High degree of BMI misclassification of malnutrition among Swedish elderly population: Age-adjusted height estimation using knee height and demispan

Eur J Clin Nutr. 2015 May;69(5):565-71. doi: 10.1038/ejcn.2014.183. Epub 2014 Sep 10.


Background/objectives: The degree of misclassification of obesity and undernutrition among elders owing to inaccurate height measurements is investigated using height predicted by knee height (KH) and demispan equations.

Subjects/methods: Cross-sectional investigation was done among a random heterogeneous sample from five municipalities in Southern Sweden from a general population study 'Good Aging in Skåne' (GÅS). The sample comprised two groups: group 1 (KH) including 2839 GÅS baseline participants aged 60-93 years with a valid KH measurement and group 2 (demispan) including 2871 GÅS follow-up examination participants (1573 baseline; 1298 new), aged 60-99 years, with a valid demispan measurement. Participation rate was 80%. Height, weight, KH and demispan were measured. KH and demispan equations were formulated using linear regression analysis among participants aged 60-64 years as reference. Body mass index (BMI) was calculated in kg/m(2).

Results: Undernutrition prevalences in men and women were 3.9 and 8.6% by KH, compared with 2.4 and 5.4% by standard BMI, and more pronounced for all women aged 85+ years (21% vs 11.3%). The corresponding value in women aged 85+ years by demispan was 16.5% vs 10% by standard BMI. Obesity prevalences in men and women were 17.5 and 14.6% by KH, compared with 19.0 and 20.03% by standard BMI. Values among women aged 85+ years were 3.7% vs 10.4% by KH and 6.5% vs 12.7% by demispan compared with the standard.

Conclusions: There is an age-related misclassification of undernutrition and obesity attributed to inaccurate height estimation among the elderly. This could affect the management of patients at true risk. We therefore propose using KH- and demispan-based formulae to address this issue.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / physiology*
  • Anthropometry / methods
  • Body Height / physiology*
  • Body Mass Index*
  • Body Weight / physiology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Knee / anatomy & histology*
  • Male
  • Malnutrition / diagnosis*
  • Malnutrition / epidemiology
  • Malnutrition / physiopathology
  • Middle Aged
  • Obesity / diagnosis*
  • Obesity / epidemiology
  • Obesity / physiopathology
  • Prevalence
  • Reference Values
  • Sweden / epidemiology