Optimizing Public Health Screening: Population-Specific BMI Thresholds for Targeted Body Composition Assessment in...

Area of Science:

• Public Health
• Cardiology
• Nutritional Science

Background:

• Body mass index (BMI) is a standard but limited proxy for nutritional status and cardiometabolic risk.
• Existing evidence on body composition assessment's role in population screening is inconsistent, especially in Central European populations.

Purpose of the Study:

• To determine sex-specific BMI inflection points for cardiometabolic risk in Hungarian adults.
• To compare the efficacy of BMI versus body composition parameters in population-level screening.
• To model the cost- and time-effectiveness of different screening strategies.

Main Methods:

• Cross-sectional analysis of 868 Hungarian adults.
• Locally weighted regression to identify BMI inflection points.
• Stratified ROC analyses and cost-effectiveness modeling.

Main Results:

• Cardiometabolic risk increased at lower BMI levels than WHO thresholds (females: 21.8-22.3 kg/m², males: 23.8-24.3 kg/m²).
• Body composition parameters generally did not outperform BMI, but showed subgroup-specific value (e.g., men with BMI 24-36 kg/m² for atherosclerosis).
• Mid-range BMI intervals (females: 22-30 kg/m², males: 24-30 kg/m²) identified as windows for phenotypic heterogeneity, where targeted body composition assessment may refine risk.

Conclusions:

• Population-specific BMI thresholds better reflect early nutritional and cardiometabolic risks than universal cutoffs.
• BMI remains a valuable first-line screening tool; body composition adds value in specific BMI ranges.
• A subgroup-specific screening approach is supported, but cost-effectiveness requires further validation.