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Published in: Cardiovascular Diabetology 1/2015

Open Access 01-12-2015 | Original investigation

Sensitivity of various adiposity indices in identifying cardiometabolic diseases in Arab adults

Authors: Nasser M Al-Daghri, Omar S Al-Attas, Kaiser Wani, Abdullah M Alnaami, Shaun Sabico, Abdulrahman Al-Ajlan, George P Chrousos, Majed S Alokail

Published in: Cardiovascular Diabetology | Issue 1/2015

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Abstract

Background

Obesity is a recognized risk factor for various cardiometabolic diseases and several indices are used clinically to assess overall cardiometabolic risk. This study aims to determine the sensitivity of six anthropometric indices [Body mass index (BMI), waist, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI) and visceral adiposity index (VAI)] in determining diabetes mellitus type 2, coronary heart disease, dyslipidemia, hypertension and metabolic syndrome (MetS) in Saudi adults recruited from two independent cohorts (2008–2009 and 2013–2014).

Methods

A total of 6,821 Saudi adults [2008–2009, N = 3,971 (1,698 males and 2,273 females); 2013–2014, N = 2,850 (926 males and 1,924 females)] aged 18–70 years old were included in this descriptive, cross-sectional study. Anthropometrics were obtained and fasting blood samples analyzed for glucose and lipids. BMI, WHR, WHtR, BAI and VAI were computed mathematically.

Results

VAI was the most sensitive index in determining DMT2 (AUC 0.72; p < 0.001) in the 2008–2009 cohort and MetS (AUC = 0.84; p < 0.001) in the 2013–2014 cohort. WHR was most discriminating for CHD in both cohorts (AUC 0.70 and 0.84 for 2008–2009 and 2013–2014, p values <0.001, respectively). WHtR was most sensitive but rather modest in determining hypertension (AUC 0.66; p < 0.001), while waist circumference was most sensitive for dyslipidemia (AUC 0.72; p < 0.001) in the 2008–2009 cohort and MetS (AUC 0.85; p < 0.001) in the 2013–2014 cohort. BAI was the least sensitive adiposity index.

Conclusion

Sensitivity of adiposity indices regarding cardiometabolic diseases highlight the importance of body fat distribution in determining overall cardiometabolic risk, with indices involving abdominal obesity being more clinically significant than BMI and BAI. The sensitivity of these adiposity indices should be noted in assessing a particular cardiometabolic disease.
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Literature
1.
go back to reference Morgen CS, Sorensen TI (2014) Obesity: global trends in the prevalence of overweight and obesity. Nat Rev Endocrinol 10(9):513–514PubMedCrossRef Morgen CS, Sorensen TI (2014) Obesity: global trends in the prevalence of overweight and obesity. Nat Rev Endocrinol 10(9):513–514PubMedCrossRef
2.
go back to reference Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Diseases Study in 2013. Lancet 384(9945):766–781PubMedCrossRef Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Diseases Study in 2013. Lancet 384(9945):766–781PubMedCrossRef
3.
go back to reference Al-Quwaidhi AJ, Pearce MS, Critchley JA, Sobngwi E, O’Flaherty M (2014) Trends and future projections of the prevalence of adult obesity in Saudi Arabia, 1992–2022. East Mediterr Health J 20(10):589–595PubMed Al-Quwaidhi AJ, Pearce MS, Critchley JA, Sobngwi E, O’Flaherty M (2014) Trends and future projections of the prevalence of adult obesity in Saudi Arabia, 1992–2022. East Mediterr Health J 20(10):589–595PubMed
4.
go back to reference Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Yousef M, Sabico SL et al (2011) Diabetes Mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): a decade of an epidemic. BMC Med 9:76PubMedCentralPubMedCrossRef Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Yousef M, Sabico SL et al (2011) Diabetes Mellitus type 2 and other chronic non-communicable diseases in the central region, Saudi Arabia (Riyadh cohort 2): a decade of an epidemic. BMC Med 9:76PubMedCentralPubMedCrossRef
5.
go back to reference Lim RB, Chen C, Naidoo N, Gay G, Tang WE, Seah D et al (2015) Anthropometrics indices of obesity, and all-cause and cardiovascular disease-related mortality, in an Asian cohort with type 2 diabetes mellitus. Diabetes Metab [Epub ahead of print] Lim RB, Chen C, Naidoo N, Gay G, Tang WE, Seah D et al (2015) Anthropometrics indices of obesity, and all-cause and cardiovascular disease-related mortality, in an Asian cohort with type 2 diabetes mellitus. Diabetes Metab [Epub ahead of print]
6.
go back to reference Czernichow S, Kengne AP, Huzley RR, Butley GD, de Galan B, Grobbee D et al (2011) Comparison of waist-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type 2 diabetes: a prospective cohort study from ADVANCE. Eur J Cardiovasc Prev Rehabil 18(2):312–319PubMedCentralPubMedCrossRef Czernichow S, Kengne AP, Huzley RR, Butley GD, de Galan B, Grobbee D et al (2011) Comparison of waist-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type 2 diabetes: a prospective cohort study from ADVANCE. Eur J Cardiovasc Prev Rehabil 18(2):312–319PubMedCentralPubMedCrossRef
7.
go back to reference Cronin O, Morris DR, Walker PJ, Golledge J (2013) The association of obesity with cardiovascular events in patients with peripheral artery disease. Atherosclerosis 228(2):316–323PubMedCrossRef Cronin O, Morris DR, Walker PJ, Golledge J (2013) The association of obesity with cardiovascular events in patients with peripheral artery disease. Atherosclerosis 228(2):316–323PubMedCrossRef
8.
go back to reference Bergman RN, Stefanovski D, Buchanan TA, Summer AE, Reynolds JC, Sebring NG et al (2011) A better index of body adiposity. Obesity (Silver Spring) 19(5):1083–1089 Bergman RN, Stefanovski D, Buchanan TA, Summer AE, Reynolds JC, Sebring NG et al (2011) A better index of body adiposity. Obesity (Silver Spring) 19(5):1083–1089
9.
go back to reference Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M et al (2010) Visceral adiposity index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 33(4):920–922PubMedCentralPubMedCrossRef Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M et al (2010) Visceral adiposity index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 33(4):920–922PubMedCentralPubMedCrossRef
10.
go back to reference Djibo DA, Araneta MR, Kritz-Silverstein D, Barrett-Connor E, Wooten W (2015) Body adiposity index is a risk factor for the metabolic syndrome in postmenopausal Caucasian African American, and Filipina women. Diabetes Metab Syndr 9(2):108–113PubMedCrossRef Djibo DA, Araneta MR, Kritz-Silverstein D, Barrett-Connor E, Wooten W (2015) Body adiposity index is a risk factor for the metabolic syndrome in postmenopausal Caucasian African American, and Filipina women. Diabetes Metab Syndr 9(2):108–113PubMedCrossRef
11.
go back to reference Garcia AI, Nino-Silva LA, Gonzalez-Ruiz K, Ramirez-Velez R (2015) Body adiposity index as a marker of obesity and cardiovascular risk in adults from Bogota, Colombia. Endocrinol Nutr 62(3):130–137PubMedCrossRef Garcia AI, Nino-Silva LA, Gonzalez-Ruiz K, Ramirez-Velez R (2015) Body adiposity index as a marker of obesity and cardiovascular risk in adults from Bogota, Colombia. Endocrinol Nutr 62(3):130–137PubMedCrossRef
12.
go back to reference Yu Y, Wang L, Liu H, Zhang S, Walker SO, Bartell T et al (2015) Body mass index and waist circumference rather than body adiposity index are better surrogates for body adiposity in a Chinese population. Nutr Clin Pract 30(2):274–282PubMedCrossRef Yu Y, Wang L, Liu H, Zhang S, Walker SO, Bartell T et al (2015) Body mass index and waist circumference rather than body adiposity index are better surrogates for body adiposity in a Chinese population. Nutr Clin Pract 30(2):274–282PubMedCrossRef
13.
go back to reference Amato MC, Giordano C (2014) Visceral adiposity index: an indicator of adipose tissue dysfunction. Int J Endocrinol 2014:730827PubMedCentralPubMed Amato MC, Giordano C (2014) Visceral adiposity index: an indicator of adipose tissue dysfunction. Int J Endocrinol 2014:730827PubMedCentralPubMed
14.
go back to reference Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Charalampidis P, Livadas S et al (2013) Visceral adiposity index is highly associated with adiponectin and glycaemic disturbances. Eur J Clin Invest 43(2):183–189PubMedCrossRef Al-Daghri NM, Al-Attas OS, Alokail MS, Alkharfy KM, Charalampidis P, Livadas S et al (2013) Visceral adiposity index is highly associated with adiponectin and glycaemic disturbances. Eur J Clin Invest 43(2):183–189PubMedCrossRef
15.
go back to reference Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502PubMed Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502PubMed
16.
go back to reference Al-Daghri N, Alokail M, Al-Attas O, Sabico S, Kumar S (2010) Establishing abdominal height cut-offs and their association with conventional indices of obesity among Arab children and adolescents. Ann Saudi Med 30(3):209–214PubMedCentralPubMedCrossRef Al-Daghri N, Alokail M, Al-Attas O, Sabico S, Kumar S (2010) Establishing abdominal height cut-offs and their association with conventional indices of obesity among Arab children and adolescents. Ann Saudi Med 30(3):209–214PubMedCentralPubMedCrossRef
17.
18.
go back to reference Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252PubMedCrossRef Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252PubMedCrossRef
19.
go back to reference Expert Panel on Detection (2001) Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497CrossRef Expert Panel on Detection (2001) Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497CrossRef
20.
go back to reference Alberti KG, Zimmet P, Shaw J (2005) IDF epidemiology task force consensus group. The metabolic syndrome: a new worldwide definition. Lancet 366:1059–1062PubMedCrossRef Alberti KG, Zimmet P, Shaw J (2005) IDF epidemiology task force consensus group. The metabolic syndrome: a new worldwide definition. Lancet 366:1059–1062PubMedCrossRef
21.
go back to reference Amato MC, Pizzolanti G, Torregrossa V, Misiano G, Milano S et al (2014) Visceral adiposity index is predictive of an altered adipokine profile in patients with type 2 diabetes. PLoS One 9(3):e91969PubMedCentralPubMedCrossRef Amato MC, Pizzolanti G, Torregrossa V, Misiano G, Milano S et al (2014) Visceral adiposity index is predictive of an altered adipokine profile in patients with type 2 diabetes. PLoS One 9(3):e91969PubMedCentralPubMedCrossRef
22.
go back to reference Amato MC, Giordano C (2013) Clinical indications and proper use of Visceral Adiposity Index. Nutr Metab Cardiovasc Dis 23:e31–e32PubMedCrossRef Amato MC, Giordano C (2013) Clinical indications and proper use of Visceral Adiposity Index. Nutr Metab Cardiovasc Dis 23:e31–e32PubMedCrossRef
23.
go back to reference Han L, Fu KL, Zhao J, Wang ZH, Tang MX, Wang J et al (2014) Visceral adiposity index score indicated the severity of coronary heart disease in Chinese adults. Diabetol Metab Syndr 6(1):143PubMedCentralPubMedCrossRef Han L, Fu KL, Zhao J, Wang ZH, Tang MX, Wang J et al (2014) Visceral adiposity index score indicated the severity of coronary heart disease in Chinese adults. Diabetol Metab Syndr 6(1):143PubMedCentralPubMedCrossRef
24.
go back to reference Mousavi SV, Mohebi R, Mozaffary A, Sheikholeslami F, Azizi F, Hadaegh F (2014) Changes in body mass index, waist and hip circumference, waist to hip ratio and risk for all-cause mortality in men. Eur J Clin Nutr [Epub ahead of print] Mousavi SV, Mohebi R, Mozaffary A, Sheikholeslami F, Azizi F, Hadaegh F (2014) Changes in body mass index, waist and hip circumference, waist to hip ratio and risk for all-cause mortality in men. Eur J Clin Nutr [Epub ahead of print]
25.
go back to reference Myint PK, Kwok CS, Luben RN, Wareham NJ, Khaw KT (2014) Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease. Heart 100(20):1613–1619PubMedCrossRef Myint PK, Kwok CS, Luben RN, Wareham NJ, Khaw KT (2014) Body fat percentage, body mass index and waist-to-hip ratio as predictors of mortality and cardiovascular disease. Heart 100(20):1613–1619PubMedCrossRef
26.
go back to reference De Koning L, Merchant AT, Pogie J, Anand SS (2007) Waist circumference and waist-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 28(7):850–856PubMedCrossRef De Koning L, Merchant AT, Pogie J, Anand SS (2007) Waist circumference and waist-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 28(7):850–856PubMedCrossRef
27.
go back to reference Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD (2011) Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant meta-analysis of 82864 participants from nine cohort studies. Obes Rev 1299:680–687 Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD (2011) Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant meta-analysis of 82864 participants from nine cohort studies. Obes Rev 1299:680–687
28.
go back to reference Lukich A, Gavish D, Shargorodsky M (2014) Normal weight diabetic patients versus obese diabetics: relation of over-all and abdominal adiposity to vascular health. Cardiovasc Diabetol 13:141PubMedCentralPubMedCrossRef Lukich A, Gavish D, Shargorodsky M (2014) Normal weight diabetic patients versus obese diabetics: relation of over-all and abdominal adiposity to vascular health. Cardiovasc Diabetol 13:141PubMedCentralPubMedCrossRef
29.
go back to reference Lam BC, Koh GC, Chen C, Wong MT, Fallows SJ (2015) Comparison of body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height-ratio as predictors of cardiovascular disease risk factors in an adult population in Singapore. PLoS One 10(4):e0122985PubMedCentralPubMedCrossRef Lam BC, Koh GC, Chen C, Wong MT, Fallows SJ (2015) Comparison of body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height-ratio as predictors of cardiovascular disease risk factors in an adult population in Singapore. PLoS One 10(4):e0122985PubMedCentralPubMedCrossRef
30.
go back to reference Ashwell M, Gunn P, Gibson S (2012) Waist-to-Height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 13(3):275–286PubMedCrossRef Ashwell M, Gunn P, Gibson S (2012) Waist-to-Height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 13(3):275–286PubMedCrossRef
31.
go back to reference Li WC, Chen IC, Chang YC, Loke SS, Wang SH, Hsiao KY (2013) Waist-to-Height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults. Eur J Nutr 52(1):57–65PubMedCentralPubMedCrossRef Li WC, Chen IC, Chang YC, Loke SS, Wang SH, Hsiao KY (2013) Waist-to-Height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults. Eur J Nutr 52(1):57–65PubMedCentralPubMedCrossRef
32.
go back to reference Park YS, Kim JS (2012) Association between waist-to-height ratio and metabolic risk factors in Korean adults with normal body mass index and waist circumference. Tohoku J Exp Med 228(1):1–8PubMedCrossRef Park YS, Kim JS (2012) Association between waist-to-height ratio and metabolic risk factors in Korean adults with normal body mass index and waist circumference. Tohoku J Exp Med 228(1):1–8PubMedCrossRef
33.
go back to reference Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X (2014) Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 13(1):146PubMedCentralPubMedCrossRef Du T, Yuan G, Zhang M, Zhou X, Sun X, Yu X (2014) Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance. Cardiovasc Diabetol 13(1):146PubMedCentralPubMedCrossRef
34.
go back to reference Zafrir B, Khashper A, Gaspar T, Dobrecky-Mery I, Azencot M, Lewis BS et al (2014) Prognostic impact of abdominal fat distribution and cardiorespiratory fitness in asymptomatic type 2 diabetics. Eur J Prev Cardiol [Epub ahead of print] Zafrir B, Khashper A, Gaspar T, Dobrecky-Mery I, Azencot M, Lewis BS et al (2014) Prognostic impact of abdominal fat distribution and cardiorespiratory fitness in asymptomatic type 2 diabetics. Eur J Prev Cardiol [Epub ahead of print]
35.
go back to reference Nagao H, Kashine S, Nishizawa H, Okada T, Kimura T, Hirata A et al (2013) Vascular complications and changes in body mass index in Japanese type 2 diabetic patients with abdominal obesity. Cardiovasc Diabetol 12:88PubMedCentralPubMedCrossRef Nagao H, Kashine S, Nishizawa H, Okada T, Kimura T, Hirata A et al (2013) Vascular complications and changes in body mass index in Japanese type 2 diabetic patients with abdominal obesity. Cardiovasc Diabetol 12:88PubMedCentralPubMedCrossRef
36.
go back to reference Chandra A, Neeland IJ, Berry JD, Ayers CR, Rohatgi A, Das SR et al (2014) The relationship of body mass index and fat distribution with incident hypertension: observations from the Dallas Heart Study. J Am Coll Cardiol 64(10):997–1002PubMedCrossRef Chandra A, Neeland IJ, Berry JD, Ayers CR, Rohatgi A, Das SR et al (2014) The relationship of body mass index and fat distribution with incident hypertension: observations from the Dallas Heart Study. J Am Coll Cardiol 64(10):997–1002PubMedCrossRef
37.
38.
go back to reference Shah RV, Murthy VL, Abbasi SA, Blankstein R, Kwong RY, Goldfine AB et al (2014) Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA study. JACC Cardiovasc Imaging 7(12):1221–1235PubMedCrossRef Shah RV, Murthy VL, Abbasi SA, Blankstein R, Kwong RY, Goldfine AB et al (2014) Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA study. JACC Cardiovasc Imaging 7(12):1221–1235PubMedCrossRef
39.
go back to reference Sulistyoningrum DC, Gasevic D, Lear SA, Ho J, Mente A, Devlin AM (2013) Total and high molecular weight adiponectin and ethnic-specific differences in adiposity and insulin resistance: a cross-sectional study. Cardiovasc Diabetol 12:170PubMedCentralPubMedCrossRef Sulistyoningrum DC, Gasevic D, Lear SA, Ho J, Mente A, Devlin AM (2013) Total and high molecular weight adiponectin and ethnic-specific differences in adiposity and insulin resistance: a cross-sectional study. Cardiovasc Diabetol 12:170PubMedCentralPubMedCrossRef
Metadata
Title
Sensitivity of various adiposity indices in identifying cardiometabolic diseases in Arab adults
Authors
Nasser M Al-Daghri
Omar S Al-Attas
Kaiser Wani
Abdullah M Alnaami
Shaun Sabico
Abdulrahman Al-Ajlan
George P Chrousos
Majed S Alokail
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2015
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/s12933-015-0265-5

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