Body surface area in normal-weight, overweight, and obese adults. A comparison study
Introduction
It is a frequent practice in medicine to estimate the human body surface area (BSA). The BSA is widely used as the biometric unit for normalizing physiologic parameters (cardiac output, left ventricular mass, renal clearance) and for the determination of appropriate drug dosages in cancer chemotherapy, in individuals of different body size [1], [2], [3]. It derives from the finding that such parameters correlate better with BSA than with any other index of body size and the fact that differences in the maximum tolerable dosages of anticancer drugs among men were normalized when doses were expressed in milligrams per square meter of BSA [4]. The commonly accepted 50th percentiles for BSA are 1.94 m2 for adult men and 1.69 m2 for adult women [5]. Physicians often depend upon elaborate formulas to establish BSA. However, these formulas are too complex to mentally calculate; even a 4-function calculator is insufficient because of the biexponential nature of the formulas [5], [6], [7], [8], [9], [10]. Moreover, the most widely used formula (DuBois and DuBois) was derived from only 9 patients [7]. Mosteller [11] proposed a simplified calculation of BSA in 1987, which can be easily used on a pocket calculator with a square root function. This formula is a modification of the BSA equation by Gehan and George [8]. However, no supporting data were included. Validation studies were only published in children [12], [13]. We wanted to compare Mosteller's formula in an extensive series of normal-weight, overweight, and obese adults to data obtained with 7 previously described and empirically derived formulas.
Section snippets
Subjects and methods
Three groups of patients were studied: normal-weight (body mass index [BMI], 20-24.9 kg/m2), overweight (BMI, 25-29.9 kg/m2), and obese adults (BMI, ≥30 kg/m2), selected from a consecutive series of patients visiting our sleep disorders center. We evaluated 1868 patients (M/F, 1425/443; age, 52 ± 12 years; BMI, 30 ± 6 kg/m2; weight, 88 ± 19 kg; height, 172 ± 9 cm). We found 397 normal-weight (M/F, 289/108; age, 50 ± 14 years; BMI, 23 ± 1 kg/m2; weight, 69 ± 10 kg; height, 172 ± 10 cm), 714
Results
The records of 1868 patients were assessed. Eight hundred twenty-five (44%) had a BSA of 2 m2 or less; of these, 120 patients (6%) were obese (BMI, > 30 kg/m2), whereas 705 (38%) were not obese (BMI, <30 kg/m2). One thousand forty-three patients (56%) had a BSA of more than 2 m2 and more than 22% (n = 409) of these were not obese, whereas 34% (n = 634) were obese. There were 754 patients (40%) defined as obese, and 16% (n = 120) of these had a BSA of 2 m2 or less.
Using Mosteller's formula, the
Discussion
The present study provides the first large sample of BSA in normal-weight, overweight, and obese males and females, obtained with Mosteller's formula. We found close agreement between Mosteller's BSA values and BSA values obtained with the traditional complex methods, with all correlations of 0.97 or higher, as well as with the mean BSA and with the most accurate BSA from Yu et al [15]. The weakest correlation was found with the formula of Mattar [17] and with Livingston and Scott's [10]
Conclusions
Our recommendation is that the formula of Mosteller deserves to be used as the first choice in clinical research and practice. It combines an accurate BSA calculation with ease of use and is applicable in normal-weight, overweight, and obese adults. Accuracy studies in whites with 3D one-pass whole-body scanning are needed.
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