Sagittal abdominal diameter: no advantage compared with other anthropometric measures as a correlate of components of the metabolic syndrome in elderly from the Hoorn Study

Anthropometric Indicators as a Tool for Diagnosis of Obesity and Other Health Risk Factors: A Literature Review

Obesity is characterized by the accumulation of an excessive amount of fat mass (FM) in the adipose tissue, subcutaneous, or inside certain organs. The risk does not lie so much in the amount of fat accumulated as in its distribution. Abdominal obesity (central or visceral) is an important risk factor for cardiovascular diseases, diabetes, and cancer, having an important role in the so-called metabolic syndrome. Therefore, it is necessary to prevent, detect, and appropriately treat obesity. The diagnosis is based on anthropometric indices that have been associated with adiposity and its distribution. Indices themselves, or a combination of some of them, conform to a big picture with different values to establish risk. Anthropometric indices can be used for risk identification, intervention, or impact evaluation on nutritional status or health; therefore, they will be called anthropometric health indicators (AHIs). We have found 17 AHIs that can be obtained or estimated from 3D human shapes, being a noninvasive alternative compared to X-ray-based systems, and more accessible than high-cost equipment. A literature review has been conducted to analyze the following information for each indicator: definition; main calculation or obtaining methods used; health aspects associated with the indicator (among others, obesity, metabolic syndrome, or diabetes); criteria to classify the population by means of percentiles or cutoff points, and based on variables such as sex, age, ethnicity, or geographic area, and limitations.

Sagittal abdominal diameter and waist circumference appear to be equally good as identifiers of cardiometabolic risk

BACKGROUND AND AIMS

Body mass index (BMI) and waist circumference (WC) are commonly used markers of cardiometabolic risk. However, sagittal abdominal diameter (SAD) has been proposed as a possibly more sensitive marker of intra-abdominal obesity. We investigated differences in how SAD, WC, and BMI were correlated with cardiometabolic risk markers.

METHODS AND RESULTS

This cross-sectional study investigated anthropometric and metabolic baseline measurements of individuals from six trials. Multiple linear regression and (partial) correlation coefficients were used to investigate associations between SAD, WC, and BMI and cardiometabolic risk markers, including components of the metabolic syndrome as well as insulin resistance, blood lipids, and lowgrade inflammation. In total 1516 mostly overweight or obese individuals were included in the study. SAD was significantly more correlated with TG than WC for all studies, and overall increase in correlation was 0.05 (95% CI (0.02; 0.08). SAD was significantly more correlated with the markers TG and DBP 0.11 (95% CI (0.08, 0.14)) and 0.04 (95% CI (0.006, 0.07), respectively compared to BMI across all or most studies.

CONCLUSION

This study showed that no single anthropometric indicator was consistently more strongly correlated across all markers of cardiometabolic risk. However, SAD was significantly more strongly correlated with TG than WC and significantly more strongly correlated with DBP and TG than BMI.

[Anthropometric measurements of general and central obesity and discriminative capacity on cardiovascular risk: RICARTO study]

INTRODUCTION AND OBJECTIVES

Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR).

MATERIAL AND METHODS

Population cross-sectional study in subjects ≥18years, residents in the Toledo (Spain) Health Area. Selection by random sampling. Measurements were made of the BMI, WC, and weight to height ratio with standardised methods. Framingham CVR. Calculation of AUC, and optimal cut-off points.

RESULTS

The study included 1,309 subjects, with mean age of 48.9±15.8years, and 55% women. The response rate was 36.6%. In women, the index that was best associated with CVR in women was the WC with an AUC=0.85 (95%CI: 0.81-0.88). In men it was the I-Conicity, with an AUC=0.81 (95%CI: 0.77-0.84). Cut points for BMI were similar in women (27.08kg/m²) and men (26.99kg/m²). The WC was lower in women (87.75cm) than in men (94.5cm). The WHR was higher in women (0.59) than in men (0.56). The I-Conicity was slightly lower in women (1.25) than in men (1.28). In women, all the ROC curves were closest to each other.

CONCLUSIONS

The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.

Sagittal abdominal diameter resembles waist circumference as a surrogate marker of insulin resistance in adolescents-Brazilian Metabolic Syndrome Study

OBJECTIVE

To evaluate the association of the sagittal abdominal diameter (SAD) with insulin resistance (IR) and metabolic syndrome (MetS) components, and to compare SAD with waist circumference (WC).

SUBJECTS/METHODS

This was a multicenter, cross-sectional study of 520 adolescents (10- to 18-years old). IR was assessed using the homeostasis model assessment of IR (HOMA-IR) and the hyperglycaemic clamp (n = 76).

RESULTS

SAD and WC were positively correlated with HOMA-IR (r = 0.637 and r = 0.653) and inversely correlated with the clamp-derived insulin sensitivity index (ISI) (r = -0.734 and r = -0.731); P < .001. In the multivariable linear regression analysis, SAD was positively associated with HOMA-IR (B = 0.046 ± 0.003) and inversely associated with the clamp-derived ISI (B = -0.084 ± 0.009) after adjusting for sex, age, and Tanner's stages (P < .001). When WC replaced the SAD, it was positively associated with HOMA-IR (B = 0.011 ± 0.001) and inversely associated with the clamp-derived ISI (B = -0.018 ± 0.002); P < .001. The values of the areas under the curves (AUC) were 0.823 and 0.813 for SAD and WC, respectively. In Bland-Altman analysis, there were agreement between both, SAD and WC, with the clamp-derived ISI (mean = 0.00; P > .05). The SAD and WC were positively associated with blood pressure, triglycerides, and uric acid, and inversely associated with high-density lipoprotein (HDL)-cholesterol after adjusting for sex, age, and Tanner's stages.

CONCLUSION

The SAD was associated with IR and MetS components, with a good discriminatory power for detecting IR. When compared to WC, SAD showed equivalent results.

Sagittal Abdominal Diameter, Waist Circumference, and BMI as Predictors of Multiple Measures of Glucose Metabolism: An NHANES Investigation of US Adults

The objective was to compare associations between sagittal abdominal diameter (SAD), waist circumference, and BMI to the oral glucose tolerance test (OGTT), along with fasting glucose, HbA1c, and HOMA-IR, in a nationally representative sample of 3582 US adults. The study also analyzed the effect of multiple covariates on the anthropometric and glucose metabolism associations. A cross-sectional design was used. SAD was assessed using an abdominal caliper. All other data were collected following strict NHANES protocols. The OGTT was the primary variable used to index glucose metabolism. Fasting glucose, HbA1c, and HOMA-IR were also evaluated. Results showed that mean ± SE values were as follows: SAD: 22.3 ± 0.1 cm, waist circumference: 98.0 ± 0.4 cm, BMI: 28.6 ± 0.2 kg/m2, OGTT: 113.9 ± 1.0 mg/dL, fasting glucose: 99.6 ± 0.3 mg/dL, HbA1c: 5.4 ± 0.01%, and HOMA-IR: 3.2 ± 0.1. Compared to waist circumference and BMI, SAD consistently emerged as the best predictor of glucose metabolism, before and after adjusting for the covariates, and with the sample stratified by gender, race, or age. SAD was not a better predictor of OGTT among normal-weight adults or non-Hispanic Black adults. Due to the ease of taking SAD measurements, we recommend that healthcare providers use this simple method to more precisely predict diabetes risk, especially among overweight and obese adults.

Prediction of cold and heat patterns using anthropometric measures based on machine learning

OBJECTIVE

To examine the association of body shape with cold and heat patterns, to determine which anthropometric measure is the best indicator for discriminating between the two patterns, and to investigate whether using a combination of measures can improve the predictive power to diagnose these patterns.

METHODS

Based on a total of 4,859 subjects (3,000 women and 1,859 men), statistical analyses using binary logistic regression were performed to assess the significance of the difference and the predictive power of each anthropometric measure, and binary logistic regression and Naive Bayes with the variable selection technique were used to assess the improvement in the predictive power of the patterns using the combined measures.

RESULTS

In women, the strongest indicators for determining the cold and heat patterns among anthropometric measures were body mass index (BMI) and rib circumference; in men, the best indicator was BMI. In experiments using a combination of measures, the values of the area under the receiver operating characteristic curve in women were 0.776 by Naive Bayes and 0.772 by logistic regression, and the values in men were 0.788 by Naive Bayes and 0.779 by logistic regression.

CONCLUSIONS

Individuals with a higher BMI have a tendency toward a heat pattern in both women and men. The use of a combination of anthropometric measures can slightly improve the diagnostic accuracy. Our findings can provide fundamental information for the diagnosis of cold and heat patterns based on body shape for personalized medicine.

Sagittal Abdominal Diameter to Measure Visceral Adipose Tissue in Overweight or Obese Adolescent Children and Its Role as A Marker of Insulin Resistance

BACKGROUND

Measurement of sagittal abdominal diameter using a revalidated caliper is simple, inexpensive, non-invasive method. It strongly correlates with insulin resistance and can be used as a surrogate marker to predict risk for Type II Diabetes Mellitus.

AIM

To assess visceral abdominal fat by measuring sagittal abdominal diameter using sliding calipers and to predict insulin resistance in obese or overweight adolescent children.

STUDY DESIGN

Explorative study for Paediatric age group among over weight and obese children aged 10-18 years in urban population in a Tertiary Care Centre.

MATERIALS AND METHODS

Paediatric population satisfying ADA guidelines for diagnosis of prediabetes were included in the study. Anthropometric measurements with SAD were recorded. Blood was collected to investigate for prediabetes and insulin resistance using HOMA-IR.

RESULTS

Out of 924 subjects who gave assent to participate in study 108 fulfilled ADA criteria. 33 subjects who didn't come for the follow up were excluded. Out of 75 subjects 12 were detected to have insulin resistance (16%) and 63 were normal (84%). Pearson's partial correlation of HOMA-IR and OGTT with SAD has demonstrated it to be better correlation with Insulin Resistance (IR) than other anthropometric measurements. Fasting Glucose correlated better with Waist Hip Circumference.

CONCLUSION

Insulin Resistance was diagnosed in 16% of the population and these had high levels of insulin resistance. SAD in relation to glucose metabolism, had a better correlation with OGTT followed by HOMA-IR and fasting Insulin. SAD with anthropometric measurements had better correlation all the parameters other than Waist Circumference, which had negative correlation. SAD can be used in evaluation of obese or overweight children for evaluation.

Food and addiction among the ageing population

Obesity among the elderly is a growing public health concern. Among the various factors that may contribute to the current rates of obesity is the rewarding aspect of highly palatable foods and beverages, which may lead to overconsumption and excess caloric intake. The present review describes recent research supporting the hypothesis that, for some individuals, the consumption these highly palatable foods and beverages may lead to the development of addictive-like behaviors. In particular, the authors consider the relevance of this hypothesis to the ageing population.

Indicators of hypertriglyceridemia from anthropometric measures based on data mining

BACKGROUND

The best indicator for the prediction of hypertriglyceridemia derived from anthropometric measures of body shape remains a matter of debate. The objectives are to determine the strongest predictor of hypertriglyceridemia from anthropometric measures and to investigate whether a combination of measures can improve the prediction accuracy compared with individual measures.

METHODS

A total of 5517 subjects aged 20-90 years participated in this study. The numbers of normal and hypertriglyceridemia subjects were 3022 and 653 females, respectively, and 1306 and 536 males, respectively. We evaluated 33 anthropometric measures for the prediction of hypertriglyceridemia using statistical analysis and data mining.

RESULTS

In the 20-90-year-old groups, age in women was the variable that exhibited the highest predictive power; however, this was not the case in men in all age groups. Of the anthropometric measures, the waist-to-height ratio (WHtR) was the best predictor of hypertriglyceridemia in women. In men, the rib-to-forehead circumference ratio (RFcR) was the strongest indicator. The use of a combination of measures provides better predictive power compared with individual measures in both women and men. However, in the subgroups of ages 20-50 and 51-90 years, the strongest indicators for hypertriglyceridemia were rib circumference in the 20-50-year-old group and WHtR in the 51-90-year-old group in women and RFcR in the 20-50-year-old group and BMI in the 51-90-year-old group in men.

CONCLUSIONS

Our results demonstrated that the best predictor of hypertriglyceridemia may differ according to gender and age.

Prediction of fasting plasma glucose status using anthropometric measures for diagnosing type 2 diabetes

It is well known that body fat distribution and obesity are important risk factors for type 2 diabetes. Prediction of type 2 diabetes using a combination of anthropometric measures remains a controversial issue. This study aims to predict the fasting plasma glucose (FPG) status that is used in the diagnosis of type 2 diabetes by a combination of various measures among Korean adults. A total of 4870 subjects (2955 females and 1915 males) participated in this study. Based on 37 anthropometric measures, we compared predictions of FPG status using individual versus combined measures using two machine-learning algorithms. The values of the area under the receiver operating characteristic curve in the predictions by logistic regression and naive Bayes classifier based on the combination of measures were 0.741 and 0.739 in females, respectively, and were 0.687 and 0.686 in males, respectively. Our results indicate that prediction of FPG status using a combination of anthropometric measures was superior to individual measures alone in both females and males. We show that using balanced data of normal and high FPG groups can improve the prediction and reduce the intrinsic bias of the model toward the majority class.

The relationship between measures of obesity and incident heart failure: the multi-ethnic study of atherosclerosis

OBJECTIVE

To evaluate the strength of association of body mass index (BMI) and waist circumference (WC) with incident heart failure (HF), exploring our associations by ethnicity and age.

DESIGN AND METHODS

6,809 participants, aged 45-84 years old, without clinical cardiovascular disease (2000-2002), from the Multi-Ethnic Study of Atherosclerosis were included. Cox-Proportional hazards models were used to examine associations of BMI and WC with incident HF. The predictive abilities of BMI and WC were compared using receiver operating characteristic curves.

RESULTS

Over a median follow-up of 7.6 years, there were 176 cases. BMI and WC were associated with incident HF in men (1.33 [1.10-1.61] and 1.38 [1.18-1.62], respectively] and women (1.70 [1.33-2.17] and 1.64 [1.29-2.08], respectively). These associations became non-significant after adjusting for obesity-related conditions (hypertension, dysglycemia, hypercholesterolemia, left ventricular hypertrophy, kidney disease, and inflammation). The associations of BMI and WC did not vary significantly by ethnicity or age-group, but were inverse in Hispanic men. The area under the curve for BMI and WC was 0.749 and 0.750, respectively, in men and 0.782 and 0.777, respectively, in women.

CONCLUSIONS

The association between obesity and incident HF is largely mediated by obesity-related conditions. BMI and WC have similar predictive abilities for incident HF.

Body mass index, waist circumference, waist-hip ratio, waist-height ratio and risk for type 2 diabetes in women: a case-control study

OBJECTIVE

To assess the relationship between various anthropometric indexes and risk for type 2 diabetes in women.

STUDY DESIGN AND METHODS

A case-control study of 168 cases with newly diagnosed type 2 diabetes and 336 controls who were free of the disease. Cases and controls (ratio 1:2) were matched by age (±5 years). A questionnaire was used to collect information on possible risk factors for type 2 diabetes. Odds ratios (OR) and 95% confidence intervals (CI) for type 2 diabetes were calculated by conditional logistic regression.

RESULTS

After adjustment for possible confounders, increased risk for type 2 diabetes was associated with body mass index (BMI) ≥30 kg/m(2) (OR 4.68, 95% CI 2.09-10.49), waist circumference (WC) >88 cm (OR 6.99, 95% CI 1.60-30.42) and waist-height ratio (WHtR) ≥0.5 (OR 3.15, 95% CI 1.91-15.81).

CONCLUSIONS

Both general and central obesity are associated with type 2 diabetes. The results suggest that high BMI, WC and WHtR are significant risk factors for type 2 diabetes in women.

Different anthropometric adiposity measures and their association with cardiovascular disease risk factors: a meta-analysis

Objectives

To investigate which anthropometric adiposity measure has the strongest association with cardiovascular disease (CVD) risk factors in Caucasian men and women without a history of CVD.

Design

Systematic review and meta-analysis.

Methods

We searched databases for studies reporting correlations between anthropometric adiposity measures and CVD risk factors in Caucasian subjects without a history of CVD. Body mass index (BMI), waist circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage were considered the anthropometric adiposity measures. Primary CVD risk factors were: systolic blood pressure, diastolic blood pressure, high density lipoprotein (HDL) cholesterol, triglycerides and fasting glucose. Two independent reviewers performed abstract, full text and data selection.

Results

Twenty articles were included describing 21,618 males and 24,139 females. Waist circumference had the strongest correlation with all CVD risk factors for both men and women, except for HDL and LDL in men. When comparing BMI with waist circumference, the latter showed significantly better correlations to CVD risk factors, except for diastolic blood pressure in women and HDL and total cholesterol in men.

Conclusions

We recommend the use of waist circumference in clinical and research studies above other anthropometric adiposity measures, especially compared with BMI, when evaluating CVD risk factors.

Association of body mass index, sagittal abdominal diameter and waist-hip ratio with cardiometabolic risk factors and adipocytokines in Arab children and adolescents

Background

Sagittal abdominal diameter (SAD) is a novel anthropometric measure hypothesized to be a surrogate measure of visceral abdominal obesity in adults. This study aims to determine whether SAD is superior to other anthropometric measures such as body mass index (BMI) and waist to hip ratio (WHR) in terms of association to cardiometabolic risk and circulating adipocytokine concentrations in a cohort of Saudi children and adolescents.

Methods

A total of 948 (495 boys and 453 girls) apparently healthy children with varying BMI, aged 10–17 years, were included in this cross sectional study. Fasting glucose, lipid profile, leptin, adiponectin, resistin, insulin, TNF-α and aPAI-1 were measured in serum and HOMA-IR was calculated. MetS components were defined according to the International Diabetes Federation (IDF) criteria.

Results

BMI was superior to SAD as well as WHR, and had the highest number of significant associations to MetS components and adipocytokines even after adjustment for age and gender, including blood pressure, lipids, glucose and leptin.

Conclusion

In conclusion, while SAD is significantly associated with components of MetS among children and adolescents, it is not superior to BMI. The use of SAD therefore may not be practical for use in the pediatric clinical setting. Follow-up studies are needed to determine whether SAD has clinical significance in terms of harder outcomes such as predicting diabetes mellitus or cardiovascular diseases.

[Association of insulin resistance to different anthropometric measures and cardiovascular risk factors in a non-diabetic population]

BACKGROUND AND OBJECTIVE

Insulin resistance (IR) has been directly related to obesity, particularly central obesity, and to other cardiovascular risk factors (CVRFs). Direct IR quantification is difficult in clinical practice, and indirect methods such as HOMA (homeostasis model assessment) have therefore been developed. The aim of this study was to assess the association of IR, as measured by HOMA, with different anthropometric measures and some CVRFs.

MATERIALS AND METHODS

A cross-sectional, observational study was carried out in a general population sample older than 18 years in the province of Albacete, Spain. Sample size was 678 subjects. Participants completed a survey and underwent physical examinations and laboratory tests. Obesity measures included body mass index, waist perimeter, and sagittal abdominal diameter. Data analysis was performed using SPSS 15.0 software.

RESULTS

Mean values of obesity measures were higher in males as compared to females and increased with age. IR prevalence was 39.8%. All assessed anthropometric measures, decreased HDL (high density lipoprotein) cholesterol and increased non-HDL cholesterol were independently associated to the risk of IR.

CONCLUSIONS

A clear association exists between different anthropometrical measures and IR in the general population. There is also an association between lipid profile cahnges and the risk of experiencing IR.

Metabolic syndrome (MS) in elderly: a cross sectional survey

This study was conducted to determine the prevalence of metabolic syndrome (MS) in Turkish elderly. All data were collected in a cross-sectional based survey on 266 elderly aged above 65 years living in capital city of Turkey, Ankara. MS was defined according to National Cholesterol Education Program: Adult Treatment Panel III (NCEP ATP III) criteria. In the total sample of participants, the 61.7% (n=164) of the group has been diagnosed as MS. High blood pressure (BP) and waist circumference (WC) and low high density lipoprotein cholesterol (HDL-C) were the criteria of MS with highest prevalence in both gender. In addition female participants have higher systolic blood pressure (93.4%) and WC (79.1%) and lower HDL-C (69.2%) than the men (74.4%, 31.1% and 52.2% respectively). Weight correlated significantly with triglyceride (TG) and MS (p<0.001). WC was the anthropometric variable which had the highest correlation with the MS (r=0.338, p<0.001). Our study indicates that MS is highly prevalent in the elderly people particularly among women. Our findings may be helpful in formulating public health policies and prevention strategies focus on elderly population.

A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value

This systematic review collated seventy-eight studies exploring waist-to-height ratio (WHtR) and waist circumference (WC) or BMI as predictors of diabetes and CVD, published in English between 1950 and 2008. Twenty-two prospective analyses showed that WHtR and WC were significant predictors of these cardiometabolic outcomes more often than BMI, with similar OR, sometimes being significant predictors after adjustment for BMI. Observations from cross-sectional analyses, forty-four in adults, thirteen in children, supported these predictions. Receiver operator characteristic (ROC) analysis revealed mean area under ROC (AUROC) values of 0·704, 0·693 and 0·671 for WHtR, WC and BMI, respectively. Mean boundary values for WHtR, covering all cardiometabolic outcomes, from studies in fourteen different countries and including Caucasian, Asian and Central American subjects, were 0·50 for men and 0·50 for women. WHtR and WC are therefore similar predictors of diabetes and CVD, both being stronger than, and independent of, BMI. To make firmer statistical comparison, a meta-analysis is required. The AUROC analyses indicate that WHtR may be a more useful global clinical screening tool than WC, with a weighted mean boundary value of 0·5, supporting the simple public health message 'keep your waist circumference to less than half your height'.

Prevention of overweight and obesity: how effective is the current public health approach

Obesity is a public health problem that has become epidemic worldwide. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. Therefore, a public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance. However, public health intervention programs have had limited success in tackling the rising prevalence of obesity. This paper reviews the definition of overweight and obesity and the variations with age and ethnicity; health consequences and factors contributing to the development of obesity; and critically reviews the effectiveness of current public health strategies for risk factor reduction and obesity prevention.

The distance between the lower edge of the xiphisternum and the center of the umbilicus as an indicator of abdominal obesity and cardiovascular disease risk

OBJECTIVE

Abdominal obesity is considered an independent risk factor for cardiovascular disease (CVD).

AIM

To compare the distance between the lower edge of xiphisternum and the center of the umbilicus (XUD) with other anthropometric measurements in predicting risk factors for CVD.

METHODS

A random sample of 4,485 (males 1,772, females 2,713) nationally representative noninstitutionalized adults aged >or=18 years were included in the analysis. XUD, BMI, waist circumference (WC), waist-to-hip ratio (WHR), systolic and diastolic blood pressure were measured and fasting venous blood samples were collected to determine glucose, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein cholesterol and triacylglyceride levels. Oral glucose tolerance test (OGTT) was also preformed.

RESULTS

The mean XUD (+/- SD) was 17.4 +/- 3.2 cm and 17.0 +/- 3.0 cm for males (M) and females (F) respectively (M vs. F; p < 0.001). XUD had significant correlations with the cardiovascular risk factors analyzed as continuous variables (p < 0.001), except LDL cholesterol for women. However, the strengths of associations were weak for all associations (<0.3). The correlations of BMI, WC and WHR with XUD were significant (p < 0.001). The area under the curve (AUC) in the receiver operating characteristic (ROC) curve analysis for XUD in predicting the presence of two or more CVD risk factors was 0.62 (95%CI 0.61- 0.64); the corresponding AUC values for BMI (0.71, 95% CI 0.69-0.72), WC (0.71 95% CI, 0.70-0.73), and WHR (0.67 95% CI, 0.65-0.68) were higher than that for XUD.

CONCLUSION

The XUD showed significant correlations with the cardiovascular risk factors among Sriii Lankan adults. However, in predicting CVD risk XUD was inferior to BMI, WC, and WHR.

Establishing abdominal height cut-offs and their association with conventional indices of obesity among Arab children and adolescents

BACKGROUND AND OBJECTIVES

Obesity, particularly childhood obesity is common in the Middle East, but no studies have examined the relationship of sagittal abdominal diameter (SAD) or abdominal height to conventional markers of obesity in this region. This is the first study to document the association of SAD with measures of obesity among Arab children and adolescents.

METHODS

Nine hundred sixty-four Saudi children aged 5-17 years (365 prepubertal, including 146 boys and 219 girls; 249 pubertal, including 125 boys and 124 girls; and 350 postpubertal, including 198 boys and 152 girls) were included in this cross-sectional study.

RESULTS

SAD was significantly correlated with indices of obesity regardless of gender, but was strongest among pubertal boys. The cut-off values were as follows: for prepubertal children, 14 cm (equivalent to 50th percentile among girls and 60th percentile among boys); for pubertal children, 15 cm for girls (30th percentile) and 16 cm for boys (50th percentile), and for postpubertal, 21.5 cm for girls (70th percentile) and 22 cm for boys (80th percentile).

CONCLUSION

SAD is a reliable indicator of visceral obesity among Arab children and adolescents in particular. Prospective studies should be done to determine whether such an association translates to a promising risk factor for hard endpoints such as diabetes mellitus and coronary heart disease.

Beyond the BMI: the search for better guidelines for bariatric surgery

The application of the BMI of > or =35 as the major prerequisite for access to bariatric surgery is no longer appropriate because the index, now incorporated in the requirements of Medicare, Medicaid and most private carriers, does not reflect the degree or distribution of adiposity, it discriminates unfairly on the basis of gender, race, age, fitness, and body fat composition. Further, with increasing evidence that bariatric surgery can also induce full and durable remission of such comorbidities as type 2 diabetes even in patients with BMIs <30, new guidelines must be pursued.

Prevention of overweight and obesity: how effective is the current public health approach

Obesity is a public health problem that has become epidemic worldwide. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality. The related health care costs are also substantial. Therefore, a public health approach to develop population-based strategies for the prevention of excess weight gain is of great importance. However, public health intervention programs have had limited success in tackling the rising prevalence of obesity. This paper reviews the definition of overweight and obesity and the variations with age and ethnicity; health consequences and factors contributing to the development of obesity; and critically reviews the effectiveness of current public health strategies for risk factor reduction and obesity prevention.

Sagittal abdominal diameter as a screening tool in clinical research: cutoffs for cardiometabolic risk

Background. Waist girth and BMI are commonly used as markers of cardiometabolic risk. Accumulating data however suggest that sagittal abdominal diameter (SAD) or "abdominal height" may be a better marker of intra-abdominal adiposity and cardiometabolic risk. We aimed to identify cutoffs for SAD using a cardiometabolic risk score. Design. A population-based cross-sectional study. Methods. In 4032 subjects (1936 men and 2096 women) at age 60, different anthropometric variables (SAD, BMI, waist girth, and waist-to-hip ratio) were measured and cardiometabolic risk score calculated. ROC curves were used to assess cutoffs. Results. Among men SAD showed the strongest correlations to the majority of the individual risk factors; whereas in women SAD was equal to that of waist girth. In the whole sample, the area under the ROC curve was highest for SAD. The optimal SAD cutoff for an elevated cardiometabolic risk score in men was approximately 22 cm (95%CI; 21.6 to 22.8) and in women approximately 20 cm (95%CI; 19.4 to 20.8). These cutoffs were similar if the Framingham risk score was used. Conclusions. These cutoffs may be used in research and screening to identify "metabolically obese" men who would benefit from lifestyle and pharmacological interventions. These results need to be verified in younger age groups.

Assessing Body Fat Changes during Moderate Weight Loss with Anthropometry and Bioelectrical Impedance

BACKGROUND/OBJECTIVES: Monitoring changes in total fat mass and abdominal adiposity are important in understanding the impact of different types of weight loss interventions on health risks. Our objective was to assess the usefulness of anthropometry and bioelectrical impedance analysis (BIA) in predicting fat mass changes during moderate weight loss. SUBJECTS/METHODS: Fat mass changes were assessed in 34 overweight adults (24 females, 10 males) after a 12-week supervised weight loss induced by caloric restriction (-30% of requirement) using BIA and DXA. Agreement between BIA and DXA measurements were assessed by Bland-Altman plots. Linear regression modeling was used to predict body and truncal fat mass from anthropometric measures. RESULTS: Diet intervention resulted in a significant decrease in body weight (- 7.86 ± 2.87 kg), body mass index (BMI - 2.69 ± 0.98 kg/m(2)), total body fat (- 5.22 ± 2.32 kg), truncal fat (- 2.80 ± 1.94 kg) and waist circumference (- 5.52 ± 3.57 cm). BMI and body weight were highly correlated with body fat (0.83 and 0.92 in females and 0.94 and 0.92 in males respectively) and truncal fat (0.75 and 0.87 in females; 0.90 and 0.84 in males respectively) during weight loss. Waist circumference was more correlated with truncal fat in males than females (0.94 vs. 0.85 in females). Compared to DXA, BIA underestimated total body fat changes in males (- 8.8 kg, p<0.001) and overestimated total body fat changes in females (+ 2.1 kg, p< 0.001). CONCLUSIONS: Body mass index, body weight, and waist circumference provide simple and more accurate than BIA estimates of relative changes in total and truncal fat during moderate weight loss in adults.

Predictive equations for body fat and abdominal fat with DXA and MRI as reference in Asian Indians

OBJECTIVE

To develop accurate and reliable equations from simple anthropometric parameters that would predict percentage of total body fat (%BF), total abdominal fat (TAF), subcutaneous abdominal adipose tissue (SCAT), and intra-abdominal adipose tissue (IAAT) with a fair degree of accuracy.

METHODS AND PROCEDURES

Anthropometry, %BF by dual-energy X-ray absorptiometry (DXA) in 171 healthy subjects (95 men and 76 women) and TAF, IAAT, and SCAT by single slice magnetic resonance imaging (MRI) at L3-4 intervertebral level in 100 healthy subjects were measured. Mean age and BMI were 32.2 years and 22.9 kg/m(2), respectively. Multiple regression analysis was used on the training data set (70%) to develop equations, by taking anthropometric and demographic variables as potential predictors. Predicted equations were applied on validation data set (30%).

RESULTS

Multiple regression analysis revealed the best equation for predicting %BF to be: %BF = 42.42 + 0.003 x age (years) + 7.04 x gender (M = 1, F = 2) + 0.42 x triceps skinfold (mm) + 0.29 x waist circumference (cm) + 0.22 [corrected] x weight (kg) - 0.42 x height (cm) (R (2) = 86.4%). The most precise predictive equation for estimating IAAT was: IAAT (mm(2)) = -238.7 + 16.9 x age (years) + 934.18 x gender (M = 1, F = 2) + 578.09 x BMI (kg/m(2)) - 441.06 x hip circumference (cm) + 434.2 x waist circumference (cm) (R (2) = 52.1%). SCAT was best predicted by: SCAT (mm(2)) = -49,376.4 - 17.15 x age (years) + 1,016.5 x gender (M = 1, F = 2) +783.3 x BMI (kg/m(2)) + 466 x hip circumference (cm) (R (2) = 67.1).

DISCUSSION

We present predictive equations to quantify body fat and abdominal adipose tissue sub-compartments in healthy Asian Indians. These equations could be used for clinical and research purposes.