Better diagnostic accuracy of neuropathy in obesity: a new challenge for neurologists
Clinical Neurophysiology, 2018•Elsevier
Objective To determine the comparative diagnostic characteristics of neuropathy measures
in an obese population. Methods We recruited obese participants from the University of
Michigan's Weight Management Program. Receiver operative characteristic analysis
determined the area under the curve (AUC) of neuropathy measures for distal symmetric
polyneuropathy (DSP), small fiber neuropathy (SFN), and cardiovascular autonomic
neuropathy (CAN). The best test combinations were determined using stepwise and Score …
in an obese population. Methods We recruited obese participants from the University of
Michigan's Weight Management Program. Receiver operative characteristic analysis
determined the area under the curve (AUC) of neuropathy measures for distal symmetric
polyneuropathy (DSP), small fiber neuropathy (SFN), and cardiovascular autonomic
neuropathy (CAN). The best test combinations were determined using stepwise and Score …
Objective
To determine the comparative diagnostic characteristics of neuropathy measures in an obese population.
Methods
We recruited obese participants from the University of Michigan’s Weight Management Program. Receiver operative characteristic analysis determined the area under the curve (AUC) of neuropathy measures for distal symmetric polyneuropathy (DSP), small fiber neuropathy (SFN), and cardiovascular autonomic neuropathy (CAN). The best test combinations were determined using stepwise and Score subset selection models.
Results
We enrolled 120 obese participants. For DSP, seven of 42 neuropathy measures (Utah Early Neuropathy Score (UENS, N = 62), Michigan Neuropathy Screening Instrument (MNSI) reduced combined index, MNSI examination, nerve fiber density (NFD) leg, tibial F response, MNSI questionnaire, peroneal distal motor latency) had AUCs ≥ 0.75. Three of 19 small fiber nerve measures for SFN (UENS, NFD leg, Sudoscan feet (N = 70)) and zero of 16 CAN measures had AUCs ≥ 0.75. Combinations of tests performed better than individual tests with AUCs of 0.82 for DSP (two parameters) and 0.84 for SFN (three parameters).
Conclusions
Many neuropathy measures demonstrate good test performance for DSP in obese participants. Select few small fiber nerve measures performed well for SFN, and none for CAN.
Significance
Specific combinations of tests should be used for research studies to maximize diagnostic performance in obese cohorts.
Elsevier
