Elsevier

Metabolism

Volume 55, Issue 4, April 2006, Pages 515-524
Metabolism

Body surface area in normal-weight, overweight, and obese adults. A comparison study

https://doi.org/10.1016/j.metabol.2005.11.004Get rights and content

Abstract

Values for body surface area (BSA) are commonly used in medicine, particularly to calculate doses of chemotherapeutic agents and index cardiac output. Various BSA formulas have been developed over the years. The DuBois and DuBois (Arch Intern Med 1916;17:863-71) BSA equation is the most widely used, although derived from only 9 subjects. More recently, Mosteller (N Engl J Med 1987;317:1098) produced a simple formula, [weight (kg) × height (cm)/3600]1/2, which could be easily remembered and evaluated on a pocket calculator, but validation data in adults are rare. The purpose of the present study was to examine the BSA based on Mosteller's formula in normal-weight (body mass index [BMI], 20-24.9 kg/m2), overweight (BMI, 25-29.9 kg/m2), and obese (BMI, ≥30 kg/m2) adults (>18 years old) in comparison with other empirically derived formulas (DuBois and DuBois, Boyd [The growth of the surface area of the human body. Minneapolis: University of Minnesota Press; 1935], Gehan and George [Cancer Chemother Rep 1970;54:225-35], US Environmental Protection Agency [Development of statistical distributions or ranges of standard factors used in exposure assessments Washington, EPA/600/8-85-010. Office of Health and Environmental Assessment; 1985), Haycock et al [J Pediatr 1978;93:62-6], Mattar [Crit Care Med 1989;17:846-7], Livingston and Scott [Am J Physiol Endocrinol Metab 2001;281:E586-91]) and with the new 3-dimensional–derived formula of Yu et al (Appl Ergon. 2003;34:273-8). One thousand eight hundred sixty-eight patients were evaluated (397 normal weight [BMI, 23 ± 1 kg/m2; age, 50 ± 14 years; M/F, 289/108], 714 overweight [BMI, 27 ± 1 kg/m2; age, 52 ± 11 years; M/F, 594/120], and 757 obese [BMI, 36 ± 6 kg/m2; age, 53 ± 11 years; M/F, 543/215]). The overall BSA was 2.04 ± 0.24 m2: 1.81 ± 0.19 m2 in normal-weight, 1.99 ± 0.16 m2 in overweight, and 2.21 ± 0.22 m2 in obese subjects. These values were significantly higher in overweight and obese patients compared with the values using the DuBois-DuBois formula (overall, 2.00 ± 0.22 m2, P < .01; normal weight, 1.81 ± 0.19 m2, P = .93; overweight, 1.97 ± 0.16 m2, P < .01; obese, 2.14 ± 0.21 m2, P < .001). We could show an excellent correlation between the results obtained from each formula, with all correlations of 0.97 or higher (between 0.971 and 0.999). Body surface area prediction with the commonly used DuBois formula underestimated BSA in obese patients by as much as 3% (male) to 5% (female). Based on the formula of Yu et al, however, BSA is overestimated when these traditional formulas are used. Although Mosteller's formula is recommended based on its simplicity and suitability for laboratory and clinical work in adults, accuracy studies in whites with 3-dimensional one-pass whole-body scanning are needed.

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.

References (41)

  • E.C. Hallynck et al.

    Should clearance be normalized to body surface area or to lean body mass?

    Br J Clin Pharmacol

    (1981)
  • D. Pinkel

    The use of body surface area as a criterion of drug dosage in cancer chemotherapy

    Cancer Res

    (1958)
  • US Environmental Protection Agency (EPA)

    Development of statistical distributions or ranges of standard factors used in exposure assessments

    (1985)
  • E. Boyd

    The growth of the surface area of the human body

    (1935)
  • D. DuBois et al.

    A formula to estimate the approximate surface area if height and weight be known

    Arch Intern Med

    (1916)
  • E.A. Gehan et al.

    Estimation of human body surface area from height and weight

    Cancer Chemother Rep

    (1970)
  • E.H. Livingston et al.

    Body surface area prediction in normal-weight and obese patients

    Am J Physiol Endocrinol Metab

    (2001)
  • R.D. Mosteller

    Simplified calculation of body surface area

    N Engl J Med

    (1987)
  • T.K.K. Lam et al.

    More on simplified calculation of body-surface area

    N Engl J Med

    (1988)
  • G.L. Briars et al.

    Surface area estimation: pocket calculator versus nomogram

    Arch Dis Child

    (1994)
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