Better diagnostic accuracy of neuropathy in obesity: A new challenge for neurologists

Clin Neurophysiol. 2018 Mar;129(3):654-662. doi: 10.1016/j.clinph.2018.01.003. Epub 2018 Jan 16.


Objective: To determine the comparative diagnostic characteristics of neuropathy measures in an obese population.

Methods: We recruited obese participants from the University of Michigan's Weight Management Program. Receiver operative characteristic analysis determined the area under the curve (AUC) of neuropathy measures for distal symmetric polyneuropathy (DSP), small fiber neuropathy (SFN), and cardiovascular autonomic neuropathy (CAN). The best test combinations were determined using stepwise and Score subset selection models.

Results: We enrolled 120 obese participants. For DSP, seven of 42 neuropathy measures (Utah Early Neuropathy Score (UENS, N = 62), Michigan Neuropathy Screening Instrument (MNSI) reduced combined index, MNSI examination, nerve fiber density (NFD) leg, tibial F response, MNSI questionnaire, peroneal distal motor latency) had AUCs ≥ 0.75. Three of 19 small fiber nerve measures for SFN (UENS, NFD leg, Sudoscan feet (N = 70)) and zero of 16 CAN measures had AUCs ≥ 0.75. Combinations of tests performed better than individual tests with AUCs of 0.82 for DSP (two parameters) and 0.84 for SFN (three parameters).

Conclusions: Many neuropathy measures demonstrate good test performance for DSP in obese participants. Select few small fiber nerve measures performed well for SFN, and none for CAN.

Significance: Specific combinations of tests should be used for research studies to maximize diagnostic performance in obese cohorts.

Keywords: Cardiovascular autonomic neuropathy; Diagnostic tests; Distal symmetric polyneuropathy; Obesity; Small fiber neuropathy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Autonomic Nervous System Diseases / complications
  • Autonomic Nervous System Diseases / diagnosis*
  • Autonomic Nervous System Diseases / physiopathology
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / physiopathology
  • Electrodiagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurologic Examination
  • Obesity / complications*
  • Obesity / physiopathology
  • Polyneuropathies / complications
  • Polyneuropathies / diagnosis*
  • Polyneuropathies / physiopathology
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Small Fiber Neuropathy / complications
  • Small Fiber Neuropathy / diagnosis*
  • Small Fiber Neuropathy / physiopathology