Comparison of Anthropometric Measurements of Abdominal Obesity as Predictors of Cardiometabolic Risk Factors: NHANES 2011-2014

Background It has been well established that screening tools for cardiometabolic diseases are less useful among obese populations as risk of these diseases is already high. However, research is lacking in regard to efficient screening tools for cardiometabolic diseases among normal weight and overweight populations. Objective This study compared the predictive strengths of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), sagittal abdominal diameter (SAD), and SAD-to-height ratio (SADHtR) with respect to risk of cardiometabolic disorders in normal and overweight U.S. populations. Design This cross-sectional study utilized data from the 2011-2014 National Health and Nutrition Examination Survey. Participants/setting The sample included non-pregnant adults with a normal weight or overweight BMI status (≥ 20 years; n = 6482). Main outcome measures Each anthropometric measure was assessed for predicting risk of the following cardiometabolic disorders: hypertension (HTN), pre-diabetes, diabetes, high total cholesterol, low high-density lipoprotein cholesterol (HDL-C), high non-HDL-C, and high apolipoprotein B. Statistical analyses performed Simple and multiple logistic regression analyses compared the odds ratio of each anthropometric measure for each cardiometabolic disorder. Results When analyzed in separate models, BMI, WC, WHtR, SAD, and SADHtR identified all cardiometabolic risks. In simultaneous models with abdominal obesity measures, BMI no longer identified cardiometabolic risks (ORs \u3c1.0), except low HDL-C. Among normal weight and overweight men, WHtR and SADHtR were stronger measures of cardiometabolic risk except low HDL-C. With normal weight and overweight women, WHtR and SADHtR were stronger measures of risk for hypertension and diabetes, while all of the abdominal obesity measures were similar in assessment of the remaining cardiometabolic risks. Conclusion In normal weight and overweight adults, anthropometric measures of abdominal obesity, especially those including a factor of height, are better predictors of cardiometabolic risk than BMI and should be a primary screening tool in this population