Comparison of multiple obesity indices for cardiovascular disease risk classification in South Asian adults: The CARRS Study

Abstract

BackgroundWe comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population.Methods8,892 participants aged 20–60 years in 2010–2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol and report associations (prevalence ratios, PRs), discrimination (area-under-the-curve, AUCs), and calibration (index χ2). We also examined a composite unhealthy cardiovascular profile score summarizing glucose, lipids, and blood pressure.ResultsNo single obesity index consistently performed statistically significantly better than the others across the outcome models. Based on point estimates, WHtR trended towards best performance in classifying diabetes (PR = 1.58 [1.45–1.72], AUC = 0.77, men; PR = 1.59 [1.47–1.71], AUC = 0.80, women) and hypertension (PR = 1.34 [1.26,1.42], AUC = 0.70, men; PR = 1.41 [1.33,1.50], AUC = 0.78, women). WC (mean difference = 0.24 SD [0.21–0.27]) and WHtR (mean difference = 0.24 SD [0.21,0.28]) had the strongest associations with the composite unhealthy cardiovascular profile score in women but not in men.ConclusionsWC and WHtR were the most useful indices for identifying South Asian adults with prevalent diabetes and hypertension. Collection of waist circumference data in South Asian health surveys will be informative for population-based CVD surveillance efforts.

Comparative Evaluation of Adiposity Indices as Predictors of Hypertension among Brazilian Adults

“…Despite this gap, a recent investigation observed that WSR is more strongly associated with hypertension than BMI, WC, and WHR in men and women from India and Pakistan [8]. In line with this, a previous research analyzing a large sample of Chinese men and women ( n = 2895; 25–74 years old) observed that WSR was the best index in predicting elevated systolic and diastolic BP in women when compared to BMI, WC, and WHR (WSR likelihood ratios in that study were 3.05 and 3.38 for systolic and diastolic BP, respectively) [10].…”

“…Moreover, excess body weight caused by genetic and/or sedentarism and bad nutrition is commonly associated with the incidence of hypertension [1]. Noteworthy, several adiposity indices, such as body mass index (BMI), waist circumference (WC), conicity index (C), and waist-to-hip-ratio (WHR), have been extensively applied to assess cardiovascular risk factors among adults and elderly people [6–8]. In fact, studies have shown that those indices, particularly when WC is accounted for, are good predictors of hypertension [7, 8].…”

The Importance of Some New Clinical Indices in the Evaluation of Childhood Obesity

“…It is reported that this index gives particularly a notion about being overweight or obese among adults. However, there are many studies performed on adults that do not recommend BMI, instead propose other obesity indices for various purposes such as prediction of hypertension, cardiovascular disease risk classification or as discriminators of in the diagnosis of metabolic syndrome (Chua, Zalilah, Haemamalar, Norhasmah, & Geeta, 2017;Patel et al, 2017;Motamed et al, 2016;Motamed et al, 2017;Fan et al, 2016). Besides, a very recent study has reported that LDL-cholesterol, which is found to be elevated in obese individuals and also known as a risk factor for CVDs is not associated with BMI or waist circumference (Oda, 2017).…”

“…Obesity indices have recently been a point of interest during the investigation of obesity, risk factors of obesity and obesity-related diseases such as metabolic syndrome, coronary artery disease, acute myocardial infarction and type 2 diabetes (Motamed et al, 2016;Motamed et al, 2017;Mondal & Mishra, 2017;Chua, Zalilah, Haemamalar, Norhasmah, & Geeta, 2017;Patel et al, 2017;Abulmeaty et al, 2017;Tsioufis et al, 2016;Jelavic, Babic & Pintaric, 2017;Liu, Ma, Lou & Zhu, 2016;Tao et al, 2016;Oguoma et al, 2016). So far a great number of studies have been performed on adults with different obesity grades, however research performed on pediatric population ) is scarce.…”

“…Some studies inform that body mass index (BMI) have no value to predict hypertension (Chua, Zalilah, Haemamalar, Norhasmah, & Geeta, 2017), the incidence of coronary artery disease in patients with essential hypertension (Tsioufis et al, 2016), the low maximal oxygen consumption-a measure of cardiorespiratory capacity (Mondal & Mishra, 2017), clinical severity and prognosis of acute ST-elevation myocardial infarction (Jelavic, Babic & Pintaric, 2017), to identify adults with cardiovascular risk factors (Patel et al, 2017), to determine the best usual discriminator index of obesity to diagnose diabetes mellitus (Motamed et al, 2016). In a similar manner, there are also reports informing waist circumference and waist-to-hip ratio have no predictive value for coronary artery disease with essential hypertension and for the identification of children with elevated blood pressure, respectively (Tsioufis et al, 2016;Ma et al, 2016).…”