Beyond Body Mass Index: Advantages of Abdominal Measurements for Recognizing Cardiometabolic Disorders

Abstract

Background: The clinical recognition of cardiometabolic disorders might be enhanced by anthropometry based on the sagittal abdominal diameter (SAD; also called "abdominal height") or waist circumference rather than on weight. Direct comparisons of body mass index (BMI, weight/height(2)) with SAD/height ratio (SADHtR) or waist circumference/height ratio (WHtR) have not previously been tested in nationally representative populations.

Methods: Nonpregnant adults without diagnosed diabetes (ages 20-64 years; n = 3071) provided conventional anthropometry and supine SAD (by sliding-beam caliper) in the 2011-2012 US National Health and Nutrition Examination Survey. Population-weighted, logistic models estimated how strongly each anthropometric indicator was associated with 5 cardiometabolic disorders: Dysglycemia (glycated hemoglobin ≥5.7%), HyperNonHDLc (non-high-density-lipoprotein [HDL] cholesterol ≥4.14 mmol/L, or taking anticholesteremic medications), Hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or taking antihypertensive medications), HyperALT (alanine transaminase ≥p75 [75th percentile, sex-specific]), and HyperGGT (gamma-glutamyltransferase ≥p75 [sex-specific]).

Results: After scaling each indicator, adjusted odds ratios (aORs) tended to be highest for SADHtR and lowest for BMI when identifying each disorder except dysglycemia. When SADHtR entered models simultaneously with BMI, the aORs for BMI no longer directly identified any condition, whereas SADHtR identified persons with HyperNonHDLc by aOR 2.78 (95% confidence interval [CI], 1.71-4.51), Hypertension by aOR 2.51 (95% CI, 1.22-5.15), HyperALT by aOR 2.89 (95% CI, 1.56-5.37), and HyperGGT by aOR 5.43 (95% CI, 3.01-9.79). WHtR competed successfully against BMI with regard to Dysglycemia, HyperNonHDLc, and HyperGGT. c-Statistics of SADHtR and WHtR were higher than those of BMI (P <.001) for identifying HyperNonHDLc and HyperGGT.

Conclusions: Among nonelderly adults, SADHtR or WHtR recognized cardiometabolic disorders better than did the BMI.

Keywords: Body mass index; Epidemiologic measurements; Hypercholesterolemia; Hypertension; Sagittal abdominal diameter.

Figure 1

Comparisons in the population for men (panel A) and women (panel B) among SADHtR, WHtR, and BMI in association with 5 cardiometabolic disorders. Each adiposity indicator is scaled to the sex-specific interquartile range. Adjusted odds ratios (aOR; with 95% confidence intervals) are plotted logarithmically on the Y-axis. ALT = alanine transaminase; BMI = body mass index; GGT = gamma-glutamyltransferase; HDL = high-density lipoprotein; SADHtR = sagittal abdominal diameter/height ratio; WHtR = waist circumference/height ratio.

Figure 2

Comparisons of adjusted odds ratios (95% confidence intervals) for SADHtR and BMI as they compete simultaneously in models identifying 5 cardiometabolic disorders. The estimated population includes both sexes, and each adiposity indicator is scaled to its sex-specific interquartile range. Y-axis values are plotted logarithmically. aOR = adjusted odds ratio; BMI = body mass index; GGT = gamma-glutamyltransferase; HDL = high-density lipoprotein; SADHtR = sagittal abdominal diameter/height ratio.

Figure 3

Comparisons of adjusted odds ratios (95% confidence intervals) for WHtR and BMI as they compete simultaneously in models identifying 5 cardiometabolic disorders. The estimated population includes both sexes, and each adiposity indicator is scaled to its sex-specific interquartile range. Y-axis values are plotted logarithmically. aOR = adjusted odds ratio; BMI = body mass index; GGT = gamma-glutamyltransferase; HDL = high-density lipoprotein; WHtR = waist circumference/height ratio.