Assessment of the nutritional status of school children in Galle Municipality area: A comparison between different body mass index classification systems

Introduction: Asian populations are at an increased risk of cardiometabolic disorders due to higher fat mass at a relatively lower body mass index (BMI). Several discrepancies have been reported in the BMI classification systems currently in practice to assess the nutritional status among children. Aim of this study was to compare the different international BMI based classification systems to identify the nutritional status in a cohort of Sri Lankan children.Methods: A cross sectional study was conducted on 833 (48.37% boys) school children aged 5-15 years in Galle Municipality area, Sri Lanka. The nutritional status of each child was defined according to five BMI classification systems: World Health Organization (WHO), Centers for Disease Control and Prevention(CDC), and International Obesity Task Force (IOTF), Indian and Sri Lankan systems. The agreement between them was tested using Cohen’s kappa coefficient.Results: Prevalence of under-weight, overweight and obesity of children, as determined by the WHO, CDC, IOTF, Indian and the Sri Lankan classification systems showed significant differences. The WHO classification system had the best agreement (k=0.649) with the Indian classification system. A wide difference between the Sri Lankan classification system (24.37%) and the Indian (9.60%) and WHO (5.04%) classification systems in defining obesity were observed.Conclusion & recommendations: A wide difference between different BMI classification systems when determining the nutritional status in children emphasise the importance of developing a country-specific classification system to identify the nutritional status among Sri Lankan children.