One size does not fit all: Assuming the same normal body temperature for everyone is not justified

Abstract

Despite the increasing personalization of medicine, surprisingly ~37.0°C (98.6°F) continues as the estimate of normal temperature. We investigated between-subject and within-subject thermal variability, whether a significant percentage of individuals have a low mean oral temperature, and whether these differ by sex, age, time of day, ethnicity, body mass index (BMI), or menstrual phase. Oral temperature was measured by Life Brand® Fast-Read Digital Oral Thermometers and sampled 14 times over two weeks, seven morning and seven evening readings. The volunteer sample consisted of 96 adults (42 men, 54 women; 27 couples, 42 singletons), ages 18-67 years. We found sizeable individual differences in body temperature and that the normal temperature of many individuals is considerably lower than 37.0°C (98.6°F). Mean temperatures ranged from 35.2°C (95.4°F) to 37.4°C (99.3°F). The mean temperature across all participants was 36.1°C (97.0°F)-lower than most studies have reported, consistent with recent evidence of temperature declining over decades. 77% had mean temperatures at least 0.55°C (1°F) lower than 37.0°C (98.6°F). Mean temperature did not differ by age, but women had higher temperatures than men, even within a couple with room temperature and warmth of clothing equated. Although oral temperature varied widely across individuals, it showed marked stability within individuals over days. Variability of temperature over days did not differ by sex, but was larger among younger adults. Using 37.0°C (98.6°F) as the assumed normal temperature for everyone can result in healthcare professionals failing to detect a serious fever in individuals with a low normal temperature or obtaining false negatives for those individuals when using temperature to screen for COVID-19, mistaking their elevated temperature as normal. Some have called for lowering the estimate of normal temperature slightly (e.g., 0.2°C [0.36°F]). That still seems an overly high estimate. More important, using any standardized "normal" temperature will lead to errors for many people. Individual differences are simply too great. Personalizing body temperature is needed. Temperature could be measured at yearly doctor visits, as blood pressure is now. That would be simple to implement. Since our results show marked thermal stability within an individual, sampling temperature only once yearly could provide an accurate indication of a person's normal temperature at that time of day. Such records over time would also provide a more accurate understanding of how temperature changes over the lifespan.

Fig 1

Distribution of the Mean Oral Temperatures of the 96 Study Participants (a). Distribution of all Oral Temperature Datapoints (N = 1,333)(b) 97.0°F indicates the mean body temperature across participants.