{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:04:05Z","timestamp":1784783045013,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background\/objectives<\/jats:title>\n                    <jats:p>Age-related changes in body composition may reduce the ability of body mass index (BMI) to accurately reflect adiposity in older adults. Fat mass index (FMI), which expresses fat mass relative to height squared, may provide a more direct estimate of adiposity. However, BMI-referenced, sex-specific FMI cutoff values have not been well characterized among older Saudi adults. This study aimed to derive sex-specific cutoff values for FMI, body fat percentage (%BF), and fat mass corresponding to selected BMI thresholds among older Saudi adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional secondary analysis included 1,954 adults aged \u226560\u202fyears who attended 15 randomly selected primary healthcare centers in Riyadh, Saudi Arabia. Anthropometric and bioelectrical impedance analysis-derived body composition data were analyzed. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to derive cutoff values, and DeLong\u2019s test for correlated ROC curves was used to compare BMI-referenced discriminatory performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across the examined BMI thresholds, FMI demonstrated high discriminatory performance relative to BMI in both men and women. For older men, FMI cutoffs corresponding to BMI\u202f&amp;gt;\u202f27\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , BMI\u202f\u2265\u202f30\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , and BMI\u202f&amp;gt;\u202f31\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      were 7.90, 9.48, and 9.71\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively. The corresponding values in older women were 10.30, 12.10, and 13.00\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . DeLong testing generally supported higher AUCs for FMI than for %BF and fat mass, although the difference between FMI and fat mass at BMI\u202f\u2265\u202f25\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      in men was not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides BMI-referenced, sex-specific FMI cutoff values for older Saudi adults. FMI may serve as a complementary body composition index when BIA-derived fat mass is available. Because the cutoffs were derived using BMI as a pragmatic reference framework in a cross-sectional sample from primary healthcare in Riyadh, they should be interpreted as BMI-corresponding values rather than definitive clinical risk thresholds. External validation against clinical outcomes and reference methods for body composition is required before broad clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1900590","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:31:11Z","timestamp":1784781071000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Deriving BMI-referenced, sex-specific fat mass index cutoff values in older Saudi adults: a cross-sectional secondary analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Maram","family":"Alsadi","sequence":"first","affiliation":[{"name":"Community Health Sciences Department, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud M. A.","family":"Abulmeaty","sequence":"additional","affiliation":[{"name":"Community Health Sciences Department, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aljazi Bin","family":"Zarah","sequence":"additional","affiliation":[{"name":"Community Health Sciences Department, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel","family":"Alhamdan","sequence":"additional","affiliation":[{"name":"Community Health Sciences Department, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e2019045","DOI":"10.29392\/joghr.3.e2019045","article-title":"Obesity in the geriatric population: a global health perspective","volume":"3","author":"Malenfant","year":"2019","journal-title":"J Global Health Reports"},{"key":"ref2","year":"2025"},{"key":"ref3","volume-title":"Prevalence of Obesity and Severe Obesity among Adults: United States, 2017\u20132018 (NCHS Data Brief No. 360)","author":"Hales","year":"2020"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"824","DOI":"10.15537\/1658-3175.2970","article-title":"Obesity in Saudi Arabia","volume":"26","author":"Al-Nozha","year":"2005","journal-title":"Saudi Med J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"25","DOI":"10.21767\/2471-8203.100025","article-title":"A review of prevalence of obesity in Saudi Arabia","volume":"2","author":"Alqarni","year":"2016","journal-title":"J Obesity and Eating Dis"},{"key":"ref6","first-page":"E174","article-title":"Obesity and associated factors\u2014Kingdom of Saudi Arabia, 2013","volume-title":"Prev Chronic Dis","author":"Memish","year":"2014"},{"key":"ref7","year":"2025"},{"key":"ref8","volume-title":"Noncommunicable Diseases in Saudi Arabia: Toward Effective Interventions for Prevention","author":"Alqunaibet","year":"2021"},{"key":"ref9","doi-asserted-by":"crossref","DOI":"10.1596\/978-1-4648-1828-8","volume-title":"Overweight and Obesity in Saudi Arabia: Consequences and Solutions","author":"Alluhidan","year":"2022"},{"key":"ref10","volume-title":"Physical Status: The Use and Interpretation of Anthropometry","year":"1995"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/S0095-4543(21)00452-8","article-title":"Screening for nutritional status in the elderly","volume":"21","author":"Lipschitz","year":"1994","journal-title":"Prim Care"},{"key":"ref12","first-page":"40","article-title":"The nutrition screening initiative","volume":"11","author":"Tonore","year":"1992","journal-title":"Caring"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"875","DOI":"10.3945\/ajcn.113.068122","article-title":"BMI and all-cause mortality in older adults: a meta-analysis","volume":"99","author":"Winter","year":"2014","journal-title":"Am J Clin Nutr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1093\/gerona\/62.7.752","article-title":"Aging, resting metabolic rate, and oxidative damage","volume":"62","author":"Frisard","year":"2007","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1017\/S0007114511003886","article-title":"Longitudinal changes in body composition associated with healthy ageing","volume":"107","author":"Jackson","year":"2012","journal-title":"Br J Nutr"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.2147\/CIA.S84632","article-title":"Body composition as a frailty marker for the elderly community","volume":"10","author":"Falsarella","year":"2015","journal-title":"Clin Interv Aging"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2301","DOI":"10.2147\/CIA.S277171","article-title":"Assessment of age-induced changes in body fat percentage and BMI aided by Bayesian modelling","volume":"15","author":"Macek","year":"2020","journal-title":"Clin Interv Aging"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e39542","DOI":"10.1097\/MD.0000000000039542","article-title":"Comparative analysis of basal metabolic rate measurement methods in overweight and obese individuals: a retrospective study","volume":"103","author":"Karagun","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e2021082","DOI":"10.23751\/pn.v23i3.10530","article-title":"Body composition analysis by bioelectrical impedance and its relationship with nutritional status in older adults","volume":"23","author":"Alhamdan","year":"2021","journal-title":"Prog Nutr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3967\/0895-3988.2013.02.003","article-title":"Body mass index and body fat percentage in assessment of obesity prevalence in Saudi adults","volume":"26","author":"Habib","year":"2013","journal-title":"Biomed Environ Sci"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1007\/s13410-015-0402-4","article-title":"New cutoff values for fat mass index and fat-free mass index in Saudi men","volume":"36","author":"Abulmeaty","year":"2016","journal-title":"Int J Diabetes Dev Ctries"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"106","DOI":"10.5144\/0256-4947.2017.106","article-title":"Trends in overweight or obesity and other anthropometric indices in adults in western Saudi Arabia","volume":"37","author":"Azzeh","year":"2017","journal-title":"Ann Saudi Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.23751\/pn.v21i4.8381","article-title":"Prevalence of malnutrition in older adults attending primary healthcare centers","volume":"21","author":"Alhamdan","year":"2019","journal-title":"Prog Nutr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1038\/sj.ijo.0802037","article-title":"Fat-free mass index and fat mass index percentiles","volume":"26","author":"Schutz","year":"2002","journal-title":"Int J Obes"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"105170","DOI":"10.1016\/j.archger.2023.105170","article-title":"Assessment of BMI performance in diagnosing obesity in older adults","volume":"116","author":"Alem\u00e1n-Mateo","year":"2024","journal-title":"Arch Gerontol Geriatr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"4848","DOI":"10.3390\/nu14224848","article-title":"New BMI cut-off points for obesity in older adults","volume":"14","author":"Di Renzo","year":"2022","journal-title":"Nutrients"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s12937-020-00569-1","article-title":"Age and gender-specific body fat cut-offs among adults in Qatar","volume":"19","author":"Bawadi","year":"2020","journal-title":"Nutr J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e0160105","DOI":"10.1371\/journal.pone.0160105","article-title":"Comparison of bioelectrical impedance analysis with DXA","volume":"11","author":"Chen","year":"2016","journal-title":"PLoS One"},{"key":"ref29","first-page":"1430","article-title":"Bioelectrical impedance analysis in clinical practice","volume-title":"Clin Nutr","author":"Kyle","year":"2004"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"54","DOI":"10.3109\/03014460.2011.637513","article-title":"Correlation of fat mass index and fat-free mass index with hypertension","volume":"39","author":"Rao","year":"2012","journal-title":"Ann Hum Biol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"15072","DOI":"10.1038\/s41598-024-63421-0","article-title":"Age-appropriate BMI cut-offs for malnutrition among older adults in India","volume":"14","author":"Singh","year":"2024","journal-title":"Sci Rep."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1038\/sj.ijo.0803208","article-title":"Is the current BMI obesity classification appropriate for black and white postmenopausal women?","volume":"30","author":"Evans","year":"2006","journal-title":"Int J Obes."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1016\/j.clnu.2024.04.033","article-title":"Identification of factors associated with sarcopenic obesity development: Literature review and expert panel voting","volume":"43","author":"Pinel","year":"2024","journal-title":"Clin Nutr."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e2021082","DOI":"10.23751\/pn.v23i3.10530","article-title":"\u201chttps:\/\/www.researchgate.net\/profile\/Adel-Alhamdan\/publication\/346332146_Body_composition_analysis_by_bioelectrical_impedance_and_its_relationship_with_nutritional_status_in_older_adults_a_cross-sectional_descriptive_study\/links\/6019bddf45851589397a3ef7\/Body-composition-analysis-by-bioelectrical-impedance-and-its-relationship-with-nutritional-status-in-older-adults-a-cross-sectional-descriptive-study.pdf\u201dBody composition analysis by bioelectrical impedance and its relationship with nutritional status in older adults: A cross-sectional descriptive study","volume":"23","author":"Alhamadan","year":"2021","journal-title":"Progress in Nutrition"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1900590\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:31:29Z","timestamp":1784781089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1900590\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":34,"alternative-id":["10.3389\/fnut.2026.1900590"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1900590","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1900590"}}