease, they note. > > > > medscape.com > > -- > > Ortiz, MS, RD > > *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > Check out my blog: mixture of deals and nutrition > > Made my own " funny but real " movie: Me interviewing a " potential " Dietetic > > student <http://www.xtranormal.com/watch/11216383/> > > > > *Healthy Diet at any Age: We are NOT just looking > > * > > > > *at the years people have behind them but also the > > * > > > > *quality of the years ahead of them.* > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 Merav, That's why we learn to interpret research. An index designed for use in healthy adults applies only to that population. Healthy adults. Pam Charney pcharney@... > But there will always be exceptions - amputees, bed-bound like you > said, > etc. > > > >> >> I am glad to hear there is work towards new index.However, this one >> may >> work only for ambulating clients/outpt settings. Hospitalized >> pt...how will >> I measure them when they are bad bound. Someone might say " the RN >> would >> have to do that on the initial screening " but I have hard time >> getting the >> Ht & Wt on admission, hip circ...? I don't see it happen. >> >> Merav Levi, RD, MS, CDNA dietitian, not the food police. >> http://www.linkedin.com/in/meravlevi >> >> " Life is not measured by the number of breath you take, but by the >> moments >> that take your breath away. " - Carlin " People don't forget >> the truth, >> they just become better in lying " (Revolutionary Road) >> >> >> >> >> To: rd-usa >> From: jennyvajda@... >> Date: Fri, 4 Mar 2011 17:05:49 -0800 >> Subject: Re: New Obesity Index Proposed, But Further Work >> Needed >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> This does seem more useful than BMI but wouldn't hip >> circumfrence miss >> the very >> >> apple - build people, those who don't have much hip storage. The >> ethnic >> >> populations it has been tested with tend to have more caboose >> action than >> whites >> >> or Asians. (I am a pear and relate more to J Lo. than J An.) >> >> >> >> " Muffin top " problems in low rise jeans led to tops with a gathered >> lower >> >> waist-line to cover up the overflow. Fashion found a way to fix its >> own >> faux >> >> pas. >> >> >> >> R Vajda, R.D. >> >> >> >> >> >> ________________________________ >> >> >> >> To: RD-USA <rd-usa > >> >> Sent: Fri, March 4, 2011 4:08:09 PM >> >> Subject: New Obesity Index Proposed, But Further Work Needed >> >> >> >> US researchers have developed a new index of adiposity that they >> say is a >> >> more accurate measure of body fat than the traditionally used body- >> mass >> >> index (BMI); the latter is calculated by dividing weight by height >> [1]. >> >> >> >> Using measurements of hip circumference and height, the new body >> adiposity >> >> index (BAI) can be used to reflect percentage of body fat for adult >> men and >> >> women of differing ethnicities, without numerical correction or >> assessment >> >> of weight, say *Dr N Bergman* (University of Southern >> California, >> >> Los Angeles) and colleagues in their paper published online March >> 3, 2011 >> in >> >> *Obesity*. >> >> >> >> However, they note that further work will be needed to extend and >> confirm >> >> their findings--tested in Mexican Americans and African Americans--to >> whites >> >> and other ethnic groups and to assess the role of the new index in >> children. >> >> And " it remains to be seen if the BAI is a more useful predictor of >> health >> >> outcome, in both males and females, than other indexes of body >> adiposity, >> >> including the BMI itself. " >> >> >> >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * >> >> >> >> " We were interested in determining whether we could find an index >> of body >> >> adiposity that at least in some ways may be better than the BMI, >> which has >> >> been around since the 1840s " and is not a very accurate measure of >> adiposity >> >> in individual patients, Bergman explained to* heartwire *. BMI is >> >> particularly inaccurate in people with elevated lean body mass, >> such as >> >> athletes, and in children, and it cannot be generalized among >> different >> >> ethnic groups, he and his colleagues note. >> >> >> >> Bergman et al are not the first to propose an alternative to BMI. >> Waist >> >> circumference is widely thought to be a better indicator of >> cardiovascular >> >> risk than BMI, although some studies have shown them to be equally >> >> predictive. Other examples include the waist-to-hip ratio (WHR) and >> the >> >> waist-to-hip-to-height index, which have both been forwarded as >> potentially >> >> better measures of obesity than BMI. But critics have said that it is >> >> difficult and time-consuming to get very accurate measurements of >> waist and >> >> hip circumference and height and that BMI has remained popular >> because it >> is >> >> simple and fast. >> >> >> >> In their study, Bergman and colleagues used a large database, >> *BetaGene*, >> >> which consisted of relatives of Mexican Americans with gestational >> diabetes, >> >> to determine whether there might be a better index. They chose the >> Mexican >> >> American population because of its prevalence in Los Angeles, >> observing, >> >> " Most of the world population is nonwhite. " >> >> >> >> " We looked at which variables most strongly related to percent >> adiposity, >> >> and they were height and hip size. Because these variables were >> >> uncorrelated, we proposed a new index, the BAI, based upon these >> measures >> >> alone, " Bergman explains. >> >> >> >> *BAI Will Be Easy to Calculate* >> >> >> >> " We showed that the BAI, calculated as (hip circumference/ >> height1.5)–18, >> was >> >> a good predictor of percent fat and worked for men and women, " he >> >> continues. The BAI also yielded the percentage of fat itself, >> rather than >> >> just a correlate (or index) of it, which is what the BMI does, he >> notes. >> The >> >> BAI was validated against the " gold standard " of dual-energy X-ray >> >> absorption (DEXA). >> >> >> >> " It will be very easy for a physician or a nurse practitioner to >> work out >> >> this index for individual patients, using a calculator, a computer >> program, >> >> or an iPhone app, " Bergman says. >> >> >> >> The researchers then went on to corroborate their findings in another >> >> population, the *Triglyceride and Cardiovascular Risk in African >> >> Americans*(TARA) study, and found that the behavior of the BAI was >> >> quite similar >> >> between the blacks in that population and the Hispanics in BetaGene. >> >> >> >> " Thus, we believe that we have presented evidence of accuracy at >> least in >> >> two ethnic populations, and further work on the generalizability of >> BAI to >> >> other groups is under way, " they state. It will also be important >> to see >> >> whether the index can reliably forecast percentage of adiposity in >> children >> >> and predict risk of cardiovascular disease, they note. >> >> >> >> medscape.com >> >> -- >> >> Ortiz, MS, RD >> >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> >> >> Check out my blog: mixture of deals and nutrition >> >> Made my own " funny but real " movie: Me interviewing a " potential " >> Dietetic >> >> student <http://www.xtranormal.com/watch/11216383/> >> >> >> >> *Healthy Diet at any Age: We are NOT just looking >> >> * >> >> >> >> *at the years people have behind them but also the >> >> * >> >> >> >> *quality of the years ahead of them.* >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 Merav, That's why we learn to interpret research. An index designed for use in healthy adults applies only to that population. Healthy adults. Pam Charney pcharney@... > But there will always be exceptions - amputees, bed-bound like you > said, > etc. > > > >> >> I am glad to hear there is work towards new index.However, this one >> may >> work only for ambulating clients/outpt settings. Hospitalized >> pt...how will >> I measure them when they are bad bound. Someone might say " the RN >> would >> have to do that on the initial screening " but I have hard time >> getting the >> Ht & Wt on admission, hip circ...? I don't see it happen. >> >> Merav Levi, RD, MS, CDNA dietitian, not the food police. >> http://www.linkedin.com/in/meravlevi >> >> " Life is not measured by the number of breath you take, but by the >> moments >> that take your breath away. " - Carlin " People don't forget >> the truth, >> they just become better in lying " (Revolutionary Road) >> >> >> >> >> To: rd-usa >> From: jennyvajda@... >> Date: Fri, 4 Mar 2011 17:05:49 -0800 >> Subject: Re: New Obesity Index Proposed, But Further Work >> Needed >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> This does seem more useful than BMI but wouldn't hip >> circumfrence miss >> the very >> >> apple - build people, those who don't have much hip storage. The >> ethnic >> >> populations it has been tested with tend to have more caboose >> action than >> whites >> >> or Asians. (I am a pear and relate more to J Lo. than J An.) >> >> >> >> " Muffin top " problems in low rise jeans led to tops with a gathered >> lower >> >> waist-line to cover up the overflow. Fashion found a way to fix its >> own >> faux >> >> pas. >> >> >> >> R Vajda, R.D. >> >> >> >> >> >> ________________________________ >> >> >> >> To: RD-USA <rd-usa > >> >> Sent: Fri, March 4, 2011 4:08:09 PM >> >> Subject: New Obesity Index Proposed, But Further Work Needed >> >> >> >> US researchers have developed a new index of adiposity that they >> say is a >> >> more accurate measure of body fat than the traditionally used body- >> mass >> >> index (BMI); the latter is calculated by dividing weight by height >> [1]. >> >> >> >> Using measurements of hip circumference and height, the new body >> adiposity >> >> index (BAI) can be used to reflect percentage of body fat for adult >> men and >> >> women of differing ethnicities, without numerical correction or >> assessment >> >> of weight, say *Dr N Bergman* (University of Southern >> California, >> >> Los Angeles) and colleagues in their paper published online March >> 3, 2011 >> in >> >> *Obesity*. >> >> >> >> However, they note that further work will be needed to extend and >> confirm >> >> their findings--tested in Mexican Americans and African Americans--to >> whites >> >> and other ethnic groups and to assess the role of the new index in >> children. >> >> And " it remains to be seen if the BAI is a more useful predictor of >> health >> >> outcome, in both males and females, than other indexes of body >> adiposity, >> >> including the BMI itself. " >> >> >> >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * >> >> >> >> " We were interested in determining whether we could find an index >> of body >> >> adiposity that at least in some ways may be better than the BMI, >> which has >> >> been around since the 1840s " and is not a very accurate measure of >> adiposity >> >> in individual patients, Bergman explained to* heartwire *. BMI is >> >> particularly inaccurate in people with elevated lean body mass, >> such as >> >> athletes, and in children, and it cannot be generalized among >> different >> >> ethnic groups, he and his colleagues note. >> >> >> >> Bergman et al are not the first to propose an alternative to BMI. >> Waist >> >> circumference is widely thought to be a better indicator of >> cardiovascular >> >> risk than BMI, although some studies have shown them to be equally >> >> predictive. Other examples include the waist-to-hip ratio (WHR) and >> the >> >> waist-to-hip-to-height index, which have both been forwarded as >> potentially >> >> better measures of obesity than BMI. But critics have said that it is >> >> difficult and time-consuming to get very accurate measurements of >> waist and >> >> hip circumference and height and that BMI has remained popular >> because it >> is >> >> simple and fast. >> >> >> >> In their study, Bergman and colleagues used a large database, >> *BetaGene*, >> >> which consisted of relatives of Mexican Americans with gestational >> diabetes, >> >> to determine whether there might be a better index. They chose the >> Mexican >> >> American population because of its prevalence in Los Angeles, >> observing, >> >> " Most of the world population is nonwhite. " >> >> >> >> " We looked at which variables most strongly related to percent >> adiposity, >> >> and they were height and hip size. Because these variables were >> >> uncorrelated, we proposed a new index, the BAI, based upon these >> measures >> >> alone, " Bergman explains. >> >> >> >> *BAI Will Be Easy to Calculate* >> >> >> >> " We showed that the BAI, calculated as (hip circumference/ >> height1.5)–18, >> was >> >> a good predictor of percent fat and worked for men and women, " he >> >> continues. The BAI also yielded the percentage of fat itself, >> rather than >> >> just a correlate (or index) of it, which is what the BMI does, he >> notes. >> The >> >> BAI was validated against the " gold standard " of dual-energy X-ray >> >> absorption (DEXA). >> >> >> >> " It will be very easy for a physician or a nurse practitioner to >> work out >> >> this index for individual patients, using a calculator, a computer >> program, >> >> or an iPhone app, " Bergman says. >> >> >> >> The researchers then went on to corroborate their findings in another >> >> population, the *Triglyceride and Cardiovascular Risk in African >> >> Americans*(TARA) study, and found that the behavior of the BAI was >> >> quite similar >> >> between the blacks in that population and the Hispanics in BetaGene. >> >> >> >> " Thus, we believe that we have presented evidence of accuracy at >> least in >> >> two ethnic populations, and further work on the generalizability of >> BAI to >> >> other groups is under way, " they state. It will also be important >> to see >> >> whether the index can reliably forecast percentage of adiposity in >> children >> >> and predict risk of cardiovascular disease, they note. >> >> >> >> medscape.com >> >> -- >> >> Ortiz, MS, RD >> >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> >> >> Check out my blog: mixture of deals and nutrition >> >> Made my own " funny but real " movie: Me interviewing a " potential " >> Dietetic >> >> student <http://www.xtranormal.com/watch/11216383/> >> >> >> >> *Healthy Diet at any Age: We are NOT just looking >> >> * >> >> >> >> *at the years people have behind them but also the >> >> * >> >> >> >> *quality of the years ahead of them.* >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 amputees we have calculations to correct, but bed bound you cannot measure to begin with.and was hoping for a better index, not one that excludes more ppl. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) > To: rd-usa > From: nrord1@... > Date: Sat, 5 Mar 2011 11:01:29 -0500 > Subject: Re: New Obesity Index Proposed, But Further Work Needed > > But there will always be exceptions - amputees, bed-bound like you said, > etc. > > > > > > > I am glad to hear there is work towards new index.However, this one may > > work only for ambulating clients/outpt settings. Hospitalized pt...how will > > I measure them when they are bad bound. Someone might say " the RN would > > have to do that on the initial screening " but I have hard time getting the > > Ht & Wt on admission, hip circ...? I don't see it happen. > > > > Merav Levi, RD, MS, CDNA dietitian, not the food police. > > http://www.linkedin.com/in/meravlevi > > > > " Life is not measured by the number of breath you take, but by the moments > > that take your breath away. " - Carlin " People don't forget the truth, > > they just become better in lying " (Revolutionary Road) > > > > > > > > > > To: rd-usa > > From: jennyvajda@... > > Date: Fri, 4 Mar 2011 17:05:49 -0800 > > Subject: Re: New Obesity Index Proposed, But Further Work Needed > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This does seem more useful than BMI but wouldn't hip circumfrence miss > > the very > > > > apple - build people, those who don't have much hip storage. The ethnic > > > > populations it has been tested with tend to have more caboose action than > > whites > > > > or Asians. (I am a pear and relate more to J Lo. than J An.) > > > > > > > > " Muffin top " problems in low rise jeans led to tops with a gathered lower > > > > waist-line to cover up the overflow. Fashion found a way to fix its own > > faux > > > > pas. > > > > > > > > R Vajda, R.D. > > > > > > > > > > > > ________________________________ > > > > > > > > To: RD-USA <rd-usa > > > > > Sent: Fri, March 4, 2011 4:08:09 PM > > > > Subject: New Obesity Index Proposed, But Further Work Needed > > > > > > > > US researchers have developed a new index of adiposity that they say is a > > > > more accurate measure of body fat than the traditionally used body-mass > > > > index (BMI); the latter is calculated by dividing weight by height [1]. > > > > > > > > Using measurements of hip circumference and height, the new body adiposity > > > > index (BAI) can be used to reflect percentage of body fat for adult men and > > > > women of differing ethnicities, without numerical correction or assessment > > > > of weight, say *Dr N Bergman* (University of Southern California, > > > > Los Angeles) and colleagues in their paper published online March 3, 2011 > > in > > > > *Obesity*. > > > > > > > > However, they note that further work will be needed to extend and confirm > > > > their findings--tested in Mexican Americans and African Americans--to > > whites > > > > and other ethnic groups and to assess the role of the new index in > > children. > > > > And " it remains to be seen if the BAI is a more useful predictor of health > > > > outcome, in both males and females, than other indexes of body adiposity, > > > > including the BMI itself. " > > > > > > > > *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > > > > > > > > " We were interested in determining whether we could find an index of body > > > > adiposity that at least in some ways may be better than the BMI, which has > > > > been around since the 1840s " and is not a very accurate measure of > > adiposity > > > > in individual patients, Bergman explained to* heartwire *. BMI is > > > > particularly inaccurate in people with elevated lean body mass, such as > > > > athletes, and in children, and it cannot be generalized among different > > > > ethnic groups, he and his colleagues note. > > > > > > > > Bergman et al are not the first to propose an alternative to BMI. Waist > > > > circumference is widely thought to be a better indicator of cardiovascular > > > > risk than BMI, although some studies have shown them to be equally > > > > predictive. Other examples include the waist-to-hip ratio (WHR) and the > > > > waist-to-hip-to-height index, which have both been forwarded as potentially > > > > better measures of obesity than BMI. But critics have said that it is > > > > difficult and time-consuming to get very accurate measurements of waist and > > > > hip circumference and height and that BMI has remained popular because it > > is > > > > simple and fast. > > > > > > > > In their study, Bergman and colleagues used a large database, *BetaGene*, > > > > which consisted of relatives of Mexican Americans with gestational > > diabetes, > > > > to determine whether there might be a better index. They chose the Mexican > > > > American population because of its prevalence in Los Angeles, observing, > > > > " Most of the world population is nonwhite. " > > > > > > > > " We looked at which variables most strongly related to percent adiposity, > > > > and they were height and hip size. Because these variables were > > > > uncorrelated, we proposed a new index, the BAI, based upon these measures > > > > alone, " Bergman explains. > > > > > > > > *BAI Will Be Easy to Calculate* > > > > > > > > " We showed that the BAI, calculated as (hip circumference/height1.5)–18, > > was > > > > a good predictor of percent fat and worked for men and women, " he > > > > continues. The BAI also yielded the percentage of fat itself, rather than > > > > just a correlate (or index) of it, which is what the BMI does, he notes. > > The > > > > BAI was validated against the " gold standard " of dual-energy X-ray > > > > absorption (DEXA). > > > > > > > > " It will be very easy for a physician or a nurse practitioner to work out > > > > this index for individual patients, using a calculator, a computer program, > > > > or an iPhone app, " Bergman says. > > > > > > > > The researchers then went on to corroborate their findings in another > > > > population, the *Triglyceride and Cardiovascular Risk in African > > > > Americans*(TARA) study, and found that the behavior of the BAI was > > > > quite similar > > > > between the blacks in that population and the Hispanics in BetaGene. > > > > > > > > " Thus, we believe that we have presented evidence of accuracy at least in > > > > two ethnic populations, and further work on the generalizability of BAI to > > > > other groups is under way, " they state. It will also be important to see > > > > whether the index can reliably forecast percentage of adiposity in children > > > > and predict risk of cardiovascular disease, they note. > > > > > > > > medscape.com > > > > -- > > > > Ortiz, MS, RD > > > > *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > > > Check out my blog: mixture of deals and nutrition > > > > Made my own " funny but real " movie: Me interviewing a " potential " Dietetic > > > > student <http://www.xtranormal.com/watch/11216383/> > > > > > > > > *Healthy Diet at any Age: We are NOT just looking > > > > * > > > > > > > > *at the years people have behind them but also the > > > > * > > > > > > > > *quality of the years ahead of them.* > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 amputees we have calculations to correct, but bed bound you cannot measure to begin with.and was hoping for a better index, not one that excludes more ppl. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) > To: rd-usa > From: nrord1@... > Date: Sat, 5 Mar 2011 11:01:29 -0500 > Subject: Re: New Obesity Index Proposed, But Further Work Needed > > But there will always be exceptions - amputees, bed-bound like you said, > etc. > > > > > > > I am glad to hear there is work towards new index.However, this one may > > work only for ambulating clients/outpt settings. Hospitalized pt...how will > > I measure them when they are bad bound. Someone might say " the RN would > > have to do that on the initial screening " but I have hard time getting the > > Ht & Wt on admission, hip circ...? I don't see it happen. > > > > Merav Levi, RD, MS, CDNA dietitian, not the food police. > > http://www.linkedin.com/in/meravlevi > > > > " Life is not measured by the number of breath you take, but by the moments > > that take your breath away. " - Carlin " People don't forget the truth, > > they just become better in lying " (Revolutionary Road) > > > > > > > > > > To: rd-usa > > From: jennyvajda@... > > Date: Fri, 4 Mar 2011 17:05:49 -0800 > > Subject: Re: New Obesity Index Proposed, But Further Work Needed > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > This does seem more useful than BMI but wouldn't hip circumfrence miss > > the very > > > > apple - build people, those who don't have much hip storage. The ethnic > > > > populations it has been tested with tend to have more caboose action than > > whites > > > > or Asians. (I am a pear and relate more to J Lo. than J An.) > > > > > > > > " Muffin top " problems in low rise jeans led to tops with a gathered lower > > > > waist-line to cover up the overflow. Fashion found a way to fix its own > > faux > > > > pas. > > > > > > > > R Vajda, R.D. > > > > > > > > > > > > ________________________________ > > > > > > > > To: RD-USA <rd-usa > > > > > Sent: Fri, March 4, 2011 4:08:09 PM > > > > Subject: New Obesity Index Proposed, But Further Work Needed > > > > > > > > US researchers have developed a new index of adiposity that they say is a > > > > more accurate measure of body fat than the traditionally used body-mass > > > > index (BMI); the latter is calculated by dividing weight by height [1]. > > > > > > > > Using measurements of hip circumference and height, the new body adiposity > > > > index (BAI) can be used to reflect percentage of body fat for adult men and > > > > women of differing ethnicities, without numerical correction or assessment > > > > of weight, say *Dr N Bergman* (University of Southern California, > > > > Los Angeles) and colleagues in their paper published online March 3, 2011 > > in > > > > *Obesity*. > > > > > > > > However, they note that further work will be needed to extend and confirm > > > > their findings--tested in Mexican Americans and African Americans--to > > whites > > > > and other ethnic groups and to assess the role of the new index in > > children. > > > > And " it remains to be seen if the BAI is a more useful predictor of health > > > > outcome, in both males and females, than other indexes of body adiposity, > > > > including the BMI itself. " > > > > > > > > *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > > > > > > > > " We were interested in determining whether we could find an index of body > > > > adiposity that at least in some ways may be better than the BMI, which has > > > > been around since the 1840s " and is not a very accurate measure of > > adiposity > > > > in individual patients, Bergman explained to* heartwire *. BMI is > > > > particularly inaccurate in people with elevated lean body mass, such as > > > > athletes, and in children, and it cannot be generalized among different > > > > ethnic groups, he and his colleagues note. > > > > > > > > Bergman et al are not the first to propose an alternative to BMI. Waist > > > > circumference is widely thought to be a better indicator of cardiovascular > > > > risk than BMI, although some studies have shown them to be equally > > > > predictive. Other examples include the waist-to-hip ratio (WHR) and the > > > > waist-to-hip-to-height index, which have both been forwarded as potentially > > > > better measures of obesity than BMI. But critics have said that it is > > > > difficult and time-consuming to get very accurate measurements of waist and > > > > hip circumference and height and that BMI has remained popular because it > > is > > > > simple and fast. > > > > > > > > In their study, Bergman and colleagues used a large database, *BetaGene*, > > > > which consisted of relatives of Mexican Americans with gestational > > diabetes, > > > > to determine whether there might be a better index. They chose the Mexican > > > > American population because of its prevalence in Los Angeles, observing, > > > > " Most of the world population is nonwhite. " > > > > > > > > " We looked at which variables most strongly related to percent adiposity, > > > > and they were height and hip size. Because these variables were > > > > uncorrelated, we proposed a new index, the BAI, based upon these measures > > > > alone, " Bergman explains. > > > > > > > > *BAI Will Be Easy to Calculate* > > > > > > > > " We showed that the BAI, calculated as (hip circumference/height1.5)–18, > > was > > > > a good predictor of percent fat and worked for men and women, " he > > > > continues. The BAI also yielded the percentage of fat itself, rather than > > > > just a correlate (or index) of it, which is what the BMI does, he notes. > > The > > > > BAI was validated against the " gold standard " of dual-energy X-ray > > > > absorption (DEXA). > > > > > > > > " It will be very easy for a physician or a nurse practitioner to work out > > > > this index for individual patients, using a calculator, a computer program, > > > > or an iPhone app, " Bergman says. > > > > > > > > The researchers then went on to corroborate their findings in another > > > > population, the *Triglyceride and Cardiovascular Risk in African > > > > Americans*(TARA) study, and found that the behavior of the BAI was > > > > quite similar > > > > between the blacks in that population and the Hispanics in BetaGene. > > > > > > > > " Thus, we believe that we have presented evidence of accuracy at least in > > > > two ethnic populations, and further work on the generalizability of BAI to > > > > other groups is under way, " they state. It will also be important to see > > > > whether the index can reliably forecast percentage of adiposity in children > > > > and predict risk of cardiovascular disease, they note. > > > > > > > > medscape.com > > > > -- > > > > Ortiz, MS, RD > > > > *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > > > Check out my blog: mixture of deals and nutrition > > > > Made my own " funny but real " movie: Me interviewing a " potential " Dietetic > > > > student <http://www.xtranormal.com/watch/11216383/> > > > > > > > > *Healthy Diet at any Age: We are NOT just looking > > > > * > > > > > > > > *at the years people have behind them but also the > > > > * > > > > > > > > *quality of the years ahead of them.* > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 OK. Thanks for the clarification. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) To: rd-usa From: pcharney@... Date: Sat, 5 Mar 2011 08:06:12 -0800 Subject: Re: New Obesity Index Proposed, But Further Work Needed Merav, That's why we learn to interpret research. An index designed for use in healthy adults applies only to that population. Healthy adults. Pam Charney pcharney@... > But there will always be exceptions - amputees, bed-bound like you > said, > etc. > > > >> >> I am glad to hear there is work towards new index.However, this one >> may >> work only for ambulating clients/outpt settings. Hospitalized >> pt...how will >> I measure them when they are bad bound. Someone might say " the RN >> would >> have to do that on the initial screening " but I have hard time >> getting the >> Ht & Wt on admission, hip circ...? I don't see it happen. >> >> Merav Levi, RD, MS, CDNA dietitian, not the food police. >> http://www.linkedin.com/in/meravlevi >> >> " Life is not measured by the number of breath you take, but by the >> moments >> that take your breath away. " - Carlin " People don't forget >> the truth, >> they just become better in lying " (Revolutionary Road) >> >> >> >> >> To: rd-usa >> From: jennyvajda@... >> Date: Fri, 4 Mar 2011 17:05:49 -0800 >> Subject: Re: New Obesity Index Proposed, But Further Work >> Needed >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> This does seem more useful than BMI but wouldn't hip >> circumfrence miss >> the very >> >> apple - build people, those who don't have much hip storage. The >> ethnic >> >> populations it has been tested with tend to have more caboose >> action than >> whites >> >> or Asians. (I am a pear and relate more to J Lo. than J An.) >> >> >> >> " Muffin top " problems in low rise jeans led to tops with a gathered >> lower >> >> waist-line to cover up the overflow. Fashion found a way to fix its >> own >> faux >> >> pas. >> >> >> >> R Vajda, R.D. >> >> >> >> >> >> ________________________________ >> >> >> >> To: RD-USA <rd-usa > >> >> Sent: Fri, March 4, 2011 4:08:09 PM >> >> Subject: New Obesity Index Proposed, But Further Work Needed >> >> >> >> US researchers have developed a new index of adiposity that they >> say is a >> >> more accurate measure of body fat than the traditionally used body- >> mass >> >> index (BMI); the latter is calculated by dividing weight by height >> [1]. >> >> >> >> Using measurements of hip circumference and height, the new body >> adiposity >> >> index (BAI) can be used to reflect percentage of body fat for adult >> men and >> >> women of differing ethnicities, without numerical correction or >> assessment >> >> of weight, say *Dr N Bergman* (University of Southern >> California, >> >> Los Angeles) and colleagues in their paper published online March >> 3, 2011 >> in >> >> *Obesity*. >> >> >> >> However, they note that further work will be needed to extend and >> confirm >> >> their findings--tested in Mexican Americans and African Americans--to >> whites >> >> and other ethnic groups and to assess the role of the new index in >> children. >> >> And " it remains to be seen if the BAI is a more useful predictor of >> health >> >> outcome, in both males and females, than other indexes of body >> adiposity, >> >> including the BMI itself. " >> >> >> >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * >> >> >> >> " We were interested in determining whether we could find an index >> of body >> >> adiposity that at least in some ways may be better than the BMI, >> which has >> >> been around since the 1840s " and is not a very accurate measure of >> adiposity >> >> in individual patients, Bergman explained to* heartwire *. BMI is >> >> particularly inaccurate in people with elevated lean body mass, >> such as >> >> athletes, and in children, and it cannot be generalized among >> different >> >> ethnic groups, he and his colleagues note. >> >> >> >> Bergman et al are not the first to propose an alternative to BMI. >> Waist >> >> circumference is widely thought to be a better indicator of >> cardiovascular >> >> risk than BMI, although some studies have shown them to be equally >> >> predictive. Other examples include the waist-to-hip ratio (WHR) and >> the >> >> waist-to-hip-to-height index, which have both been forwarded as >> potentially >> >> better measures of obesity than BMI. But critics have said that it is >> >> difficult and time-consuming to get very accurate measurements of >> waist and >> >> hip circumference and height and that BMI has remained popular >> because it >> is >> >> simple and fast. >> >> >> >> In their study, Bergman and colleagues used a large database, >> *BetaGene*, >> >> which consisted of relatives of Mexican Americans with gestational >> diabetes, >> >> to determine whether there might be a better index. They chose the >> Mexican >> >> American population because of its prevalence in Los Angeles, >> observing, >> >> " Most of the world population is nonwhite. " >> >> >> >> " We looked at which variables most strongly related to percent >> adiposity, >> >> and they were height and hip size. Because these variables were >> >> uncorrelated, we proposed a new index, the BAI, based upon these >> measures >> >> alone, " Bergman explains. >> >> >> >> *BAI Will Be Easy to Calculate* >> >> >> >> " We showed that the BAI, calculated as (hip circumference/ >> height1.5)–18, >> was >> >> a good predictor of percent fat and worked for men and women, " he >> >> continues. The BAI also yielded the percentage of fat itself, >> rather than >> >> just a correlate (or index) of it, which is what the BMI does, he >> notes. >> The >> >> BAI was validated against the " gold standard " of dual-energy X-ray >> >> absorption (DEXA). >> >> >> >> " It will be very easy for a physician or a nurse practitioner to >> work out >> >> this index for individual patients, using a calculator, a computer >> program, >> >> or an iPhone app, " Bergman says. >> >> >> >> The researchers then went on to corroborate their findings in another >> >> population, the *Triglyceride and Cardiovascular Risk in African >> >> Americans*(TARA) study, and found that the behavior of the BAI was >> >> quite similar >> >> between the blacks in that population and the Hispanics in BetaGene. >> >> >> >> " Thus, we believe that we have presented evidence of accuracy at >> least in >> >> two ethnic populations, and further work on the generalizability of >> BAI to >> >> other groups is under way, " they state. It will also be important >> to see >> >> whether the index can reliably forecast percentage of adiposity in >> children >> >> and predict risk of cardiovascular disease, they note. >> >> >> >> medscape.com >> >> -- >> >> Ortiz, MS, RD >> >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> >> >> Check out my blog: mixture of deals and nutrition >> >> Made my own " funny but real " movie: Me interviewing a " potential " >> Dietetic >> >> student <http://www.xtranormal.com/watch/11216383/> >> >> >> >> *Healthy Diet at any Age: We are NOT just looking >> >> * >> >> >> >> *at the years people have behind them but also the >> >> * >> >> >> >> *quality of the years ahead of them.* >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 OK. Thanks for the clarification. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) To: rd-usa From: pcharney@... Date: Sat, 5 Mar 2011 08:06:12 -0800 Subject: Re: New Obesity Index Proposed, But Further Work Needed Merav, That's why we learn to interpret research. An index designed for use in healthy adults applies only to that population. Healthy adults. Pam Charney pcharney@... > But there will always be exceptions - amputees, bed-bound like you > said, > etc. > > > >> >> I am glad to hear there is work towards new index.However, this one >> may >> work only for ambulating clients/outpt settings. Hospitalized >> pt...how will >> I measure them when they are bad bound. Someone might say " the RN >> would >> have to do that on the initial screening " but I have hard time >> getting the >> Ht & Wt on admission, hip circ...? I don't see it happen. >> >> Merav Levi, RD, MS, CDNA dietitian, not the food police. >> http://www.linkedin.com/in/meravlevi >> >> " Life is not measured by the number of breath you take, but by the >> moments >> that take your breath away. " - Carlin " People don't forget >> the truth, >> they just become better in lying " (Revolutionary Road) >> >> >> >> >> To: rd-usa >> From: jennyvajda@... >> Date: Fri, 4 Mar 2011 17:05:49 -0800 >> Subject: Re: New Obesity Index Proposed, But Further Work >> Needed >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> This does seem more useful than BMI but wouldn't hip >> circumfrence miss >> the very >> >> apple - build people, those who don't have much hip storage. The >> ethnic >> >> populations it has been tested with tend to have more caboose >> action than >> whites >> >> or Asians. (I am a pear and relate more to J Lo. than J An.) >> >> >> >> " Muffin top " problems in low rise jeans led to tops with a gathered >> lower >> >> waist-line to cover up the overflow. Fashion found a way to fix its >> own >> faux >> >> pas. >> >> >> >> R Vajda, R.D. >> >> >> >> >> >> ________________________________ >> >> >> >> To: RD-USA <rd-usa > >> >> Sent: Fri, March 4, 2011 4:08:09 PM >> >> Subject: New Obesity Index Proposed, But Further Work Needed >> >> >> >> US researchers have developed a new index of adiposity that they >> say is a >> >> more accurate measure of body fat than the traditionally used body- >> mass >> >> index (BMI); the latter is calculated by dividing weight by height >> [1]. >> >> >> >> Using measurements of hip circumference and height, the new body >> adiposity >> >> index (BAI) can be used to reflect percentage of body fat for adult >> men and >> >> women of differing ethnicities, without numerical correction or >> assessment >> >> of weight, say *Dr N Bergman* (University of Southern >> California, >> >> Los Angeles) and colleagues in their paper published online March >> 3, 2011 >> in >> >> *Obesity*. >> >> >> >> However, they note that further work will be needed to extend and >> confirm >> >> their findings--tested in Mexican Americans and African Americans--to >> whites >> >> and other ethnic groups and to assess the role of the new index in >> children. >> >> And " it remains to be seen if the BAI is a more useful predictor of >> health >> >> outcome, in both males and females, than other indexes of body >> adiposity, >> >> including the BMI itself. " >> >> >> >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * >> >> >> >> " We were interested in determining whether we could find an index >> of body >> >> adiposity that at least in some ways may be better than the BMI, >> which has >> >> been around since the 1840s " and is not a very accurate measure of >> adiposity >> >> in individual patients, Bergman explained to* heartwire *. BMI is >> >> particularly inaccurate in people with elevated lean body mass, >> such as >> >> athletes, and in children, and it cannot be generalized among >> different >> >> ethnic groups, he and his colleagues note. >> >> >> >> Bergman et al are not the first to propose an alternative to BMI. >> Waist >> >> circumference is widely thought to be a better indicator of >> cardiovascular >> >> risk than BMI, although some studies have shown them to be equally >> >> predictive. Other examples include the waist-to-hip ratio (WHR) and >> the >> >> waist-to-hip-to-height index, which have both been forwarded as >> potentially >> >> better measures of obesity than BMI. But critics have said that it is >> >> difficult and time-consuming to get very accurate measurements of >> waist and >> >> hip circumference and height and that BMI has remained popular >> because it >> is >> >> simple and fast. >> >> >> >> In their study, Bergman and colleagues used a large database, >> *BetaGene*, >> >> which consisted of relatives of Mexican Americans with gestational >> diabetes, >> >> to determine whether there might be a better index. They chose the >> Mexican >> >> American population because of its prevalence in Los Angeles, >> observing, >> >> " Most of the world population is nonwhite. " >> >> >> >> " We looked at which variables most strongly related to percent >> adiposity, >> >> and they were height and hip size. Because these variables were >> >> uncorrelated, we proposed a new index, the BAI, based upon these >> measures >> >> alone, " Bergman explains. >> >> >> >> *BAI Will Be Easy to Calculate* >> >> >> >> " We showed that the BAI, calculated as (hip circumference/ >> height1.5)–18, >> was >> >> a good predictor of percent fat and worked for men and women, " he >> >> continues. The BAI also yielded the percentage of fat itself, >> rather than >> >> just a correlate (or index) of it, which is what the BMI does, he >> notes. >> The >> >> BAI was validated against the " gold standard " of dual-energy X-ray >> >> absorption (DEXA). >> >> >> >> " It will be very easy for a physician or a nurse practitioner to >> work out >> >> this index for individual patients, using a calculator, a computer >> program, >> >> or an iPhone app, " Bergman says. >> >> >> >> The researchers then went on to corroborate their findings in another >> >> population, the *Triglyceride and Cardiovascular Risk in African >> >> Americans*(TARA) study, and found that the behavior of the BAI was >> >> quite similar >> >> between the blacks in that population and the Hispanics in BetaGene. >> >> >> >> " Thus, we believe that we have presented evidence of accuracy at >> least in >> >> two ethnic populations, and further work on the generalizability of >> BAI to >> >> other groups is under way, " they state. It will also be important >> to see >> >> whether the index can reliably forecast percentage of adiposity in >> children >> >> and predict risk of cardiovascular disease, they note. >> >> >> >> medscape.com >> >> -- >> >> Ortiz, MS, RD >> >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> >> >> Check out my blog: mixture of deals and nutrition >> >> Made my own " funny but real " movie: Me interviewing a " potential " >> Dietetic >> >> student <http://www.xtranormal.com/watch/11216383/> >> >> >> >> *Healthy Diet at any Age: We are NOT just looking >> >> * >> >> >> >> *at the years people have behind them but also the >> >> * >> >> >> >> *quality of the years ahead of them.* >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 Pam, You may be correct, but just to play the devil's advocate, I'm now forced to calculate BMI for 80 to 90 year olds, when we all agree (except CMS evidently) that this is not a good indicator of weight status for the elderly. Furthermore, I always seem to be in disagreement with the MDS 3.0 calculation and determination of weight status. So, how does our analysis as nutrition experts come into play in this case? I see the new index as just another way to automate and take away one of more area within our expertise. I do agree we must use all available markers, but disagree with having to accept the cookie-cutter standard if my opinion differs. Digna From: rd-usa [mailto:rd-usa ] On Behalf Of Pam Charney Sent: Saturday, March 05, 2011 8:06 AM To: rd-usa Subject: Re: New Obesity Index Proposed, But Further Work Needed Merav, That's why we learn to interpret research. An index designed for use in healthy adults applies only to that population. Healthy adults. Pam Charney pcharney@... <mailto:pcharney%40mac.com> > But there will always be exceptions - amputees, bed-bound like you > said, > etc. > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... <mailto:meravls%40msn.com> > wrote: > >> >> I am glad to hear there is work towards new index.However, this one >> may >> work only for ambulating clients/outpt settings. Hospitalized >> pt...how will >> I measure them when they are bad bound. Someone might say " the RN >> would >> have to do that on the initial screening " but I have hard time >> getting the >> Ht & Wt on admission, hip circ...? I don't see it happen. >> >> Merav Levi, RD, MS, CDNA dietitian, not the food police. >> http://www.linkedin.com/in/meravlevi >> >> " Life is not measured by the number of breath you take, but by the >> moments >> that take your breath away. " - Carlin " People don't forget >> the truth, >> they just become better in lying " (Revolutionary Road) >> >> >> >> >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net> >> Date: Fri, 4 Mar 2011 17:05:49 -0800 >> Subject: Re: New Obesity Index Proposed, But Further Work >> Needed >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> This does seem more useful than BMI but wouldn't hip >> circumfrence miss >> the very >> >> apple - build people, those who don't have much hip storage. The >> ethnic >> >> populations it has been tested with tend to have more caboose >> action than >> whites >> >> or Asians. (I am a pear and relate more to J Lo. than J An.) >> >> >> >> " Muffin top " problems in low rise jeans led to tops with a gathered >> lower >> >> waist-line to cover up the overflow. Fashion found a way to fix its >> own >> faux >> >> pas. >> >> >> >> R Vajda, R.D. >> >> >> >> >> >> ________________________________ >> >> From: Ortiz <nrord1@... <mailto:nrord1%40gmail.com> > >> >> To: RD-USA <rd-usa <mailto:rd-usa%40yahoogroups.com> > >> >> Sent: Fri, March 4, 2011 4:08:09 PM >> >> Subject: New Obesity Index Proposed, But Further Work Needed >> >> >> >> US researchers have developed a new index of adiposity that they >> say is a >> >> more accurate measure of body fat than the traditionally used body- >> mass >> >> index (BMI); the latter is calculated by dividing weight by height >> [1]. >> >> >> >> Using measurements of hip circumference and height, the new body >> adiposity >> >> index (BAI) can be used to reflect percentage of body fat for adult >> men and >> >> women of differing ethnicities, without numerical correction or >> assessment >> >> of weight, say *Dr N Bergman* (University of Southern >> California, >> >> Los Angeles) and colleagues in their paper published online March >> 3, 2011 >> in >> >> *Obesity*. >> >> >> >> However, they note that further work will be needed to extend and >> confirm >> >> their findings--tested in Mexican Americans and African Americans--to >> whites >> >> and other ethnic groups and to assess the role of the new index in >> children. >> >> And " it remains to be seen if the BAI is a more useful predictor of >> health >> >> outcome, in both males and females, than other indexes of body >> adiposity, >> >> including the BMI itself. " >> >> >> >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * >> >> >> >> " We were interested in determining whether we could find an index >> of body >> >> adiposity that at least in some ways may be better than the BMI, >> which has >> >> been around since the 1840s " and is not a very accurate measure of >> adiposity >> >> in individual patients, Bergman explained to* heartwire *. BMI is >> >> particularly inaccurate in people with elevated lean body mass, >> such as >> >> athletes, and in children, and it cannot be generalized among >> different >> >> ethnic groups, he and his colleagues note. >> >> >> >> Bergman et al are not the first to propose an alternative to BMI. >> Waist >> >> circumference is widely thought to be a better indicator of >> cardiovascular >> >> risk than BMI, although some studies have shown them to be equally >> >> predictive. Other examples include the waist-to-hip ratio (WHR) and >> the >> >> waist-to-hip-to-height index, which have both been forwarded as >> potentially >> >> better measures of obesity than BMI. But critics have said that it is >> >> difficult and time-consuming to get very accurate measurements of >> waist and >> >> hip circumference and height and that BMI has remained popular >> because it >> is >> >> simple and fast. >> >> >> >> In their study, Bergman and colleagues used a large database, >> *BetaGene*, >> >> which consisted of relatives of Mexican Americans with gestational >> diabetes, >> >> to determine whether there might be a better index. They chose the >> Mexican >> >> American population because of its prevalence in Los Angeles, >> observing, >> >> " Most of the world population is nonwhite. " >> >> >> >> " We looked at which variables most strongly related to percent >> adiposity, >> >> and they were height and hip size. Because these variables were >> >> uncorrelated, we proposed a new index, the BAI, based upon these >> measures >> >> alone, " Bergman explains. >> >> >> >> *BAI Will Be Easy to Calculate* >> >> >> >> " We showed that the BAI, calculated as (hip circumference/ >> height1.5)-18, >> was >> >> a good predictor of percent fat and worked for men and women, " he >> >> continues. The BAI also yielded the percentage of fat itself, >> rather than >> >> just a correlate (or index) of it, which is what the BMI does, he >> notes. >> The >> >> BAI was validated against the " gold standard " of dual-energy X-ray >> >> absorption (DEXA). >> >> >> >> " It will be very easy for a physician or a nurse practitioner to >> work out >> >> this index for individual patients, using a calculator, a computer >> program, >> >> or an iPhone app, " Bergman says. >> >> >> >> The researchers then went on to corroborate their findings in another >> >> population, the *Triglyceride and Cardiovascular Risk in African >> >> Americans*(TARA) study, and found that the behavior of the BAI was >> >> quite similar >> >> between the blacks in that population and the Hispanics in BetaGene. >> >> >> >> " Thus, we believe that we have presented evidence of accuracy at >> least in >> >> two ethnic populations, and further work on the generalizability of >> BAI to >> >> other groups is under way, " they state. It will also be important >> to see >> >> whether the index can reliably forecast percentage of adiposity in >> children >> >> and predict risk of cardiovascular disease, they note. >> >> >> >> medscape.com >> >> -- >> >> Ortiz, MS, RD >> >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> >> >> Check out my blog: mixture of deals and nutrition >> >> Made my own " funny but real " movie: Me interviewing a " potential " >> Dietetic >> >> student <http://www.xtranormal.com/watch/11216383/> >> >> >> >> *Healthy Diet at any Age: We are NOT just looking >> >> * >> >> >> >> *at the years people have behind them but also the >> >> * >> >> >> >> *quality of the years ahead of them.* >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 Maybe hip circumference (ideally two people and a flexible, but non-stretchy tape measure with a little grip rather than slip to the fabric) would be more accurate than waist circ. (or BMI) in the ill population as well as health. The waist circumference could be monitored for edema changes and the hip might represent catabolic weight loss change. For better results an intake mst for baseline comparison to the individual's future mst change would be more useful than comparison to an " average " person. The prevalence of edema and dehydration in the elderly makes tracking weight frequently seem useless. I am not an expert on measuring the elderly but I have measured thousands of babies, children and women. And examined tape measures at every store in town trying to find flat, non-stretchy, but more than 60 inches, to tape to the wall, to comply with federal regulations. (never found, used more tape on the curved metal hardware style.) The mid-arm circumference band is used for head circumference as well, and it has the nice slot to hold the end in place but the plastic is slippery on the skin. Is the mid-arm circumference band used to track edema in the lower leg or weight loss change in catabolic patients (elderly but also anorexics or alcoholics)? R Vajda, R.D. ________________________________ To: rd-usa Sent: Sat, March 5, 2011 11:46:58 AM Subject: RE: New Obesity Index Proposed, But Further Work Needed Pam, You may be correct, but just to play the devil's advocate, I'm now forced to calculate BMI for 80 to 90 year olds, when we all agree (except CMS evidently) that this is not a good indicator of weight status for the elderly. Furthermore, I always seem to be in disagreement with the MDS 3.0 calculation and determination of weight status. So, how does our analysis as nutrition experts come into play in this case? I see the new index as just another way to automate and take away one of more area within our expertise. I do agree we must use all available markers, but disagree with having to accept the cookie-cutter standard if my opinion differs. Digna From: rd-usa [mailto:rd-usa ] On Behalf Of Pam Charney Sent: Saturday, March 05, 2011 8:06 AM To: rd-usa Subject: Re: New Obesity Index Proposed, But Further Work Needed Merav, That's why we learn to interpret research. An index designed for use in healthy adults applies only to that population. Healthy adults. Pam Charney pcharney@... <mailto:pcharney%40mac.com> > But there will always be exceptions - amputees, bed-bound like you > said, > etc. > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... <mailto:meravls%40msn.com> > wrote: > >> >> I am glad to hear there is work towards new index.However, this one >> may >> work only for ambulating clients/outpt settings. Hospitalized >> pt...how will >> I measure them when they are bad bound. Someone might say " the RN >> would >> have to do that on the initial screening " but I have hard time >> getting the >> Ht & Wt on admission, hip circ...? I don't see it happen. >> >> Merav Levi, RD, MS, CDNA dietitian, not the food police. >> http://www.linkedin.com/in/meravlevi >> >> " Life is not measured by the number of breath you take, but by the >> moments >> that take your breath away. " - Carlin " People don't forget >> the truth, >> they just become better in lying " (Revolutionary Road) >> >> >> >> >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net> >> Date: Fri, 4 Mar 2011 17:05:49 -0800 >> Subject: Re: New Obesity Index Proposed, But Further Work >> Needed >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> This does seem more useful than BMI but wouldn't hip >> circumfrence miss >> the very >> >> apple - build people, those who don't have much hip storage. The >> ethnic >> >> populations it has been tested with tend to have more caboose >> action than >> whites >> >> or Asians. (I am a pear and relate more to J Lo. than J An.) >> >> >> >> " Muffin top " problems in low rise jeans led to tops with a gathered >> lower >> >> waist-line to cover up the overflow. Fashion found a way to fix its >> own >> faux >> >> pas. >> >> >> >> R Vajda, R.D. >> >> >> >> >> >> ________________________________ >> >> From: Ortiz <nrord1@... <mailto:nrord1%40gmail.com> > >> >> To: RD-USA <rd-usa <mailto:rd-usa%40yahoogroups.com> > >> >> Sent: Fri, March 4, 2011 4:08:09 PM >> >> Subject: New Obesity Index Proposed, But Further Work Needed >> >> >> >> US researchers have developed a new index of adiposity that they >> say is a >> >> more accurate measure of body fat than the traditionally used body- >> mass >> >> index (BMI); the latter is calculated by dividing weight by height >> [1]. >> >> >> >> Using measurements of hip circumference and height, the new body >> adiposity >> >> index (BAI) can be used to reflect percentage of body fat for adult >> men and >> >> women of differing ethnicities, without numerical correction or >> assessment >> >> of weight, say *Dr N Bergman* (University of Southern >> California, >> >> Los Angeles) and colleagues in their paper published online March >> 3, 2011 >> in >> >> *Obesity*. >> >> >> >> However, they note that further work will be needed to extend and >> confirm >> >> their findings--tested in Mexican Americans and African Americans--to >> whites >> >> and other ethnic groups and to assess the role of the new index in >> children. >> >> And " it remains to be seen if the BAI is a more useful predictor of >> health >> >> outcome, in both males and females, than other indexes of body >> adiposity, >> >> including the BMI itself. " >> >> >> >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * >> >> >> >> " We were interested in determining whether we could find an index >> of body >> >> adiposity that at least in some ways may be better than the BMI, >> which has >> >> been around since the 1840s " and is not a very accurate measure of >> adiposity >> >> in individual patients, Bergman explained to* heartwire *. BMI is >> >> particularly inaccurate in people with elevated lean body mass, >> such as >> >> athletes, and in children, and it cannot be generalized among >> different >> >> ethnic groups, he and his colleagues note. >> >> >> >> Bergman et al are not the first to propose an alternative to BMI. >> Waist >> >> circumference is widely thought to be a better indicator of >> cardiovascular >> >> risk than BMI, although some studies have shown them to be equally >> >> predictive. Other examples include the waist-to-hip ratio (WHR) and >> the >> >> waist-to-hip-to-height index, which have both been forwarded as >> potentially >> >> better measures of obesity than BMI. But critics have said that it is >> >> difficult and time-consuming to get very accurate measurements of >> waist and >> >> hip circumference and height and that BMI has remained popular >> because it >> is >> >> simple and fast. >> >> >> >> In their study, Bergman and colleagues used a large database, >> *BetaGene*, >> >> which consisted of relatives of Mexican Americans with gestational >> diabetes, >> >> to determine whether there might be a better index. They chose the >> Mexican >> >> American population because of its prevalence in Los Angeles, >> observing, >> >> " Most of the world population is nonwhite. " >> >> >> >> " We looked at which variables most strongly related to percent >> adiposity, >> >> and they were height and hip size. Because these variables were >> >> uncorrelated, we proposed a new index, the BAI, based upon these >> measures >> >> alone, " Bergman explains. >> >> >> >> *BAI Will Be Easy to Calculate* >> >> >> >> " We showed that the BAI, calculated as (hip circumference/ >> height1.5)-18, >> was >> >> a good predictor of percent fat and worked for men and women, " he >> >> continues. The BAI also yielded the percentage of fat itself, >> rather than >> >> just a correlate (or index) of it, which is what the BMI does, he >> notes. >> The >> >> BAI was validated against the " gold standard " of dual-energy X-ray >> >> absorption (DEXA). >> >> >> >> " It will be very easy for a physician or a nurse practitioner to >> work out >> >> this index for individual patients, using a calculator, a computer >> program, >> >> or an iPhone app, " Bergman says. >> >> >> >> The researchers then went on to corroborate their findings in another >> >> population, the *Triglyceride and Cardiovascular Risk in African >> >> Americans*(TARA) study, and found that the behavior of the BAI was >> >> quite similar >> >> between the blacks in that population and the Hispanics in BetaGene. >> >> >> >> " Thus, we believe that we have presented evidence of accuracy at >> least in >> >> two ethnic populations, and further work on the generalizability of >> BAI to >> >> other groups is under way, " they state. It will also be important >> to see >> >> whether the index can reliably forecast percentage of adiposity in >> children >> >> and predict risk of cardiovascular disease, they note. >> >> >> >> medscape.com >> >> -- >> >> Ortiz, MS, RD >> >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> >> >> Check out my blog: mixture of deals and nutrition >> >> Made my own " funny but real " movie: Me interviewing a " potential " >> Dietetic >> >> student <http://www.xtranormal.com/watch/11216383/> >> >> >> >> *Healthy Diet at any Age: We are NOT just looking >> >> * >> >> >> >> *at the years people have behind them but also the >> >> * >> >> >> >> *quality of the years ahead of them.* >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 Maybe hip circumference (ideally two people and a flexible, but non-stretchy tape measure with a little grip rather than slip to the fabric) would be more accurate than waist circ. (or BMI) in the ill population as well as health. The waist circumference could be monitored for edema changes and the hip might represent catabolic weight loss change. For better results an intake mst for baseline comparison to the individual's future mst change would be more useful than comparison to an " average " person. The prevalence of edema and dehydration in the elderly makes tracking weight frequently seem useless. I am not an expert on measuring the elderly but I have measured thousands of babies, children and women. And examined tape measures at every store in town trying to find flat, non-stretchy, but more than 60 inches, to tape to the wall, to comply with federal regulations. (never found, used more tape on the curved metal hardware style.) The mid-arm circumference band is used for head circumference as well, and it has the nice slot to hold the end in place but the plastic is slippery on the skin. Is the mid-arm circumference band used to track edema in the lower leg or weight loss change in catabolic patients (elderly but also anorexics or alcoholics)? R Vajda, R.D. ________________________________ To: rd-usa Sent: Sat, March 5, 2011 11:46:58 AM Subject: RE: New Obesity Index Proposed, But Further Work Needed Pam, You may be correct, but just to play the devil's advocate, I'm now forced to calculate BMI for 80 to 90 year olds, when we all agree (except CMS evidently) that this is not a good indicator of weight status for the elderly. Furthermore, I always seem to be in disagreement with the MDS 3.0 calculation and determination of weight status. So, how does our analysis as nutrition experts come into play in this case? I see the new index as just another way to automate and take away one of more area within our expertise. I do agree we must use all available markers, but disagree with having to accept the cookie-cutter standard if my opinion differs. Digna From: rd-usa [mailto:rd-usa ] On Behalf Of Pam Charney Sent: Saturday, March 05, 2011 8:06 AM To: rd-usa Subject: Re: New Obesity Index Proposed, But Further Work Needed Merav, That's why we learn to interpret research. An index designed for use in healthy adults applies only to that population. Healthy adults. Pam Charney pcharney@... <mailto:pcharney%40mac.com> > But there will always be exceptions - amputees, bed-bound like you > said, > etc. > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... <mailto:meravls%40msn.com> > wrote: > >> >> I am glad to hear there is work towards new index.However, this one >> may >> work only for ambulating clients/outpt settings. Hospitalized >> pt...how will >> I measure them when they are bad bound. Someone might say " the RN >> would >> have to do that on the initial screening " but I have hard time >> getting the >> Ht & Wt on admission, hip circ...? I don't see it happen. >> >> Merav Levi, RD, MS, CDNA dietitian, not the food police. >> http://www.linkedin.com/in/meravlevi >> >> " Life is not measured by the number of breath you take, but by the >> moments >> that take your breath away. " - Carlin " People don't forget >> the truth, >> they just become better in lying " (Revolutionary Road) >> >> >> >> >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net> >> Date: Fri, 4 Mar 2011 17:05:49 -0800 >> Subject: Re: New Obesity Index Proposed, But Further Work >> Needed >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> >> This does seem more useful than BMI but wouldn't hip >> circumfrence miss >> the very >> >> apple - build people, those who don't have much hip storage. The >> ethnic >> >> populations it has been tested with tend to have more caboose >> action than >> whites >> >> or Asians. (I am a pear and relate more to J Lo. than J An.) >> >> >> >> " Muffin top " problems in low rise jeans led to tops with a gathered >> lower >> >> waist-line to cover up the overflow. Fashion found a way to fix its >> own >> faux >> >> pas. >> >> >> >> R Vajda, R.D. >> >> >> >> >> >> ________________________________ >> >> From: Ortiz <nrord1@... <mailto:nrord1%40gmail.com> > >> >> To: RD-USA <rd-usa <mailto:rd-usa%40yahoogroups.com> > >> >> Sent: Fri, March 4, 2011 4:08:09 PM >> >> Subject: New Obesity Index Proposed, But Further Work Needed >> >> >> >> US researchers have developed a new index of adiposity that they >> say is a >> >> more accurate measure of body fat than the traditionally used body- >> mass >> >> index (BMI); the latter is calculated by dividing weight by height >> [1]. >> >> >> >> Using measurements of hip circumference and height, the new body >> adiposity >> >> index (BAI) can be used to reflect percentage of body fat for adult >> men and >> >> women of differing ethnicities, without numerical correction or >> assessment >> >> of weight, say *Dr N Bergman* (University of Southern >> California, >> >> Los Angeles) and colleagues in their paper published online March >> 3, 2011 >> in >> >> *Obesity*. >> >> >> >> However, they note that further work will be needed to extend and >> confirm >> >> their findings--tested in Mexican Americans and African Americans--to >> whites >> >> and other ethnic groups and to assess the role of the new index in >> children. >> >> And " it remains to be seen if the BAI is a more useful predictor of >> health >> >> outcome, in both males and females, than other indexes of body >> adiposity, >> >> including the BMI itself. " >> >> >> >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * >> >> >> >> " We were interested in determining whether we could find an index >> of body >> >> adiposity that at least in some ways may be better than the BMI, >> which has >> >> been around since the 1840s " and is not a very accurate measure of >> adiposity >> >> in individual patients, Bergman explained to* heartwire *. BMI is >> >> particularly inaccurate in people with elevated lean body mass, >> such as >> >> athletes, and in children, and it cannot be generalized among >> different >> >> ethnic groups, he and his colleagues note. >> >> >> >> Bergman et al are not the first to propose an alternative to BMI. >> Waist >> >> circumference is widely thought to be a better indicator of >> cardiovascular >> >> risk than BMI, although some studies have shown them to be equally >> >> predictive. Other examples include the waist-to-hip ratio (WHR) and >> the >> >> waist-to-hip-to-height index, which have both been forwarded as >> potentially >> >> better measures of obesity than BMI. But critics have said that it is >> >> difficult and time-consuming to get very accurate measurements of >> waist and >> >> hip circumference and height and that BMI has remained popular >> because it >> is >> >> simple and fast. >> >> >> >> In their study, Bergman and colleagues used a large database, >> *BetaGene*, >> >> which consisted of relatives of Mexican Americans with gestational >> diabetes, >> >> to determine whether there might be a better index. They chose the >> Mexican >> >> American population because of its prevalence in Los Angeles, >> observing, >> >> " Most of the world population is nonwhite. " >> >> >> >> " We looked at which variables most strongly related to percent >> adiposity, >> >> and they were height and hip size. Because these variables were >> >> uncorrelated, we proposed a new index, the BAI, based upon these >> measures >> >> alone, " Bergman explains. >> >> >> >> *BAI Will Be Easy to Calculate* >> >> >> >> " We showed that the BAI, calculated as (hip circumference/ >> height1.5)-18, >> was >> >> a good predictor of percent fat and worked for men and women, " he >> >> continues. The BAI also yielded the percentage of fat itself, >> rather than >> >> just a correlate (or index) of it, which is what the BMI does, he >> notes. >> The >> >> BAI was validated against the " gold standard " of dual-energy X-ray >> >> absorption (DEXA). >> >> >> >> " It will be very easy for a physician or a nurse practitioner to >> work out >> >> this index for individual patients, using a calculator, a computer >> program, >> >> or an iPhone app, " Bergman says. >> >> >> >> The researchers then went on to corroborate their findings in another >> >> population, the *Triglyceride and Cardiovascular Risk in African >> >> Americans*(TARA) study, and found that the behavior of the BAI was >> >> quite similar >> >> between the blacks in that population and the Hispanics in BetaGene. >> >> >> >> " Thus, we believe that we have presented evidence of accuracy at >> least in >> >> two ethnic populations, and further work on the generalizability of >> BAI to >> >> other groups is under way, " they state. It will also be important >> to see >> >> whether the index can reliably forecast percentage of adiposity in >> children >> >> and predict risk of cardiovascular disease, they note. >> >> >> >> medscape.com >> >> -- >> >> Ortiz, MS, RD >> >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> >> >> Check out my blog: mixture of deals and nutrition >> >> Made my own " funny but real " movie: Me interviewing a " potential " >> Dietetic >> >> student <http://www.xtranormal.com/watch/11216383/> >> >> >> >> *Healthy Diet at any Age: We are NOT just looking >> >> * >> >> >> >> *at the years people have behind them but also the >> >> * >> >> >> >> *quality of the years ahead of them.* >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 I was perhaps too brief. BMI works for the elderly; the problem is when we attempt to apply a standard that was developed for a different population. There is plenty of research in epidemiology demonstrating a strong relationship between BMI and both short and long term survival in the elderly (I cannot recall age ranges; the definition of elderly seems to shift, especially as I get older). However, the cut off for BMI in older populations is higher than the cut off for younger age groups. So, if we say that a BMI less than 18-19 in someone who is between 18 and 60 years of age requires further investigation (notice, I did not say that a low BMI is automatically an indicator of anything), we have to apply a higher standard to older adults. If I remember correctly, recommendations I've seen are in the range of 22 - 24 for older folks. I'm sure that varies if the person is community dwelling or in long term care. CMS won't change until someone (you?) comes forth to demonstrate that there is sufficient evidence to do so. Just as we want to practice based on the best available evidence, CMS is attempting to do the same. We cannot expect them to do the work for us, so guidelines they use won't change until there is sufficient impetus to make a change. We throw the phrase " cookie-cutter " around all the time and I think it's lost it's underlying meaning. What do you mean? Is it cookie cutter to use BMI as a screening tool for the elderly? I would argue that it's probably negligent to not evaluate weight status using some sort of standard for comparison. Regards, pam Pam Charney, PhD, RD Affiliate Associate Professor Pharmacy MS Student Clinical Informatics and Patient Centered Technology School of Nursing University of Washington Seattle, WA pcharney@... http://www.linkedin.com/in/pamcharney > Pam, You may be correct, but just to play the devil's advocate, I'm > now > forced to calculate BMI for 80 to 90 year olds, when we all agree > (except > CMS evidently) that this is not a good indicator of weight status > for the > elderly. Furthermore, I always seem to be in disagreement with the > MDS 3.0 > calculation and determination of weight status. So, how does our > analysis as > nutrition experts come into play in this case? I see the new index > as just > another way to automate and take away one of more area within our > expertise. > I do agree we must use all available markers, but disagree with > having to > accept the cookie-cutter standard if my opinion differs. > > Digna > > From: rd-usa [mailto:rd-usa ] On > Behalf Of > Pam Charney > Sent: Saturday, March 05, 2011 8:06 AM > To: rd-usa > Subject: Re: New Obesity Index Proposed, But Further Work > Needed > > Merav, > > That's why we learn to interpret research. An index designed for use > in healthy adults applies only to that population. Healthy adults. > > Pam Charney > pcharney@... <mailto:pcharney%40mac.com> > > > > > But there will always be exceptions - amputees, bed-bound like you > > said, > > etc. > > > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... > <mailto:meravls%40msn.com> > wrote: > > > >> > >> I am glad to hear there is work towards new index.However, this one > >> may > >> work only for ambulating clients/outpt settings. Hospitalized > >> pt...how will > >> I measure them when they are bad bound. Someone might say " the RN > >> would > >> have to do that on the initial screening " but I have hard time > >> getting the > >> Ht & Wt on admission, hip circ...? I don't see it happen. > >> > >> Merav Levi, RD, MS, CDNA dietitian, not the food police. > >> http://www.linkedin.com/in/meravlevi > >> > >> " Life is not measured by the number of breath you take, but by the > >> moments > >> that take your breath away. " - Carlin " People don't forget > >> the truth, > >> they just become better in lying " (Revolutionary Road) > >> > >> > >> > >> > >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> > >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net> > >> Date: Fri, 4 Mar 2011 17:05:49 -0800 > >> Subject: Re: New Obesity Index Proposed, But Further Work > >> Needed > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> This does seem more useful than BMI but wouldn't hip > >> circumfrence miss > >> the very > >> > >> apple - build people, those who don't have much hip storage. The > >> ethnic > >> > >> populations it has been tested with tend to have more caboose > >> action than > >> whites > >> > >> or Asians. (I am a pear and relate more to J Lo. than J An.) > >> > >> > >> > >> " Muffin top " problems in low rise jeans led to tops with a gathered > >> lower > >> > >> waist-line to cover up the overflow. Fashion found a way to fix its > >> own > >> faux > >> > >> pas. > >> > >> > >> > >> R Vajda, R.D. > >> > >> > >> > >> > >> > >> ________________________________ > >> > >> From: Ortiz <nrord1@... <mailto:nrord1%40gmail.com> > > >> > >> To: RD-USA <rd-usa <mailto:rd-usa > %40yahoogroups.com> > > >> > >> Sent: Fri, March 4, 2011 4:08:09 PM > >> > >> Subject: New Obesity Index Proposed, But Further Work > Needed > >> > >> > >> > >> US researchers have developed a new index of adiposity that they > >> say is a > >> > >> more accurate measure of body fat than the traditionally used body- > >> mass > >> > >> index (BMI); the latter is calculated by dividing weight by height > >> [1]. > >> > >> > >> > >> Using measurements of hip circumference and height, the new body > >> adiposity > >> > >> index (BAI) can be used to reflect percentage of body fat for adult > >> men and > >> > >> women of differing ethnicities, without numerical correction or > >> assessment > >> > >> of weight, say *Dr N Bergman* (University of Southern > >> California, > >> > >> Los Angeles) and colleagues in their paper published online March > >> 3, 2011 > >> in > >> > >> *Obesity*. > >> > >> > >> > >> However, they note that further work will be needed to extend and > >> confirm > >> > >> their findings--tested in Mexican Americans and African > Americans--to > >> whites > >> > >> and other ethnic groups and to assess the role of the new index in > >> children. > >> > >> And " it remains to be seen if the BAI is a more useful predictor of > >> health > >> > >> outcome, in both males and females, than other indexes of body > >> adiposity, > >> > >> including the BMI itself. " > >> > >> > >> > >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > >> > >> > >> > >> " We were interested in determining whether we could find an index > >> of body > >> > >> adiposity that at least in some ways may be better than the BMI, > >> which has > >> > >> been around since the 1840s " and is not a very accurate measure of > >> adiposity > >> > >> in individual patients, Bergman explained to* heartwire *. BMI is > >> > >> particularly inaccurate in people with elevated lean body mass, > >> such as > >> > >> athletes, and in children, and it cannot be generalized among > >> different > >> > >> ethnic groups, he and his colleagues note. > >> > >> > >> > >> Bergman et al are not the first to propose an alternative to BMI. > >> Waist > >> > >> circumference is widely thought to be a better indicator of > >> cardiovascular > >> > >> risk than BMI, although some studies have shown them to be equally > >> > >> predictive. Other examples include the waist-to-hip ratio (WHR) and > >> the > >> > >> waist-to-hip-to-height index, which have both been forwarded as > >> potentially > >> > >> better measures of obesity than BMI. But critics have said that > it is > >> > >> difficult and time-consuming to get very accurate measurements of > >> waist and > >> > >> hip circumference and height and that BMI has remained popular > >> because it > >> is > >> > >> simple and fast. > >> > >> > >> > >> In their study, Bergman and colleagues used a large database, > >> *BetaGene*, > >> > >> which consisted of relatives of Mexican Americans with gestational > >> diabetes, > >> > >> to determine whether there might be a better index. They chose the > >> Mexican > >> > >> American population because of its prevalence in Los Angeles, > >> observing, > >> > >> " Most of the world population is nonwhite. " > >> > >> > >> > >> " We looked at which variables most strongly related to percent > >> adiposity, > >> > >> and they were height and hip size. Because these variables were > >> > >> uncorrelated, we proposed a new index, the BAI, based upon these > >> measures > >> > >> alone, " Bergman explains. > >> > >> > >> > >> *BAI Will Be Easy to Calculate* > >> > >> > >> > >> " We showed that the BAI, calculated as (hip circumference/ > >> height1.5)-18, > >> was > >> > >> a good predictor of percent fat and worked for men and women, " he > >> > >> continues. The BAI also yielded the percentage of fat itself, > >> rather than > >> > >> just a correlate (or index) of it, which is what the BMI does, he > >> notes. > >> The > >> > >> BAI was validated against the " gold standard " of dual-energy X-ray > >> > >> absorption (DEXA). > >> > >> > >> > >> " It will be very easy for a physician or a nurse practitioner to > >> work out > >> > >> this index for individual patients, using a calculator, a computer > >> program, > >> > >> or an iPhone app, " Bergman says. > >> > >> > >> > >> The researchers then went on to corroborate their findings in > another > >> > >> population, the *Triglyceride and Cardiovascular Risk in African > >> > >> Americans*(TARA) study, and found that the behavior of the BAI was > >> > >> quite similar > >> > >> between the blacks in that population and the Hispanics in > BetaGene. > >> > >> > >> > >> " Thus, we believe that we have presented evidence of accuracy at > >> least in > >> > >> two ethnic populations, and further work on the generalizability of > >> BAI to > >> > >> other groups is under way, " they state. It will also be important > >> to see > >> > >> whether the index can reliably forecast percentage of adiposity in > >> children > >> > >> and predict risk of cardiovascular disease, they note. > >> > >> > >> > >> medscape.com > >> > >> -- > >> > >> Ortiz, MS, RD > >> > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > >> > >> Check out my blog: mixture of deals and nutrition > >> > >> Made my own " funny but real " movie: Me interviewing a " potential " > >> Dietetic > >> > >> student <http://www.xtranormal.com/watch/11216383/> > >> > >> > >> > >> *Healthy Diet at any Age: We are NOT just looking > >> > >> * > >> > >> > >> > >> *at the years people have behind them but also the > >> > >> * > >> > >> > >> > >> *quality of the years ahead of them.* > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2011 Report Share Posted March 5, 2011 I was perhaps too brief. BMI works for the elderly; the problem is when we attempt to apply a standard that was developed for a different population. There is plenty of research in epidemiology demonstrating a strong relationship between BMI and both short and long term survival in the elderly (I cannot recall age ranges; the definition of elderly seems to shift, especially as I get older). However, the cut off for BMI in older populations is higher than the cut off for younger age groups. So, if we say that a BMI less than 18-19 in someone who is between 18 and 60 years of age requires further investigation (notice, I did not say that a low BMI is automatically an indicator of anything), we have to apply a higher standard to older adults. If I remember correctly, recommendations I've seen are in the range of 22 - 24 for older folks. I'm sure that varies if the person is community dwelling or in long term care. CMS won't change until someone (you?) comes forth to demonstrate that there is sufficient evidence to do so. Just as we want to practice based on the best available evidence, CMS is attempting to do the same. We cannot expect them to do the work for us, so guidelines they use won't change until there is sufficient impetus to make a change. We throw the phrase " cookie-cutter " around all the time and I think it's lost it's underlying meaning. What do you mean? Is it cookie cutter to use BMI as a screening tool for the elderly? I would argue that it's probably negligent to not evaluate weight status using some sort of standard for comparison. Regards, pam Pam Charney, PhD, RD Affiliate Associate Professor Pharmacy MS Student Clinical Informatics and Patient Centered Technology School of Nursing University of Washington Seattle, WA pcharney@... http://www.linkedin.com/in/pamcharney > Pam, You may be correct, but just to play the devil's advocate, I'm > now > forced to calculate BMI for 80 to 90 year olds, when we all agree > (except > CMS evidently) that this is not a good indicator of weight status > for the > elderly. Furthermore, I always seem to be in disagreement with the > MDS 3.0 > calculation and determination of weight status. So, how does our > analysis as > nutrition experts come into play in this case? I see the new index > as just > another way to automate and take away one of more area within our > expertise. > I do agree we must use all available markers, but disagree with > having to > accept the cookie-cutter standard if my opinion differs. > > Digna > > From: rd-usa [mailto:rd-usa ] On > Behalf Of > Pam Charney > Sent: Saturday, March 05, 2011 8:06 AM > To: rd-usa > Subject: Re: New Obesity Index Proposed, But Further Work > Needed > > Merav, > > That's why we learn to interpret research. An index designed for use > in healthy adults applies only to that population. Healthy adults. > > Pam Charney > pcharney@... <mailto:pcharney%40mac.com> > > > > > But there will always be exceptions - amputees, bed-bound like you > > said, > > etc. > > > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... > <mailto:meravls%40msn.com> > wrote: > > > >> > >> I am glad to hear there is work towards new index.However, this one > >> may > >> work only for ambulating clients/outpt settings. Hospitalized > >> pt...how will > >> I measure them when they are bad bound. Someone might say " the RN > >> would > >> have to do that on the initial screening " but I have hard time > >> getting the > >> Ht & Wt on admission, hip circ...? I don't see it happen. > >> > >> Merav Levi, RD, MS, CDNA dietitian, not the food police. > >> http://www.linkedin.com/in/meravlevi > >> > >> " Life is not measured by the number of breath you take, but by the > >> moments > >> that take your breath away. " - Carlin " People don't forget > >> the truth, > >> they just become better in lying " (Revolutionary Road) > >> > >> > >> > >> > >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> > >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net> > >> Date: Fri, 4 Mar 2011 17:05:49 -0800 > >> Subject: Re: New Obesity Index Proposed, But Further Work > >> Needed > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> > >> This does seem more useful than BMI but wouldn't hip > >> circumfrence miss > >> the very > >> > >> apple - build people, those who don't have much hip storage. The > >> ethnic > >> > >> populations it has been tested with tend to have more caboose > >> action than > >> whites > >> > >> or Asians. (I am a pear and relate more to J Lo. than J An.) > >> > >> > >> > >> " Muffin top " problems in low rise jeans led to tops with a gathered > >> lower > >> > >> waist-line to cover up the overflow. Fashion found a way to fix its > >> own > >> faux > >> > >> pas. > >> > >> > >> > >> R Vajda, R.D. > >> > >> > >> > >> > >> > >> ________________________________ > >> > >> From: Ortiz <nrord1@... <mailto:nrord1%40gmail.com> > > >> > >> To: RD-USA <rd-usa <mailto:rd-usa > %40yahoogroups.com> > > >> > >> Sent: Fri, March 4, 2011 4:08:09 PM > >> > >> Subject: New Obesity Index Proposed, But Further Work > Needed > >> > >> > >> > >> US researchers have developed a new index of adiposity that they > >> say is a > >> > >> more accurate measure of body fat than the traditionally used body- > >> mass > >> > >> index (BMI); the latter is calculated by dividing weight by height > >> [1]. > >> > >> > >> > >> Using measurements of hip circumference and height, the new body > >> adiposity > >> > >> index (BAI) can be used to reflect percentage of body fat for adult > >> men and > >> > >> women of differing ethnicities, without numerical correction or > >> assessment > >> > >> of weight, say *Dr N Bergman* (University of Southern > >> California, > >> > >> Los Angeles) and colleagues in their paper published online March > >> 3, 2011 > >> in > >> > >> *Obesity*. > >> > >> > >> > >> However, they note that further work will be needed to extend and > >> confirm > >> > >> their findings--tested in Mexican Americans and African > Americans--to > >> whites > >> > >> and other ethnic groups and to assess the role of the new index in > >> children. > >> > >> And " it remains to be seen if the BAI is a more useful predictor of > >> health > >> > >> outcome, in both males and females, than other indexes of body > >> adiposity, > >> > >> including the BMI itself. " > >> > >> > >> > >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > >> > >> > >> > >> " We were interested in determining whether we could find an index > >> of body > >> > >> adiposity that at least in some ways may be better than the BMI, > >> which has > >> > >> been around since the 1840s " and is not a very accurate measure of > >> adiposity > >> > >> in individual patients, Bergman explained to* heartwire *. BMI is > >> > >> particularly inaccurate in people with elevated lean body mass, > >> such as > >> > >> athletes, and in children, and it cannot be generalized among > >> different > >> > >> ethnic groups, he and his colleagues note. > >> > >> > >> > >> Bergman et al are not the first to propose an alternative to BMI. > >> Waist > >> > >> circumference is widely thought to be a better indicator of > >> cardiovascular > >> > >> risk than BMI, although some studies have shown them to be equally > >> > >> predictive. Other examples include the waist-to-hip ratio (WHR) and > >> the > >> > >> waist-to-hip-to-height index, which have both been forwarded as > >> potentially > >> > >> better measures of obesity than BMI. But critics have said that > it is > >> > >> difficult and time-consuming to get very accurate measurements of > >> waist and > >> > >> hip circumference and height and that BMI has remained popular > >> because it > >> is > >> > >> simple and fast. > >> > >> > >> > >> In their study, Bergman and colleagues used a large database, > >> *BetaGene*, > >> > >> which consisted of relatives of Mexican Americans with gestational > >> diabetes, > >> > >> to determine whether there might be a better index. They chose the > >> Mexican > >> > >> American population because of its prevalence in Los Angeles, > >> observing, > >> > >> " Most of the world population is nonwhite. " > >> > >> > >> > >> " We looked at which variables most strongly related to percent > >> adiposity, > >> > >> and they were height and hip size. Because these variables were > >> > >> uncorrelated, we proposed a new index, the BAI, based upon these > >> measures > >> > >> alone, " Bergman explains. > >> > >> > >> > >> *BAI Will Be Easy to Calculate* > >> > >> > >> > >> " We showed that the BAI, calculated as (hip circumference/ > >> height1.5)-18, > >> was > >> > >> a good predictor of percent fat and worked for men and women, " he > >> > >> continues. The BAI also yielded the percentage of fat itself, > >> rather than > >> > >> just a correlate (or index) of it, which is what the BMI does, he > >> notes. > >> The > >> > >> BAI was validated against the " gold standard " of dual-energy X-ray > >> > >> absorption (DEXA). > >> > >> > >> > >> " It will be very easy for a physician or a nurse practitioner to > >> work out > >> > >> this index for individual patients, using a calculator, a computer > >> program, > >> > >> or an iPhone app, " Bergman says. > >> > >> > >> > >> The researchers then went on to corroborate their findings in > another > >> > >> population, the *Triglyceride and Cardiovascular Risk in African > >> > >> Americans*(TARA) study, and found that the behavior of the BAI was > >> > >> quite similar > >> > >> between the blacks in that population and the Hispanics in > BetaGene. > >> > >> > >> > >> " Thus, we believe that we have presented evidence of accuracy at > >> least in > >> > >> two ethnic populations, and further work on the generalizability of > >> BAI to > >> > >> other groups is under way, " they state. It will also be important > >> to see > >> > >> whether the index can reliably forecast percentage of adiposity in > >> children > >> > >> and predict risk of cardiovascular disease, they note. > >> > >> > >> > >> medscape.com > >> > >> -- > >> > >> Ortiz, MS, RD > >> > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > >> > >> Check out my blog: mixture of deals and nutrition > >> > >> Made my own " funny but real " movie: Me interviewing a " potential " > >> Dietetic > >> > >> student <http://www.xtranormal.com/watch/11216383/> > >> > >> > >> > >> *Healthy Diet at any Age: We are NOT just looking > >> > >> * > >> > >> > >> > >> *at the years people have behind them but also the > >> > >> * > >> > >> > >> > >> *quality of the years ahead of them.* > >> > >> > >> > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2011 Report Share Posted March 6, 2011 Pam What evidence do you see in the elderly and BMI? My concern is the decreasing muscle mass I see in my nursing home clients and BMI wouldn't account for this. Would pre-albumin and transferrin be the best indicators (which most MDs do not order)? Thanks > I was perhaps too brief. BMI works for the elderly; the problem is > when we attempt to apply a standard that was developed for a different > population. There is plenty of research in epidemiology demonstrating > a strong relationship between BMI and both short and long term > survival in the elderly (I cannot recall age ranges; the definition of > elderly seems to shift, especially as I get older). However, the cut > off for BMI in older populations is higher than the cut off for > younger age groups. > > So, if we say that a BMI less than 18-19 in someone who is between 18 > and 60 years of age requires further investigation (notice, I did not > say that a low BMI is automatically an indicator of anything), we have > to apply a higher standard to older adults. If I remember correctly, > recommendations I've seen are in the range of 22 - 24 for older folks. > I'm sure that varies if the person is community dwelling or in long > term care. > > CMS won't change until someone (you?) comes forth to demonstrate that > there is sufficient evidence to do so. Just as we want to practice > based on the best available evidence, CMS is attempting to do the > same. We cannot expect them to do the work for us, so guidelines they > use won't change until there is sufficient impetus to make a change. > > We throw the phrase " cookie-cutter " around all the time and I think > it's lost it's underlying meaning. What do you mean? Is it cookie > cutter to use BMI as a screening tool for the elderly? I would argue > that it's probably negligent to not evaluate weight status using some > sort of standard for comparison. > > Regards, > pam > > Pam Charney, PhD, RD > Affiliate Associate Professor > Pharmacy > > MS Student > Clinical Informatics and Patient Centered Technology > School of Nursing > > University of Washington > Seattle, WA > pcharney@... > http://www.linkedin.com/in/pamcharney > > > > > > > Pam, You may be correct, but just to play the devil's advocate, I'm > > now > > forced to calculate BMI for 80 to 90 year olds, when we all agree > > (except > > CMS evidently) that this is not a good indicator of weight status > > for the > > elderly. Furthermore, I always seem to be in disagreement with the > > MDS 3.0 > > calculation and determination of weight status. So, how does our > > analysis as > > nutrition experts come into play in this case? I see the new index > > as just > > another way to automate and take away one of more area within our > > expertise. > > I do agree we must use all available markers, but disagree with > > having to > > accept the cookie-cutter standard if my opinion differs. > > > > Digna > > > > From: rd-usa [mailto:rd-usa ] On > > Behalf Of > > Pam Charney > > Sent: Saturday, March 05, 2011 8:06 AM > > To: rd-usa > > Subject: Re: New Obesity Index Proposed, But Further Work > > Needed > > > > Merav, > > > > That's why we learn to interpret research. An index designed for use > > in healthy adults applies only to that population. Healthy adults. > > > > Pam Charney > > pcharney@... <mailto:pcharney%40mac.com> > > > > > > > > > But there will always be exceptions - amputees, bed-bound like you > > > said, > > > etc. > > > > > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... > > <mailto:meravls%40msn.com> > wrote: > > > > > >> > > >> I am glad to hear there is work towards new index.However, this one > > >> may > > >> work only for ambulating clients/outpt settings. Hospitalized > > >> pt...how will > > >> I measure them when they are bad bound. Someone might say " the RN > > >> would > > >> have to do that on the initial screening " but I have hard time > > >> getting the > > >> Ht & Wt on admission, hip circ...? I don't see it happen. > > >> > > >> Merav Levi, RD, MS, CDNA dietitian, not the food police. > > >> http://www.linkedin.com/in/meravlevi > > >> > > >> " Life is not measured by the number of breath you take, but by the > > >> moments > > >> that take your breath away. " - Carlin " People don't forget > > >> the truth, > > >> they just become better in lying " (Revolutionary Road) > > >> > > >> > > >> > > >> > > >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> > > >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net> > > >> Date: Fri, 4 Mar 2011 17:05:49 -0800 > > >> Subject: Re: New Obesity Index Proposed, But Further Work > > >> Needed > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> This does seem more useful than BMI but wouldn't hip > > >> circumfrence miss > > >> the very > > >> > > >> apple - build people, those who don't have much hip storage. The > > >> ethnic > > >> > > >> populations it has been tested with tend to have more caboose > > >> action than > > >> whites > > >> > > >> or Asians. (I am a pear and relate more to J Lo. than J An.) > > >> > > >> > > >> > > >> " Muffin top " problems in low rise jeans led to tops with a gathered > > >> lower > > >> > > >> waist-line to cover up the overflow. Fashion found a way to fix its > > >> own > > >> faux > > >> > > >> pas. > > >> > > >> > > >> > > >> R Vajda, R.D. > > >> > > >> > > >> > > >> > > >> > > >> ________________________________ > > >> > > >> From: Ortiz <nrord1@... <mailto:nrord1%40gmail.com> > > > >> > > >> To: RD-USA <rd-usa <mailto:rd-usa > > %40yahoogroups.com> > > > >> > > >> Sent: Fri, March 4, 2011 4:08:09 PM > > >> > > >> Subject: New Obesity Index Proposed, But Further Work > > Needed > > >> > > >> > > >> > > >> US researchers have developed a new index of adiposity that they > > >> say is a > > >> > > >> more accurate measure of body fat than the traditionally used body- > > >> mass > > >> > > >> index (BMI); the latter is calculated by dividing weight by height > > >> [1]. > > >> > > >> > > >> > > >> Using measurements of hip circumference and height, the new body > > >> adiposity > > >> > > >> index (BAI) can be used to reflect percentage of body fat for adult > > >> men and > > >> > > >> women of differing ethnicities, without numerical correction or > > >> assessment > > >> > > >> of weight, say *Dr N Bergman* (University of Southern > > >> California, > > >> > > >> Los Angeles) and colleagues in their paper published online March > > >> 3, 2011 > > >> in > > >> > > >> *Obesity*. > > >> > > >> > > >> > > >> However, they note that further work will be needed to extend and > > >> confirm > > >> > > >> their findings--tested in Mexican Americans and African > > Americans--to > > >> whites > > >> > > >> and other ethnic groups and to assess the role of the new index in > > >> children. > > >> > > >> And " it remains to be seen if the BAI is a more useful predictor of > > >> health > > >> > > >> outcome, in both males and females, than other indexes of body > > >> adiposity, > > >> > > >> including the BMI itself. " > > >> > > >> > > >> > > >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > > >> > > >> > > >> > > >> " We were interested in determining whether we could find an index > > >> of body > > >> > > >> adiposity that at least in some ways may be better than the BMI, > > >> which has > > >> > > >> been around since the 1840s " and is not a very accurate measure of > > >> adiposity > > >> > > >> in individual patients, Bergman explained to* heartwire *. BMI is > > >> > > >> particularly inaccurate in people with elevated lean body mass, > > >> such as > > >> > > >> athletes, and in children, and it cannot be generalized among > > >> different > > >> > > >> ethnic groups, he and his colleagues note. > > >> > > >> > > >> > > >> Bergman et al are not the first to propose an alternative to BMI. > > >> Waist > > >> > > >> circumference is widely thought to be a better indicator of > > >> cardiovascular > > >> > > >> risk than BMI, although some studies have shown them to be equally > > >> > > >> predictive. Other examples include the waist-to-hip ratio (WHR) and > > >> the > > >> > > >> waist-to-hip-to-height index, which have both been forwarded as > > >> potentially > > >> > > >> better measures of obesity than BMI. But critics have said that > > it is > > >> > > >> difficult and time-consuming to get very accurate measurements of > > >> waist and > > >> > > >> hip circumference and height and that BMI has remained popular > > >> because it > > >> is > > >> > > >> simple and fast. > > >> > > >> > > >> > > >> In their study, Bergman and colleagues used a large database, > > >> *BetaGene*, > > >> > > >> which consisted of relatives of Mexican Americans with gestational > > >> diabetes, > > >> > > >> to determine whether there might be a better index. They chose the > > >> Mexican > > >> > > >> American population because of its prevalence in Los Angeles, > > >> observing, > > >> > > >> " Most of the world population is nonwhite. " > > >> > > >> > > >> > > >> " We looked at which variables most strongly related to percent > > >> adiposity, > > >> > > >> and they were height and hip size. Because these variables were > > >> > > >> uncorrelated, we proposed a new index, the BAI, based upon these > > >> measures > > >> > > >> alone, " Bergman explains. > > >> > > >> > > >> > > >> *BAI Will Be Easy to Calculate* > > >> > > >> > > >> > > >> " We showed that the BAI, calculated as (hip circumference/ > > >> height1.5)-18, > > >> was > > >> > > >> a good predictor of percent fat and worked for men and women, " he > > >> > > >> continues. The BAI also yielded the percentage of fat itself, > > >> rather than > > >> > > >> just a correlate (or index) of it, which is what the BMI does, he > > >> notes. > > >> The > > >> > > >> BAI was validated against the " gold standard " of dual-energy X-ray > > >> > > >> absorption (DEXA). > > >> > > >> > > >> > > >> " It will be very easy for a physician or a nurse practitioner to > > >> work out > > >> > > >> this index for individual patients, using a calculator, a computer > > >> program, > > >> > > >> or an iPhone app, " Bergman says. > > >> > > >> > > >> > > >> The researchers then went on to corroborate their findings in > > another > > >> > > >> population, the *Triglyceride and Cardiovascular Risk in African > > >> > > >> Americans*(TARA) study, and found that the behavior of the BAI was > > >> > > >> quite similar > > >> > > >> between the blacks in that population and the Hispanics in > > BetaGene. > > >> > > >> > > >> > > >> " Thus, we believe that we have presented evidence of accuracy at > > >> least in > > >> > > >> two ethnic populations, and further work on the generalizability of > > >> BAI to > > >> > > >> other groups is under way, " they state. It will also be important > > >> to see > > >> > > >> whether the index can reliably forecast percentage of adiposity in > > >> children > > >> > > >> and predict risk of cardiovascular disease, they note. > > >> > > >> > > >> > > >> medscape.com > > >> > > >> -- > > >> > > >> Ortiz, MS, RD > > >> > > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > >> > > >> Check out my blog: mixture of deals and nutrition > > >> > > >> Made my own " funny but real " movie: Me interviewing a " potential " > > >> Dietetic > > >> > > >> student <http://www.xtranormal.com/watch/11216383/> > > >> > > >> > > >> > > >> *Healthy Diet at any Age: We are NOT just looking > > >> > > >> * > > >> > > >> > > >> > > >> *at the years people have behind them but also the > > >> > > >> * > > >> > > >> > > >> > > >> *quality of the years ahead of them.* > > >> > > >> > > >> > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2011 Report Share Posted March 6, 2011 Pam What evidence do you see in the elderly and BMI? My concern is the decreasing muscle mass I see in my nursing home clients and BMI wouldn't account for this. Would pre-albumin and transferrin be the best indicators (which most MDs do not order)? Thanks > I was perhaps too brief. BMI works for the elderly; the problem is > when we attempt to apply a standard that was developed for a different > population. There is plenty of research in epidemiology demonstrating > a strong relationship between BMI and both short and long term > survival in the elderly (I cannot recall age ranges; the definition of > elderly seems to shift, especially as I get older). However, the cut > off for BMI in older populations is higher than the cut off for > younger age groups. > > So, if we say that a BMI less than 18-19 in someone who is between 18 > and 60 years of age requires further investigation (notice, I did not > say that a low BMI is automatically an indicator of anything), we have > to apply a higher standard to older adults. If I remember correctly, > recommendations I've seen are in the range of 22 - 24 for older folks. > I'm sure that varies if the person is community dwelling or in long > term care. > > CMS won't change until someone (you?) comes forth to demonstrate that > there is sufficient evidence to do so. Just as we want to practice > based on the best available evidence, CMS is attempting to do the > same. We cannot expect them to do the work for us, so guidelines they > use won't change until there is sufficient impetus to make a change. > > We throw the phrase " cookie-cutter " around all the time and I think > it's lost it's underlying meaning. What do you mean? Is it cookie > cutter to use BMI as a screening tool for the elderly? I would argue > that it's probably negligent to not evaluate weight status using some > sort of standard for comparison. > > Regards, > pam > > Pam Charney, PhD, RD > Affiliate Associate Professor > Pharmacy > > MS Student > Clinical Informatics and Patient Centered Technology > School of Nursing > > University of Washington > Seattle, WA > pcharney@... > http://www.linkedin.com/in/pamcharney > > > > > > > Pam, You may be correct, but just to play the devil's advocate, I'm > > now > > forced to calculate BMI for 80 to 90 year olds, when we all agree > > (except > > CMS evidently) that this is not a good indicator of weight status > > for the > > elderly. Furthermore, I always seem to be in disagreement with the > > MDS 3.0 > > calculation and determination of weight status. So, how does our > > analysis as > > nutrition experts come into play in this case? I see the new index > > as just > > another way to automate and take away one of more area within our > > expertise. > > I do agree we must use all available markers, but disagree with > > having to > > accept the cookie-cutter standard if my opinion differs. > > > > Digna > > > > From: rd-usa [mailto:rd-usa ] On > > Behalf Of > > Pam Charney > > Sent: Saturday, March 05, 2011 8:06 AM > > To: rd-usa > > Subject: Re: New Obesity Index Proposed, But Further Work > > Needed > > > > Merav, > > > > That's why we learn to interpret research. An index designed for use > > in healthy adults applies only to that population. Healthy adults. > > > > Pam Charney > > pcharney@... <mailto:pcharney%40mac.com> > > > > > > > > > But there will always be exceptions - amputees, bed-bound like you > > > said, > > > etc. > > > > > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... > > <mailto:meravls%40msn.com> > wrote: > > > > > >> > > >> I am glad to hear there is work towards new index.However, this one > > >> may > > >> work only for ambulating clients/outpt settings. Hospitalized > > >> pt...how will > > >> I measure them when they are bad bound. Someone might say " the RN > > >> would > > >> have to do that on the initial screening " but I have hard time > > >> getting the > > >> Ht & Wt on admission, hip circ...? I don't see it happen. > > >> > > >> Merav Levi, RD, MS, CDNA dietitian, not the food police. > > >> http://www.linkedin.com/in/meravlevi > > >> > > >> " Life is not measured by the number of breath you take, but by the > > >> moments > > >> that take your breath away. " - Carlin " People don't forget > > >> the truth, > > >> they just become better in lying " (Revolutionary Road) > > >> > > >> > > >> > > >> > > >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> > > >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net> > > >> Date: Fri, 4 Mar 2011 17:05:49 -0800 > > >> Subject: Re: New Obesity Index Proposed, But Further Work > > >> Needed > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> > > >> This does seem more useful than BMI but wouldn't hip > > >> circumfrence miss > > >> the very > > >> > > >> apple - build people, those who don't have much hip storage. The > > >> ethnic > > >> > > >> populations it has been tested with tend to have more caboose > > >> action than > > >> whites > > >> > > >> or Asians. (I am a pear and relate more to J Lo. than J An.) > > >> > > >> > > >> > > >> " Muffin top " problems in low rise jeans led to tops with a gathered > > >> lower > > >> > > >> waist-line to cover up the overflow. Fashion found a way to fix its > > >> own > > >> faux > > >> > > >> pas. > > >> > > >> > > >> > > >> R Vajda, R.D. > > >> > > >> > > >> > > >> > > >> > > >> ________________________________ > > >> > > >> From: Ortiz <nrord1@... <mailto:nrord1%40gmail.com> > > > >> > > >> To: RD-USA <rd-usa <mailto:rd-usa > > %40yahoogroups.com> > > > >> > > >> Sent: Fri, March 4, 2011 4:08:09 PM > > >> > > >> Subject: New Obesity Index Proposed, But Further Work > > Needed > > >> > > >> > > >> > > >> US researchers have developed a new index of adiposity that they > > >> say is a > > >> > > >> more accurate measure of body fat than the traditionally used body- > > >> mass > > >> > > >> index (BMI); the latter is calculated by dividing weight by height > > >> [1]. > > >> > > >> > > >> > > >> Using measurements of hip circumference and height, the new body > > >> adiposity > > >> > > >> index (BAI) can be used to reflect percentage of body fat for adult > > >> men and > > >> > > >> women of differing ethnicities, without numerical correction or > > >> assessment > > >> > > >> of weight, say *Dr N Bergman* (University of Southern > > >> California, > > >> > > >> Los Angeles) and colleagues in their paper published online March > > >> 3, 2011 > > >> in > > >> > > >> *Obesity*. > > >> > > >> > > >> > > >> However, they note that further work will be needed to extend and > > >> confirm > > >> > > >> their findings--tested in Mexican Americans and African > > Americans--to > > >> whites > > >> > > >> and other ethnic groups and to assess the role of the new index in > > >> children. > > >> > > >> And " it remains to be seen if the BAI is a more useful predictor of > > >> health > > >> > > >> outcome, in both males and females, than other indexes of body > > >> adiposity, > > >> > > >> including the BMI itself. " > > >> > > >> > > >> > > >> *Height and Hip Size Most Strongly Relate to Percentage Adiposity * > > >> > > >> > > >> > > >> " We were interested in determining whether we could find an index > > >> of body > > >> > > >> adiposity that at least in some ways may be better than the BMI, > > >> which has > > >> > > >> been around since the 1840s " and is not a very accurate measure of > > >> adiposity > > >> > > >> in individual patients, Bergman explained to* heartwire *. BMI is > > >> > > >> particularly inaccurate in people with elevated lean body mass, > > >> such as > > >> > > >> athletes, and in children, and it cannot be generalized among > > >> different > > >> > > >> ethnic groups, he and his colleagues note. > > >> > > >> > > >> > > >> Bergman et al are not the first to propose an alternative to BMI. > > >> Waist > > >> > > >> circumference is widely thought to be a better indicator of > > >> cardiovascular > > >> > > >> risk than BMI, although some studies have shown them to be equally > > >> > > >> predictive. Other examples include the waist-to-hip ratio (WHR) and > > >> the > > >> > > >> waist-to-hip-to-height index, which have both been forwarded as > > >> potentially > > >> > > >> better measures of obesity than BMI. But critics have said that > > it is > > >> > > >> difficult and time-consuming to get very accurate measurements of > > >> waist and > > >> > > >> hip circumference and height and that BMI has remained popular > > >> because it > > >> is > > >> > > >> simple and fast. > > >> > > >> > > >> > > >> In their study, Bergman and colleagues used a large database, > > >> *BetaGene*, > > >> > > >> which consisted of relatives of Mexican Americans with gestational > > >> diabetes, > > >> > > >> to determine whether there might be a better index. They chose the > > >> Mexican > > >> > > >> American population because of its prevalence in Los Angeles, > > >> observing, > > >> > > >> " Most of the world population is nonwhite. " > > >> > > >> > > >> > > >> " We looked at which variables most strongly related to percent > > >> adiposity, > > >> > > >> and they were height and hip size. Because these variables were > > >> > > >> uncorrelated, we proposed a new index, the BAI, based upon these > > >> measures > > >> > > >> alone, " Bergman explains. > > >> > > >> > > >> > > >> *BAI Will Be Easy to Calculate* > > >> > > >> > > >> > > >> " We showed that the BAI, calculated as (hip circumference/ > > >> height1.5)-18, > > >> was > > >> > > >> a good predictor of percent fat and worked for men and women, " he > > >> > > >> continues. The BAI also yielded the percentage of fat itself, > > >> rather than > > >> > > >> just a correlate (or index) of it, which is what the BMI does, he > > >> notes. > > >> The > > >> > > >> BAI was validated against the " gold standard " of dual-energy X-ray > > >> > > >> absorption (DEXA). > > >> > > >> > > >> > > >> " It will be very easy for a physician or a nurse practitioner to > > >> work out > > >> > > >> this index for individual patients, using a calculator, a computer > > >> program, > > >> > > >> or an iPhone app, " Bergman says. > > >> > > >> > > >> > > >> The researchers then went on to corroborate their findings in > > another > > >> > > >> population, the *Triglyceride and Cardiovascular Risk in African > > >> > > >> Americans*(TARA) study, and found that the behavior of the BAI was > > >> > > >> quite similar > > >> > > >> between the blacks in that population and the Hispanics in > > BetaGene. > > >> > > >> > > >> > > >> " Thus, we believe that we have presented evidence of accuracy at > > >> least in > > >> > > >> two ethnic populations, and further work on the generalizability of > > >> BAI to > > >> > > >> other groups is under way, " they state. It will also be important > > >> to see > > >> > > >> whether the index can reliably forecast percentage of adiposity in > > >> children > > >> > > >> and predict risk of cardiovascular disease, they note. > > >> > > >> > > >> > > >> medscape.com > > >> > > >> -- > > >> > > >> Ortiz, MS, RD > > >> > > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > >> > > >> Check out my blog: mixture of deals and nutrition > > >> > > >> Made my own " funny but real " movie: Me interviewing a " potential " > > >> Dietetic > > >> > > >> student <http://www.xtranormal.com/watch/11216383/> > > >> > > >> > > >> > > >> *Healthy Diet at any Age: We are NOT just looking > > >> > > >> * > > >> > > >> > > >> > > >> *at the years people have behind them but also the > > >> > > >> * > > >> > > >> > > >> > > >> *quality of the years ahead of them.* > > >> > > >> > > >> > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2011 Report Share Posted March 6, 2011 We need to let go of the paradigm (what we think about something before we think about it) that albumin, transferrin and prealbumin have anything to do with nutrition. You can search PubMed using the key words " elderly " , " weight loss " , " outcomes " " body mass index " or any combination thereof to find some of the research. If you know how to limit searches, you can add the limits " epidemiology " and adults > 65 years. Pam Charney pcharney@... > Pam > What evidence do you see in the elderly and BMI? My concern is the > decreasing muscle mass I see in my nursing home clients and BMI > wouldn't > account for this. Would pre-albumin and transferrin be the best > indicators > (which most MDs do not order)? > Thanks > > > > > I was perhaps too brief. BMI works for the elderly; the problem is > > when we attempt to apply a standard that was developed for a > different > > population. There is plenty of research in epidemiology > demonstrating > > a strong relationship between BMI and both short and long term > > survival in the elderly (I cannot recall age ranges; the > definition of > > elderly seems to shift, especially as I get older). However, the cut > > off for BMI in older populations is higher than the cut off for > > younger age groups. > > > > So, if we say that a BMI less than 18-19 in someone who is between > 18 > > and 60 years of age requires further investigation (notice, I did > not > > say that a low BMI is automatically an indicator of anything), we > have > > to apply a higher standard to older adults. If I remember correctly, > > recommendations I've seen are in the range of 22 - 24 for older > folks. > > I'm sure that varies if the person is community dwelling or in long > > term care. > > > > CMS won't change until someone (you?) comes forth to demonstrate > that > > there is sufficient evidence to do so. Just as we want to practice > > based on the best available evidence, CMS is attempting to do the > > same. We cannot expect them to do the work for us, so guidelines > they > > use won't change until there is sufficient impetus to make a change. > > > > We throw the phrase " cookie-cutter " around all the time and I think > > it's lost it's underlying meaning. What do you mean? Is it cookie > > cutter to use BMI as a screening tool for the elderly? I would argue > > that it's probably negligent to not evaluate weight status using > some > > sort of standard for comparison. > > > > Regards, > > pam > > > > Pam Charney, PhD, RD > > Affiliate Associate Professor > > Pharmacy > > > > MS Student > > Clinical Informatics and Patient Centered Technology > > School of Nursing > > > > University of Washington > > Seattle, WA > > pcharney@... > > http://www.linkedin.com/in/pamcharney > > > > > > > > > > > > > Pam, You may be correct, but just to play the devil's advocate, > I'm > > > now > > > forced to calculate BMI for 80 to 90 year olds, when we all agree > > > (except > > > CMS evidently) that this is not a good indicator of weight status > > > for the > > > elderly. Furthermore, I always seem to be in disagreement with the > > > MDS 3.0 > > > calculation and determination of weight status. So, how does our > > > analysis as > > > nutrition experts come into play in this case? I see the new index > > > as just > > > another way to automate and take away one of more area within our > > > expertise. > > > I do agree we must use all available markers, but disagree with > > > having to > > > accept the cookie-cutter standard if my opinion differs. > > > > > > Digna > > > > > > From: rd-usa [mailto:rd-usa ] On > > > Behalf Of > > > Pam Charney > > > Sent: Saturday, March 05, 2011 8:06 AM > > > To: rd-usa > > > Subject: Re: New Obesity Index Proposed, But Further Work > > > Needed > > > > > > Merav, > > > > > > That's why we learn to interpret research. An index designed for > use > > > in healthy adults applies only to that population. Healthy adults. > > > > > > Pam Charney > > > pcharney@... <mailto:pcharney%40mac.com> > > > > > > > > > > > > > But there will always be exceptions - amputees, bed-bound like > you > > > > said, > > > > etc. > > > > > > > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... > > > <mailto:meravls%40msn.com> > wrote: > > > > > > > >> > > > >> I am glad to hear there is work towards new index.However, > this one > > > >> may > > > >> work only for ambulating clients/outpt settings. Hospitalized > > > >> pt...how will > > > >> I measure them when they are bad bound. Someone might say " > the RN > > > >> would > > > >> have to do that on the initial screening " but I have hard time > > > >> getting the > > > >> Ht & Wt on admission, hip circ...? I don't see it happen. > > > >> > > > >> Merav Levi, RD, MS, CDNA dietitian, not the food police. > > > >> http://www.linkedin.com/in/meravlevi > > > >> > > > >> " Life is not measured by the number of breath you take, but > by the > > > >> moments > > > >> that take your breath away. " - Carlin " People don't > forget > > > >> the truth, > > > >> they just become better in lying " (Revolutionary Road) > > > >> > > > >> > > > >> > > > >> > > > >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> > > > >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net > > > > > >> Date: Fri, 4 Mar 2011 17:05:49 -0800 > > > >> Subject: Re: New Obesity Index Proposed, But Further > Work > > > >> Needed > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> This does seem more useful than BMI but wouldn't hip > > > >> circumfrence miss > > > >> the very > > > >> > > > >> apple - build people, those who don't have much hip storage. > The > > > >> ethnic > > > >> > > > >> populations it has been tested with tend to have more caboose > > > >> action than > > > >> whites > > > >> > > > >> or Asians. (I am a pear and relate more to J Lo. than J An.) > > > >> > > > >> > > > >> > > > >> " Muffin top " problems in low rise jeans led to tops with a > gathered > > > >> lower > > > >> > > > >> waist-line to cover up the overflow. Fashion found a way to > fix its > > > >> own > > > >> faux > > > >> > > > >> pas. > > > >> > > > >> > > > >> > > > >> R Vajda, R.D. > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> ________________________________ > > > >> > > > >> From: Ortiz <nrord1@... > <mailto:nrord1%40gmail.com> > > > > >> > > > >> To: RD-USA <rd-usa <mailto:rd-usa > > > %40yahoogroups.com> > > > > >> > > > >> Sent: Fri, March 4, 2011 4:08:09 PM > > > >> > > > >> Subject: New Obesity Index Proposed, But Further Work > > > Needed > > > >> > > > >> > > > >> > > > >> US researchers have developed a new index of adiposity that > they > > > >> say is a > > > >> > > > >> more accurate measure of body fat than the traditionally used > body- > > > >> mass > > > >> > > > >> index (BMI); the latter is calculated by dividing weight by > height > > > >> [1]. > > > >> > > > >> > > > >> > > > >> Using measurements of hip circumference and height, the new > body > > > >> adiposity > > > >> > > > >> index (BAI) can be used to reflect percentage of body fat for > adult > > > >> men and > > > >> > > > >> women of differing ethnicities, without numerical correction or > > > >> assessment > > > >> > > > >> of weight, say *Dr N Bergman* (University of Southern > > > >> California, > > > >> > > > >> Los Angeles) and colleagues in their paper published online > March > > > >> 3, 2011 > > > >> in > > > >> > > > >> *Obesity*. > > > >> > > > >> > > > >> > > > >> However, they note that further work will be needed to extend > and > > > >> confirm > > > >> > > > >> their findings--tested in Mexican Americans and African > > > Americans--to > > > >> whites > > > >> > > > >> and other ethnic groups and to assess the role of the new > index in > > > >> children. > > > >> > > > >> And " it remains to be seen if the BAI is a more useful > predictor of > > > >> health > > > >> > > > >> outcome, in both males and females, than other indexes of body > > > >> adiposity, > > > >> > > > >> including the BMI itself. " > > > >> > > > >> > > > >> > > > >> *Height and Hip Size Most Strongly Relate to Percentage > Adiposity * > > > >> > > > >> > > > >> > > > >> " We were interested in determining whether we could find an > index > > > >> of body > > > >> > > > >> adiposity that at least in some ways may be better than the > BMI, > > > >> which has > > > >> > > > >> been around since the 1840s " and is not a very accurate > measure of > > > >> adiposity > > > >> > > > >> in individual patients, Bergman explained to* heartwire *. > BMI is > > > >> > > > >> particularly inaccurate in people with elevated lean body mass, > > > >> such as > > > >> > > > >> athletes, and in children, and it cannot be generalized among > > > >> different > > > >> > > > >> ethnic groups, he and his colleagues note. > > > >> > > > >> > > > >> > > > >> Bergman et al are not the first to propose an alternative to > BMI. > > > >> Waist > > > >> > > > >> circumference is widely thought to be a better indicator of > > > >> cardiovascular > > > >> > > > >> risk than BMI, although some studies have shown them to be > equally > > > >> > > > >> predictive. Other examples include the waist-to-hip ratio > (WHR) and > > > >> the > > > >> > > > >> waist-to-hip-to-height index, which have both been forwarded as > > > >> potentially > > > >> > > > >> better measures of obesity than BMI. But critics have said that > > > it is > > > >> > > > >> difficult and time-consuming to get very accurate > measurements of > > > >> waist and > > > >> > > > >> hip circumference and height and that BMI has remained popular > > > >> because it > > > >> is > > > >> > > > >> simple and fast. > > > >> > > > >> > > > >> > > > >> In their study, Bergman and colleagues used a large database, > > > >> *BetaGene*, > > > >> > > > >> which consisted of relatives of Mexican Americans with > gestational > > > >> diabetes, > > > >> > > > >> to determine whether there might be a better index. They > chose the > > > >> Mexican > > > >> > > > >> American population because of its prevalence in Los Angeles, > > > >> observing, > > > >> > > > >> " Most of the world population is nonwhite. " > > > >> > > > >> > > > >> > > > >> " We looked at which variables most strongly related to percent > > > >> adiposity, > > > >> > > > >> and they were height and hip size. Because these variables were > > > >> > > > >> uncorrelated, we proposed a new index, the BAI, based upon > these > > > >> measures > > > >> > > > >> alone, " Bergman explains. > > > >> > > > >> > > > >> > > > >> *BAI Will Be Easy to Calculate* > > > >> > > > >> > > > >> > > > >> " We showed that the BAI, calculated as (hip circumference/ > > > >> height1.5)-18, > > > >> was > > > >> > > > >> a good predictor of percent fat and worked for men and > women, " he > > > >> > > > >> continues. The BAI also yielded the percentage of fat itself, > > > >> rather than > > > >> > > > >> just a correlate (or index) of it, which is what the BMI > does, he > > > >> notes. > > > >> The > > > >> > > > >> BAI was validated against the " gold standard " of dual-energy > X-ray > > > >> > > > >> absorption (DEXA). > > > >> > > > >> > > > >> > > > >> " It will be very easy for a physician or a nurse practitioner > to > > > >> work out > > > >> > > > >> this index for individual patients, using a calculator, a > computer > > > >> program, > > > >> > > > >> or an iPhone app, " Bergman says. > > > >> > > > >> > > > >> > > > >> The researchers then went on to corroborate their findings in > > > another > > > >> > > > >> population, the *Triglyceride and Cardiovascular Risk in > African > > > >> > > > >> Americans*(TARA) study, and found that the behavior of the > BAI was > > > >> > > > >> quite similar > > > >> > > > >> between the blacks in that population and the Hispanics in > > > BetaGene. > > > >> > > > >> > > > >> > > > >> " Thus, we believe that we have presented evidence of accuracy > at > > > >> least in > > > >> > > > >> two ethnic populations, and further work on the > generalizability of > > > >> BAI to > > > >> > > > >> other groups is under way, " they state. It will also be > important > > > >> to see > > > >> > > > >> whether the index can reliably forecast percentage of > adiposity in > > > >> children > > > >> > > > >> and predict risk of cardiovascular disease, they note. > > > >> > > > >> > > > >> > > > >> medscape.com > > > >> > > > >> -- > > > >> > > > >> Ortiz, MS, RD > > > >> > > > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > > >> > > > >> Check out my blog: mixture of deals and nutrition > > > >> > > > >> Made my own " funny but real " movie: Me interviewing a > " potential " > > > >> Dietetic > > > >> > > > >> student <http://www.xtranormal.com/watch/11216383/> > > > >> > > > >> > > > >> > > > >> *Healthy Diet at any Age: We are NOT just looking > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *at the years people have behind them but also the > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *quality of the years ahead of them.* > > > >> > > > >> > > > >> > > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2011 Report Share Posted March 6, 2011 We need to let go of the paradigm (what we think about something before we think about it) that albumin, transferrin and prealbumin have anything to do with nutrition. You can search PubMed using the key words " elderly " , " weight loss " , " outcomes " " body mass index " or any combination thereof to find some of the research. If you know how to limit searches, you can add the limits " epidemiology " and adults > 65 years. Pam Charney pcharney@... > Pam > What evidence do you see in the elderly and BMI? My concern is the > decreasing muscle mass I see in my nursing home clients and BMI > wouldn't > account for this. Would pre-albumin and transferrin be the best > indicators > (which most MDs do not order)? > Thanks > > > > > I was perhaps too brief. BMI works for the elderly; the problem is > > when we attempt to apply a standard that was developed for a > different > > population. There is plenty of research in epidemiology > demonstrating > > a strong relationship between BMI and both short and long term > > survival in the elderly (I cannot recall age ranges; the > definition of > > elderly seems to shift, especially as I get older). However, the cut > > off for BMI in older populations is higher than the cut off for > > younger age groups. > > > > So, if we say that a BMI less than 18-19 in someone who is between > 18 > > and 60 years of age requires further investigation (notice, I did > not > > say that a low BMI is automatically an indicator of anything), we > have > > to apply a higher standard to older adults. If I remember correctly, > > recommendations I've seen are in the range of 22 - 24 for older > folks. > > I'm sure that varies if the person is community dwelling or in long > > term care. > > > > CMS won't change until someone (you?) comes forth to demonstrate > that > > there is sufficient evidence to do so. Just as we want to practice > > based on the best available evidence, CMS is attempting to do the > > same. We cannot expect them to do the work for us, so guidelines > they > > use won't change until there is sufficient impetus to make a change. > > > > We throw the phrase " cookie-cutter " around all the time and I think > > it's lost it's underlying meaning. What do you mean? Is it cookie > > cutter to use BMI as a screening tool for the elderly? I would argue > > that it's probably negligent to not evaluate weight status using > some > > sort of standard for comparison. > > > > Regards, > > pam > > > > Pam Charney, PhD, RD > > Affiliate Associate Professor > > Pharmacy > > > > MS Student > > Clinical Informatics and Patient Centered Technology > > School of Nursing > > > > University of Washington > > Seattle, WA > > pcharney@... > > http://www.linkedin.com/in/pamcharney > > > > > > > > > > > > > Pam, You may be correct, but just to play the devil's advocate, > I'm > > > now > > > forced to calculate BMI for 80 to 90 year olds, when we all agree > > > (except > > > CMS evidently) that this is not a good indicator of weight status > > > for the > > > elderly. Furthermore, I always seem to be in disagreement with the > > > MDS 3.0 > > > calculation and determination of weight status. So, how does our > > > analysis as > > > nutrition experts come into play in this case? I see the new index > > > as just > > > another way to automate and take away one of more area within our > > > expertise. > > > I do agree we must use all available markers, but disagree with > > > having to > > > accept the cookie-cutter standard if my opinion differs. > > > > > > Digna > > > > > > From: rd-usa [mailto:rd-usa ] On > > > Behalf Of > > > Pam Charney > > > Sent: Saturday, March 05, 2011 8:06 AM > > > To: rd-usa > > > Subject: Re: New Obesity Index Proposed, But Further Work > > > Needed > > > > > > Merav, > > > > > > That's why we learn to interpret research. An index designed for > use > > > in healthy adults applies only to that population. Healthy adults. > > > > > > Pam Charney > > > pcharney@... <mailto:pcharney%40mac.com> > > > > > > > > > > > > > But there will always be exceptions - amputees, bed-bound like > you > > > > said, > > > > etc. > > > > > > > > On Sat, Mar 5, 2011 at 10:58 AM, Merav Levi <meravls@... > > > <mailto:meravls%40msn.com> > wrote: > > > > > > > >> > > > >> I am glad to hear there is work towards new index.However, > this one > > > >> may > > > >> work only for ambulating clients/outpt settings. Hospitalized > > > >> pt...how will > > > >> I measure them when they are bad bound. Someone might say " > the RN > > > >> would > > > >> have to do that on the initial screening " but I have hard time > > > >> getting the > > > >> Ht & Wt on admission, hip circ...? I don't see it happen. > > > >> > > > >> Merav Levi, RD, MS, CDNA dietitian, not the food police. > > > >> http://www.linkedin.com/in/meravlevi > > > >> > > > >> " Life is not measured by the number of breath you take, but > by the > > > >> moments > > > >> that take your breath away. " - Carlin " People don't > forget > > > >> the truth, > > > >> they just become better in lying " (Revolutionary Road) > > > >> > > > >> > > > >> > > > >> > > > >> To: rd-usa <mailto:rd-usa%40yahoogroups.com> > > > >> From: jennyvajda@... <mailto:jennyvajda%40sbcglobal.net > > > > > >> Date: Fri, 4 Mar 2011 17:05:49 -0800 > > > >> Subject: Re: New Obesity Index Proposed, But Further > Work > > > >> Needed > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> This does seem more useful than BMI but wouldn't hip > > > >> circumfrence miss > > > >> the very > > > >> > > > >> apple - build people, those who don't have much hip storage. > The > > > >> ethnic > > > >> > > > >> populations it has been tested with tend to have more caboose > > > >> action than > > > >> whites > > > >> > > > >> or Asians. (I am a pear and relate more to J Lo. than J An.) > > > >> > > > >> > > > >> > > > >> " Muffin top " problems in low rise jeans led to tops with a > gathered > > > >> lower > > > >> > > > >> waist-line to cover up the overflow. Fashion found a way to > fix its > > > >> own > > > >> faux > > > >> > > > >> pas. > > > >> > > > >> > > > >> > > > >> R Vajda, R.D. > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> ________________________________ > > > >> > > > >> From: Ortiz <nrord1@... > <mailto:nrord1%40gmail.com> > > > > >> > > > >> To: RD-USA <rd-usa <mailto:rd-usa > > > %40yahoogroups.com> > > > > >> > > > >> Sent: Fri, March 4, 2011 4:08:09 PM > > > >> > > > >> Subject: New Obesity Index Proposed, But Further Work > > > Needed > > > >> > > > >> > > > >> > > > >> US researchers have developed a new index of adiposity that > they > > > >> say is a > > > >> > > > >> more accurate measure of body fat than the traditionally used > body- > > > >> mass > > > >> > > > >> index (BMI); the latter is calculated by dividing weight by > height > > > >> [1]. > > > >> > > > >> > > > >> > > > >> Using measurements of hip circumference and height, the new > body > > > >> adiposity > > > >> > > > >> index (BAI) can be used to reflect percentage of body fat for > adult > > > >> men and > > > >> > > > >> women of differing ethnicities, without numerical correction or > > > >> assessment > > > >> > > > >> of weight, say *Dr N Bergman* (University of Southern > > > >> California, > > > >> > > > >> Los Angeles) and colleagues in their paper published online > March > > > >> 3, 2011 > > > >> in > > > >> > > > >> *Obesity*. > > > >> > > > >> > > > >> > > > >> However, they note that further work will be needed to extend > and > > > >> confirm > > > >> > > > >> their findings--tested in Mexican Americans and African > > > Americans--to > > > >> whites > > > >> > > > >> and other ethnic groups and to assess the role of the new > index in > > > >> children. > > > >> > > > >> And " it remains to be seen if the BAI is a more useful > predictor of > > > >> health > > > >> > > > >> outcome, in both males and females, than other indexes of body > > > >> adiposity, > > > >> > > > >> including the BMI itself. " > > > >> > > > >> > > > >> > > > >> *Height and Hip Size Most Strongly Relate to Percentage > Adiposity * > > > >> > > > >> > > > >> > > > >> " We were interested in determining whether we could find an > index > > > >> of body > > > >> > > > >> adiposity that at least in some ways may be better than the > BMI, > > > >> which has > > > >> > > > >> been around since the 1840s " and is not a very accurate > measure of > > > >> adiposity > > > >> > > > >> in individual patients, Bergman explained to* heartwire *. > BMI is > > > >> > > > >> particularly inaccurate in people with elevated lean body mass, > > > >> such as > > > >> > > > >> athletes, and in children, and it cannot be generalized among > > > >> different > > > >> > > > >> ethnic groups, he and his colleagues note. > > > >> > > > >> > > > >> > > > >> Bergman et al are not the first to propose an alternative to > BMI. > > > >> Waist > > > >> > > > >> circumference is widely thought to be a better indicator of > > > >> cardiovascular > > > >> > > > >> risk than BMI, although some studies have shown them to be > equally > > > >> > > > >> predictive. Other examples include the waist-to-hip ratio > (WHR) and > > > >> the > > > >> > > > >> waist-to-hip-to-height index, which have both been forwarded as > > > >> potentially > > > >> > > > >> better measures of obesity than BMI. But critics have said that > > > it is > > > >> > > > >> difficult and time-consuming to get very accurate > measurements of > > > >> waist and > > > >> > > > >> hip circumference and height and that BMI has remained popular > > > >> because it > > > >> is > > > >> > > > >> simple and fast. > > > >> > > > >> > > > >> > > > >> In their study, Bergman and colleagues used a large database, > > > >> *BetaGene*, > > > >> > > > >> which consisted of relatives of Mexican Americans with > gestational > > > >> diabetes, > > > >> > > > >> to determine whether there might be a better index. They > chose the > > > >> Mexican > > > >> > > > >> American population because of its prevalence in Los Angeles, > > > >> observing, > > > >> > > > >> " Most of the world population is nonwhite. " > > > >> > > > >> > > > >> > > > >> " We looked at which variables most strongly related to percent > > > >> adiposity, > > > >> > > > >> and they were height and hip size. Because these variables were > > > >> > > > >> uncorrelated, we proposed a new index, the BAI, based upon > these > > > >> measures > > > >> > > > >> alone, " Bergman explains. > > > >> > > > >> > > > >> > > > >> *BAI Will Be Easy to Calculate* > > > >> > > > >> > > > >> > > > >> " We showed that the BAI, calculated as (hip circumference/ > > > >> height1.5)-18, > > > >> was > > > >> > > > >> a good predictor of percent fat and worked for men and > women, " he > > > >> > > > >> continues. The BAI also yielded the percentage of fat itself, > > > >> rather than > > > >> > > > >> just a correlate (or index) of it, which is what the BMI > does, he > > > >> notes. > > > >> The > > > >> > > > >> BAI was validated against the " gold standard " of dual-energy > X-ray > > > >> > > > >> absorption (DEXA). > > > >> > > > >> > > > >> > > > >> " It will be very easy for a physician or a nurse practitioner > to > > > >> work out > > > >> > > > >> this index for individual patients, using a calculator, a > computer > > > >> program, > > > >> > > > >> or an iPhone app, " Bergman says. > > > >> > > > >> > > > >> > > > >> The researchers then went on to corroborate their findings in > > > another > > > >> > > > >> population, the *Triglyceride and Cardiovascular Risk in > African > > > >> > > > >> Americans*(TARA) study, and found that the behavior of the > BAI was > > > >> > > > >> quite similar > > > >> > > > >> between the blacks in that population and the Hispanics in > > > BetaGene. > > > >> > > > >> > > > >> > > > >> " Thus, we believe that we have presented evidence of accuracy > at > > > >> least in > > > >> > > > >> two ethnic populations, and further work on the > generalizability of > > > >> BAI to > > > >> > > > >> other groups is under way, " they state. It will also be > important > > > >> to see > > > >> > > > >> whether the index can reliably forecast percentage of > adiposity in > > > >> children > > > >> > > > >> and predict risk of cardiovascular disease, they note. > > > >> > > > >> > > > >> > > > >> medscape.com > > > >> > > > >> -- > > > >> > > > >> Ortiz, MS, RD > > > >> > > > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > > >> > > > >> Check out my blog: mixture of deals and nutrition > > > >> > > > >> Made my own " funny but real " movie: Me interviewing a > " potential " > > > >> Dietetic > > > >> > > > >> student <http://www.xtranormal.com/watch/11216383/> > > > >> > > > >> > > > >> > > > >> *Healthy Diet at any Age: We are NOT just looking > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *at the years people have behind them but also the > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *quality of the years ahead of them.* > > > >> > > > >> > > > >> > > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2011 Report Share Posted March 6, 2011 So, Pam, is there any lab value that is indicative of malnutrition? Ro New Obesity Index Proposed, But Further Work > > > Needed > > > >> > > > >> > > > >> > > > >> US researchers have developed a new index of adiposity that > they > > > >> say is a > > > >> > > > >> more accurate measure of body fat than the traditionally used > body- > > > >> mass > > > >> > > > >> index (BMI); the latter is calculated by dividing weight by > height > > > >> [1]. > > > >> > > > >> > > > >> > > > >> Using measurements of hip circumference and height, the new > body > > > >> adiposity > > > >> > > > >> index (BAI) can be used to reflect percentage of body fat for > adult > > > >> men and > > > >> > > > >> women of differing ethnicities, without numerical correction or > > > >> assessment > > > >> > > > >> of weight, say *Dr N Bergman* (University of Southern > > > >> California, > > > >> > > > >> Los Angeles) and colleagues in their paper published online > March > > > >> 3, 2011 > > > >> in > > > >> > > > >> *Obesity*. > > > >> > > > >> > > > >> > > > >> However, they note that further work will be needed to extend > and > > > >> confirm > > > >> > > > >> their findings--tested in Mexican Americans and African > > > Americans--to > > > >> whites > > > >> > > > >> and other ethnic groups and to assess the role of the new > index in > > > >> children. > > > >> > > > >> And " it remains to be seen if the BAI is a more useful > predictor of > > > >> health > > > >> > > > >> outcome, in both males and females, than other indexes of body > > > >> adiposity, > > > >> > > > >> including the BMI itself. " > > > >> > > > >> > > > >> > > > >> *Height and Hip Size Most Strongly Relate to Percentage > Adiposity * > > > >> > > > >> > > > >> > > > >> " We were interested in determining whether we could find an > index > > > >> of body > > > >> > > > >> adiposity that at least in some ways may be better than the > BMI, > > > >> which has > > > >> > > > >> been around since the 1840s " and is not a very accurate > measure of > > > >> adiposity > > > >> > > > >> in individual patients, Bergman explained to* heartwire *. > BMI is > > > >> > > > >> particularly inaccurate in people with elevated lean body mass, > > > >> such as > > > >> > > > >> athletes, and in children, and it cannot be generalized among > > > >> different > > > >> > > > >> ethnic groups, he and his colleagues note. > > > >> > > > >> > > > >> > > > >> Bergman et al are not the first to propose an alternative to > BMI. > > > >> Waist > > > >> > > > >> circumference is widely thought to be a better indicator of > > > >> cardiovascular > > > >> > > > >> risk than BMI, although some studies have shown them to be > equally > > > >> > > > >> predictive. Other examples include the waist-to-hip ratio > (WHR) and > > > >> the > > > >> > > > >> waist-to-hip-to-height index, which have both been forwarded as > > > >> potentially > > > >> > > > >> better measures of obesity than BMI. But critics have said that > > > it is > > > >> > > > >> difficult and time-consuming to get very accurate > measurements of > > > >> waist and > > > >> > > > >> hip circumference and height and that BMI has remained popular > > > >> because it > > > >> is > > > >> > > > >> simple and fast. > > > >> > > > >> > > > >> > > > >> In their study, Bergman and colleagues used a large database, > > > >> *BetaGene*, > > > >> > > > >> which consisted of relatives of Mexican Americans with > gestational > > > >> diabetes, > > > >> > > > >> to determine whether there might be a better index. They > chose the > > > >> Mexican > > > >> > > > >> American population because of its prevalence in Los Angeles, > > > >> observing, > > > >> > > > >> " Most of the world population is nonwhite. " > > > >> > > > >> > > > >> > > > >> " We looked at which variables most strongly related to percent > > > >> adiposity, > > > >> > > > >> and they were height and hip size. Because these variables were > > > >> > > > >> uncorrelated, we proposed a new index, the BAI, based upon > these > > > >> measures > > > >> > > > >> alone, " Bergman explains. > > > >> > > > >> > > > >> > > > >> *BAI Will Be Easy to Calculate* > > > >> > > > >> > > > >> > > > >> " We showed that the BAI, calculated as (hip circumference/ > > > >> height1.5)-18, > > > >> was > > > >> > > > >> a good predictor of percent fat and worked for men and > women, " he > > > >> > > > >> continues. The BAI also yielded the percentage of fat itself, > > > >> rather than > > > >> > > > >> just a correlate (or index) of it, which is what the BMI > does, he > > > >> notes. > > > >> The > > > >> > > > >> BAI was validated against the " gold standard " of dual-energy > X-ray > > > >> > > > >> absorption (DEXA). > > > >> > > > >> > > > >> > > > >> " It will be very easy for a physician or a nurse practitioner > to > > > >> work out > > > >> > > > >> this index for individual patients, using a calculator, a > computer > > > >> program, > > > >> > > > >> or an iPhone app, " Bergman says. > > > >> > > > >> > > > >> > > > >> The researchers then went on to corroborate their findings in > > > another > > > >> > > > >> population, the *Triglyceride and Cardiovascular Risk in > African > > > >> > > > >> Americans*(TARA) study, and found that the behavior of the > BAI was > > > >> > > > >> quite similar > > > >> > > > >> between the blacks in that population and the Hispanics in > > > BetaGene. > > > >> > > > >> > > > >> > > > >> " Thus, we believe that we have presented evidence of accuracy > at > > > >> least in > > > >> > > > >> two ethnic populations, and further work on the > generalizability of > > > >> BAI to > > > >> > > > >> other groups is under way, " they state. It will also be > important > > > >> to see > > > >> > > > >> whether the index can reliably forecast percentage of > adiposity in > > > >> children > > > >> > > > >> and predict risk of cardiovascular disease, they note. > > > >> > > > >> > > > >> > > > >> medscape.com > > > >> > > > >> -- > > > >> > > > >> Ortiz, MS, RD > > > >> > > > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > > >> > > > >> Check out my blog: mixture of deals and nutrition > > > >> > > > >> Made my own " funny but real " movie: Me interviewing a > " potential " > > > >> Dietetic > > > >> > > > >> student <http://www.xtranormal.com/watch/11216383/> > > > >> > > > >> > > > >> > > > >> *Healthy Diet at any Age: We are NOT just looking > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *at the years people have behind them but also the > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *quality of the years ahead of them.* > > > >> > > > >> > > > >> > > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2011 Report Share Posted March 6, 2011 you have to look at the whole picture. there is no one lab value that will be nutrition only related. Merav Levi, RD, MS, CDNA dietitian, not the food police. http://www.linkedin.com/in/meravlevi " Life is not measured by the number of breath you take, but by the moments that take your breath away. " - Carlin " People don't forget the truth, they just become better in lying " (Revolutionary Road) To: rd-usa From: lindarord@... Date: Sun, 6 Mar 2011 13:42:36 -0500 Subject: Re: New Obesity Index Proposed, But Further Work Needed So, Pam, is there any lab value that is indicative of malnutrition? Ro New Obesity Index Proposed, But Further Work > > > Needed > > > >> > > > >> > > > >> > > > >> US researchers have developed a new index of adiposity that > they > > > >> say is a > > > >> > > > >> more accurate measure of body fat than the traditionally used > body- > > > >> mass > > > >> > > > >> index (BMI); the latter is calculated by dividing weight by > height > > > >> [1]. > > > >> > > > >> > > > >> > > > >> Using measurements of hip circumference and height, the new > body > > > >> adiposity > > > >> > > > >> index (BAI) can be used to reflect percentage of body fat for > adult > > > >> men and > > > >> > > > >> women of differing ethnicities, without numerical correction or > > > >> assessment > > > >> > > > >> of weight, say *Dr N Bergman* (University of Southern > > > >> California, > > > >> > > > >> Los Angeles) and colleagues in their paper published online > March > > > >> 3, 2011 > > > >> in > > > >> > > > >> *Obesity*. > > > >> > > > >> > > > >> > > > >> However, they note that further work will be needed to extend > and > > > >> confirm > > > >> > > > >> their findings--tested in Mexican Americans and African > > > Americans--to > > > >> whites > > > >> > > > >> and other ethnic groups and to assess the role of the new > index in > > > >> children. > > > >> > > > >> And " it remains to be seen if the BAI is a more useful > predictor of > > > >> health > > > >> > > > >> outcome, in both males and females, than other indexes of body > > > >> adiposity, > > > >> > > > >> including the BMI itself. " > > > >> > > > >> > > > >> > > > >> *Height and Hip Size Most Strongly Relate to Percentage > Adiposity * > > > >> > > > >> > > > >> > > > >> " We were interested in determining whether we could find an > index > > > >> of body > > > >> > > > >> adiposity that at least in some ways may be better than the > BMI, > > > >> which has > > > >> > > > >> been around since the 1840s " and is not a very accurate > measure of > > > >> adiposity > > > >> > > > >> in individual patients, Bergman explained to* heartwire *. > BMI is > > > >> > > > >> particularly inaccurate in people with elevated lean body mass, > > > >> such as > > > >> > > > >> athletes, and in children, and it cannot be generalized among > > > >> different > > > >> > > > >> ethnic groups, he and his colleagues note. > > > >> > > > >> > > > >> > > > >> Bergman et al are not the first to propose an alternative to > BMI. > > > >> Waist > > > >> > > > >> circumference is widely thought to be a better indicator of > > > >> cardiovascular > > > >> > > > >> risk than BMI, although some studies have shown them to be > equally > > > >> > > > >> predictive. Other examples include the waist-to-hip ratio > (WHR) and > > > >> the > > > >> > > > >> waist-to-hip-to-height index, which have both been forwarded as > > > >> potentially > > > >> > > > >> better measures of obesity than BMI. But critics have said that > > > it is > > > >> > > > >> difficult and time-consuming to get very accurate > measurements of > > > >> waist and > > > >> > > > >> hip circumference and height and that BMI has remained popular > > > >> because it > > > >> is > > > >> > > > >> simple and fast. > > > >> > > > >> > > > >> > > > >> In their study, Bergman and colleagues used a large database, > > > >> *BetaGene*, > > > >> > > > >> which consisted of relatives of Mexican Americans with > gestational > > > >> diabetes, > > > >> > > > >> to determine whether there might be a better index. They > chose the > > > >> Mexican > > > >> > > > >> American population because of its prevalence in Los Angeles, > > > >> observing, > > > >> > > > >> " Most of the world population is nonwhite. " > > > >> > > > >> > > > >> > > > >> " We looked at which variables most strongly related to percent > > > >> adiposity, > > > >> > > > >> and they were height and hip size. Because these variables were > > > >> > > > >> uncorrelated, we proposed a new index, the BAI, based upon > these > > > >> measures > > > >> > > > >> alone, " Bergman explains. > > > >> > > > >> > > > >> > > > >> *BAI Will Be Easy to Calculate* > > > >> > > > >> > > > >> > > > >> " We showed that the BAI, calculated as (hip circumference/ > > > >> height1.5)-18, > > > >> was > > > >> > > > >> a good predictor of percent fat and worked for men and > women, " he > > > >> > > > >> continues. The BAI also yielded the percentage of fat itself, > > > >> rather than > > > >> > > > >> just a correlate (or index) of it, which is what the BMI > does, he > > > >> notes. > > > >> The > > > >> > > > >> BAI was validated against the " gold standard " of dual-energy > X-ray > > > >> > > > >> absorption (DEXA). > > > >> > > > >> > > > >> > > > >> " It will be very easy for a physician or a nurse practitioner > to > > > >> work out > > > >> > > > >> this index for individual patients, using a calculator, a > computer > > > >> program, > > > >> > > > >> or an iPhone app, " Bergman says. > > > >> > > > >> > > > >> > > > >> The researchers then went on to corroborate their findings in > > > another > > > >> > > > >> population, the *Triglyceride and Cardiovascular Risk in > African > > > >> > > > >> Americans*(TARA) study, and found that the behavior of the > BAI was > > > >> > > > >> quite similar > > > >> > > > >> between the blacks in that population and the Hispanics in > > > BetaGene. > > > >> > > > >> > > > >> > > > >> " Thus, we believe that we have presented evidence of accuracy > at > > > >> least in > > > >> > > > >> two ethnic populations, and further work on the > generalizability of > > > >> BAI to > > > >> > > > >> other groups is under way, " they state. It will also be > important > > > >> to see > > > >> > > > >> whether the index can reliably forecast percentage of > adiposity in > > > >> children > > > >> > > > >> and predict risk of cardiovascular disease, they note. > > > >> > > > >> > > > >> > > > >> medscape.com > > > >> > > > >> -- > > > >> > > > >> Ortiz, MS, RD > > > >> > > > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > > >> > > > >> Check out my blog: mixture of deals and nutrition > > > >> > > > >> Made my own " funny but real " movie: Me interviewing a > " potential " > > > >> Dietetic > > > >> > > > >> student <http://www.xtranormal.com/watch/11216383/> > > > >> > > > >> > > > >> > > > >> *Healthy Diet at any Age: We are NOT just looking > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *at the years people have behind them but also the > > > >> > > > >> * > > > >> > > > >> > > > >> > > > >> *quality of the years ahead of them.* > > > >> > > > >> > > > >> > > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2011 Report Share Posted March 6, 2011 No. In fact, we could probably count on the fingers of one finger the number of conditions for which there is one diagnostic test with sufficient reliability and validity to diagnose much of anything..... Pam Charney pcharney@... > So, Pam, is there any lab value that is indicative of malnutrition? > Ro > > New Obesity Index Proposed, But Further > Work > > > > Needed > > > > >> > > > > >> > > > > >> > > > > >> US researchers have developed a new index of adiposity that > > they > > > > >> say is a > > > > >> > > > > >> more accurate measure of body fat than the traditionally used > > body- > > > > >> mass > > > > >> > > > > >> index (BMI); the latter is calculated by dividing weight by > > height > > > > >> [1]. > > > > >> > > > > >> > > > > >> > > > > >> Using measurements of hip circumference and height, the new > > body > > > > >> adiposity > > > > >> > > > > >> index (BAI) can be used to reflect percentage of body fat for > > adult > > > > >> men and > > > > >> > > > > >> women of differing ethnicities, without numerical > correction or > > > > >> assessment > > > > >> > > > > >> of weight, say *Dr N Bergman* (University of Southern > > > > >> California, > > > > >> > > > > >> Los Angeles) and colleagues in their paper published online > > March > > > > >> 3, 2011 > > > > >> in > > > > >> > > > > >> *Obesity*. > > > > >> > > > > >> > > > > >> > > > > >> However, they note that further work will be needed to extend > > and > > > > >> confirm > > > > >> > > > > >> their findings--tested in Mexican Americans and African > > > > Americans--to > > > > >> whites > > > > >> > > > > >> and other ethnic groups and to assess the role of the new > > index in > > > > >> children. > > > > >> > > > > >> And " it remains to be seen if the BAI is a more useful > > predictor of > > > > >> health > > > > >> > > > > >> outcome, in both males and females, than other indexes of > body > > > > >> adiposity, > > > > >> > > > > >> including the BMI itself. " > > > > >> > > > > >> > > > > >> > > > > >> *Height and Hip Size Most Strongly Relate to Percentage > > Adiposity * > > > > >> > > > > >> > > > > >> > > > > >> " We were interested in determining whether we could find an > > index > > > > >> of body > > > > >> > > > > >> adiposity that at least in some ways may be better than the > > BMI, > > > > >> which has > > > > >> > > > > >> been around since the 1840s " and is not a very accurate > > measure of > > > > >> adiposity > > > > >> > > > > >> in individual patients, Bergman explained to* heartwire *. > > BMI is > > > > >> > > > > >> particularly inaccurate in people with elevated lean body > mass, > > > > >> such as > > > > >> > > > > >> athletes, and in children, and it cannot be generalized among > > > > >> different > > > > >> > > > > >> ethnic groups, he and his colleagues note. > > > > >> > > > > >> > > > > >> > > > > >> Bergman et al are not the first to propose an alternative to > > BMI. > > > > >> Waist > > > > >> > > > > >> circumference is widely thought to be a better indicator of > > > > >> cardiovascular > > > > >> > > > > >> risk than BMI, although some studies have shown them to be > > equally > > > > >> > > > > >> predictive. Other examples include the waist-to-hip ratio > > (WHR) and > > > > >> the > > > > >> > > > > >> waist-to-hip-to-height index, which have both been > forwarded as > > > > >> potentially > > > > >> > > > > >> better measures of obesity than BMI. But critics have said > that > > > > it is > > > > >> > > > > >> difficult and time-consuming to get very accurate > > measurements of > > > > >> waist and > > > > >> > > > > >> hip circumference and height and that BMI has remained > popular > > > > >> because it > > > > >> is > > > > >> > > > > >> simple and fast. > > > > >> > > > > >> > > > > >> > > > > >> In their study, Bergman and colleagues used a large database, > > > > >> *BetaGene*, > > > > >> > > > > >> which consisted of relatives of Mexican Americans with > > gestational > > > > >> diabetes, > > > > >> > > > > >> to determine whether there might be a better index. They > > chose the > > > > >> Mexican > > > > >> > > > > >> American population because of its prevalence in Los Angeles, > > > > >> observing, > > > > >> > > > > >> " Most of the world population is nonwhite. " > > > > >> > > > > >> > > > > >> > > > > >> " We looked at which variables most strongly related to > percent > > > > >> adiposity, > > > > >> > > > > >> and they were height and hip size. Because these variables > were > > > > >> > > > > >> uncorrelated, we proposed a new index, the BAI, based upon > > these > > > > >> measures > > > > >> > > > > >> alone, " Bergman explains. > > > > >> > > > > >> > > > > >> > > > > >> *BAI Will Be Easy to Calculate* > > > > >> > > > > >> > > > > >> > > > > >> " We showed that the BAI, calculated as (hip circumference/ > > > > >> height1.5)-18, > > > > >> was > > > > >> > > > > >> a good predictor of percent fat and worked for men and > > women, " he > > > > >> > > > > >> continues. The BAI also yielded the percentage of fat itself, > > > > >> rather than > > > > >> > > > > >> just a correlate (or index) of it, which is what the BMI > > does, he > > > > >> notes. > > > > >> The > > > > >> > > > > >> BAI was validated against the " gold standard " of dual-energy > > X-ray > > > > >> > > > > >> absorption (DEXA). > > > > >> > > > > >> > > > > >> > > > > >> " It will be very easy for a physician or a nurse practitioner > > to > > > > >> work out > > > > >> > > > > >> this index for individual patients, using a calculator, a > > computer > > > > >> program, > > > > >> > > > > >> or an iPhone app, " Bergman says. > > > > >> > > > > >> > > > > >> > > > > >> The researchers then went on to corroborate their findings in > > > > another > > > > >> > > > > >> population, the *Triglyceride and Cardiovascular Risk in > > African > > > > >> > > > > >> Americans*(TARA) study, and found that the behavior of the > > BAI was > > > > >> > > > > >> quite similar > > > > >> > > > > >> between the blacks in that population and the Hispanics in > > > > BetaGene. > > > > >> > > > > >> > > > > >> > > > > >> " Thus, we believe that we have presented evidence of accuracy > > at > > > > >> least in > > > > >> > > > > >> two ethnic populations, and further work on the > > generalizability of > > > > >> BAI to > > > > >> > > > > >> other groups is under way, " they state. It will also be > > important > > > > >> to see > > > > >> > > > > >> whether the index can reliably forecast percentage of > > adiposity in > > > > >> children > > > > >> > > > > >> and predict risk of cardiovascular disease, they note. > > > > >> > > > > >> > > > > >> > > > > >> medscape.com > > > > >> > > > > >> -- > > > > >> > > > > >> Ortiz, MS, RD > > > > >> > > > > >> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com> > > > > >> > > > > >> Check out my blog: mixture of deals and nutrition > > > > >> > > > > >> Made my own " funny but real " movie: Me interviewing a > > " potential " > > > > >> Dietetic > > > > >> > > > > >> student <http://www.xtranormal.com/watch/11216383/> > > > > >> > > > > >> > > > > >> > > > > >> *Healthy Diet at any Age: We are NOT just looking > > > > >> > > > > >> * > > > > >> > > > > >> > > > > >> > > > > >> *at the years people have behind them but also the > > > > >> > > > > >> * > > > > >> > > > > >> > > > > >> > > > > >> *quality of the years ahead of them.* > > > > >> > > > > >> > > > > >> > > > > >> Quote Link to comment Share on other sites More sharing options...
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