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Velasquez-Mieyer PA, Nieto-Martinez R, Neira CP, De Oliveira-Gomes D, Velasquez Rodriguez AE, Ugel E, Cowan PA. Relative Body Mass Index Improves the BMI Percentile Performance for Detection and Monitoring of Excess Adiposity in Adolescents. Nutrients 2024; 16:703. [PMID: 38474830 DOI: 10.3390/nu16050703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Obesity is defined as excess adipose tissue; however, commonly used methods may under-detect adiposity in adolescents. This study compared the performance of body mass index percentile (BMI%) and relative body mass index (RBMI) in identifying excess body fat percentage (BF%) and estimated RBMI cut points to better stratify severity of adiposity. In 567 adolescents ages 11-19 year, BF% measured by DXA was used to compare BMI% and RBMI performance at different degrees of adiposity. RBMI cut points for adiposity detection were derived via ROC curve analysis. BF% was strongly correlated with BMI% (r = 0.889, p < 0.001) and RBMI (r = 0.901, p < 0.001). However, RBMI exhibited less dispersion and better discriminated the relationship with BF% independent of age, race, and gender. Both BMI% and RBMI performed similarly for detecting high BF% (≥25 BF% in males; ≥30 BF% in females). Nonetheless, the relationship of BMI% with BF% was diminished among leaner adolescents. RBMI detected overweight in 21.3% more females and 14.2% more males. RBMI improved the detection of excess adiposity in individuals otherwise classified as having normal weight or overweight by BMI%. RBMI is a valuable and accessible tool for earlier detection, intervention, and effective follow-up of excess adiposity in youth at higher risk for complications.
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Affiliation(s)
- Pedro A Velasquez-Mieyer
- Lifedoc Health, 6625 Lenox Park Drive, Suite 205, Memphis, TN 38115, USA
- Lifedoc Research, 6625 Lenox Park Drive, Suite 205, Memphis, TN 38115, USA
| | - Ramfis Nieto-Martinez
- Lifedoc Health, 6625 Lenox Park Drive, Suite 205, Memphis, TN 38115, USA
- Departments of Global Health and Population and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Claudia P Neira
- Lifedoc Health, 6625 Lenox Park Drive, Suite 205, Memphis, TN 38115, USA
- Lifedoc Research, 6625 Lenox Park Drive, Suite 205, Memphis, TN 38115, USA
| | - Diana De Oliveira-Gomes
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Eunice Ugel
- Departments of Global Health and Population and Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Patricia A Cowan
- College of Nursing, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
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Nieto-Martinez R, Neira C, de Oliveira D, Velasquez-Rodriguez A, Neira A, Velasquez-Rodriguez P, Garcia G, González-Rivas JP, Mechanick JI, Velasquez-Mieyer P. Lifestyle Medicine in Diabetes Care: The Lifedoc Health Model. Am J Lifestyle Med 2023; 17:336-354. [PMID: 37304744 PMCID: PMC10248374 DOI: 10.1177/15598276221103470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Introduction The relevance of lifestyle medicine in diabetes treatment is now incorporated in clinical practice guidelines but finding an exemplar for the creation of a Lifestyle Medicine Program (LMP) is a difficult task. Aim To use Lifedoc Health (LDH) as a LMP exemplar by describing their multidisciplinary team (MDT) approach to diabetes care along with tactics to address sustainability challenges. Results The LDH model facilitates early activation of patients with diabetes and other cardiometabolic risk factors, MDT approaches, and protocols/policies that are able to overcome barriers to equitable healthcare in the community. Specific programmatic targets are clinical outcomes, effective dissemination, economic viability, and sustainability. Infrastructure centers on patient-driven problem-based visits, shared medical appointments, telemedicine, and patient tracking. Further discussions on program conceptualization and operationalization are provided. Conclusion Even though strategic plans for LMPs that specialize in diabetes care are well represented in the literature, implementation protocols, and performance metrics are lacking. The LDH experience provides a starting point for those healthcare professionals interested in translating ideas into action.
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Affiliation(s)
- Ramfis Nieto-Martinez
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Claudia Neira
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Diana de Oliveira
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Andrés Velasquez-Rodriguez
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Andres Neira
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Pedro Velasquez-Rodriguez
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Gabriela Garcia
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Juan P. González-Rivas
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Jeffrey I. Mechanick
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
| | - Pedro Velasquez-Mieyer
- LifeDoc Health, Memphis, TN, USA (RN-M, CN, AN, PV-R, GG, PV-M);
Departments of Global Health and Population and Epidemiology, Harvard TH Chan
School of Public Health, Harvard University, Boston, MA, USA (RN-M, JPG-R); Foundation for Clinic, Public Health,
and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela (RN-M, DdO, JPG-R); LifeDoc Research, Memphis, TN, USA (CN, AV-R, PV-M); International Clinical
Research Centre (ICRC), St Anne’s University Hospital Brno
(FNUSA), Czech Republic (JPG-R); and The Marie-Josée and Henry R.
Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of
Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount
Sinai, New York, NY, USA (JIM)
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