| Summary: | Rabia Anwer,1 Lubna Ansari Baig,2 Mehjabeen Musharraf3 1Registered Dietitian Nutritionist, PNS Shifa Hospital, Karachi, 75270, Pakistan; 2Chairperson, APPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, 75510, Pakistan; 3Senior Lecturer, APPNA Institute of Public Health, Jinnah Sindh Medical University Karachi, Karachi, 75510, PakistanCorrespondence: Rabia Anwer, THB Global, 59 C Khyaban-e-Seher DHA Phase 6, Karachi, 75500, Pakistan, Tel + 92 333-5289010, Email rabiaanwer70@gmail.com Lubna Ansari Baig, APPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, 75510, Pakistan, Tel +92300-8239680, Email lubna.shakil1983@gmail.comPurpose: To determine the validity of hand-to-foot bioelectrical impedance analysis (HF-BIA) versus body mass index (BMI) to assess overweight and obesity status in adults against a reference method, dual-energy x-ray absorptiometry (DXA).Patients and Methods: It is a validation study conducted on 206 Pakistani adults ≥ 20 years recruited through convenience sampling technique at PNS Shifa Hospital and Jinnah Post Medical Centre, Karachi, Pakistan.Results: HF-BIA showed better sensitivity of 90.1% and 100% specificity with no false positive, but 9% false negative as compared to BMI which indicated 80.3% sensitivity and 100% specificity with a false-negative rate of 19.6%.HF-BIA also showed better sensitivity 80.9– 97.1% with 100% specificity and PPV across all age groups. The correlation coefficient between BMI and DXA bf% (r=0.67) was moderate and less than the correlation coefficient between HF-BIA and DXA bf % (r=0.87). Kappa agreement showed weak to a fair agreement between BMI and DXA bf % (0.1 overall; 0.22 men; 0.14 women) compared to HF-BIA, which had a better agreement between BIA bf% and DXA bf% (0.43 overall; 0.46 men; 0.34 women). HF-BIA bf % demonstrated a better discriminatory power than BMI (AUC of ≥ 0.91) and was better predictor of body fat than BMI.Conclusion: HF-BIA is a more accurate method than BMI and may be used consistently throughout the country in primary care and research to identify the fat-based overweight and obese in the Pakistani population.Keywords: body fat, area under the curve, correlation, sensitivity, specificity
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