Urgency of reassessment of role of obesity indices for metabolic risks

Obesity and Diabetes: A Sword of Damocles for Future Generations

Childhood obesity is one of the most challenging problem of the 21st century. The prevalence has increased, reaching an alarming rate. Furthermore, the problem is global and is also affecting low- and middle-income countries. This global obesity epidemic explains how the roots of cardiovascular disease, the most common cause of mortality among adults, begin in childhood. Overweight and obese children are likely to stay obese into adulthood and to develop noncommunicable diseases such as diabetes and cardiovascular diseases at a younger age. Thus, prevention should be the major goal and should start early in life. The aim of this review is to present an updated framework of the current understanding of the cardiovascular and metabolic risks in obese children and adolescents and to discuss the available therapeutic options.

Usefulness of waist-to-height ratio in screening incident hypertension among Japanese community-dwelling middle-aged and elderly individuals

Background

The incidence of hypertension is increasing worldwide and obesity is one of the most significant risk factors. Obesity can be defined by various anthropometric indices such as body mass index (BMI), waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR). This study examined a range of anthropometric indices and their relationships with hypertension.

Methods

This study included 768 men aged 70 ± 10 years and 959 women aged 70 ± 8 years from a rural village. The relationship between anthropometric indices (BMI, WHpR, and WHtR) and hypertension was examined using cross-sectional (baseline, N = 1727) and cohort data (follow-up, N = 419). Receiver operating characteristic (ROC) analysis was used to determine the predictive ability of obesity indices for hypertension in both genders. Logistic regression models were used to evaluate WHtR as a significant predictor of hypertension.

Results

In the cross-sectional study, WHtR, BMI, and WHpR showed significant predictive abilities for hypertension in both genders, with WHtR showing the strongest predictive ability. Also, in the cohort study, WHtR showed a significant predictive ability for incident hypertension in both genders, and, for women, BMI as well as WHtR had also predictive ability. In the cross-sectional study, the optimal WHtR cutoff values were 0.53 (sensitivity, 44.3%; specificity, 80.2%) for men and 0.54 (sensitivity, 60.9%; specificity, 68.6%) for women. In the cohort study, the optimal WHtR values were 0.47 (sensitivity, 85.4%; specificity, 39.8%) for men and 0.51 (sensitivity, 66.7%; specificity, 58.2%) for women.

Conclusions

The results suggest that WHtR is a useful screening tool for hypertension among Japanese middle-aged and elderly community-dwelling individuals.

Metabolic Syndrome in Children and Adolescents: Diagnostic Criteria, Therapeutic Options and Perspectives

PURPOSE OF REVIEW

This review summarizes our current understanding of the metabolic syndrome (MetS) in children and adolescents. Special emphasis is given towards diagnostic criteria and therapeutic options.

RECENT FINDINGS

Consistent diagnostic criteria to define MetS in childhood and adolescence are not available to date. There is common agreement that the main features defining MetS include (1) disturbed glucose metabolism, (2) arterial hypertension, (3) dyslipidemia, and (4) abdominal obesity. However, settings of cut-off values are still heterogeneous in the pediatric population. Additional features that may define cardiometabolic risk, such as non-alcoholic fatty liver disease (NAFDL) or hyperuricemia, are not considered to date. Prevalence of childhood obesity has more than doubled since 1980, and 6-39% of obese children and adolescents already present with MetS, depending on the definition applied. There is common agreement that a consistent definition of MetS is urgently needed for children to identify those at risk as early as possible. Such definition criteria should consider age, gender, pubertal stage, or ethnicity. Additional features such as NAFDL or hyperuricemia should also be included in MetS criteria. Lifestyle modification is still the main basis to prevent or treat childhood obesity and MetS, as other therapeutic options (pharmacotherapy, bariatric surgery) are not available or not recommended for the majority of affected youngster.

Optimal Cut-off Point of Waist to Height Ratio in Beijing and Its Association with Clusters of Metabolic Risk Factors

A host of studies found waist-to-height ratio (WHtR) having higher diagnostic value than other abdominal obesity anthropometric indicators for metabolic disorders. But the cut-off points are still not consistent. This study was aimed to explore the optimal cut-off point of WHtR in Chinese population and identify the association between WHtR and cluster of metabolic risk factors. In total, 13379 Han adults (7553 men and 5726 women) from over 40 institutions who took physical examination in Xuanwu Hospital of Capital Medical University between January 2014 and January 2015 were involved in this cross-sectional study. Subjects with two or more components of metabolic syndrome (MetS) were considered to have multiple risk factors. Optimal cut-off points of WHtR for cluster of metabolic risk factors were analyzed by receiver operating characteristic (ROC) curve analysis. The optimal cut-off points of WHtR were 0.51 for men and 0.49 for women. People with elevated WHtR had higher levels of metabolic risk factors. And the prevalence of individual and clusters of 5 risk factors were all higher among WHtR-defined abdominal obesity people than in normal subjects. The optimal cut-off points of WHtR were 0.51 for men and 0.49 for women. In conclusion, people with elevated WHtR are susceptible to cluster of metabolic risk factors.

Associations between anthropometric parameters and lipid profiles in Chinese individuals with age ≥40 years and BMI <28kg/m2

BACKGROUND

Lipid abnormalities are associated with overweight and obesity. Some simple anthropometric measurements such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR), may link to increased risk of dyslipidemia. However, diverse results were found in different population studies. We focused on the associations between these measurements and dyslipidemia in non-obese (BMI <28kg/m2) population aged more than 40 years.

METHODS AND FINDINGS

Cross-sectional study of 4185 non-obese adults aged more than 40 years was conducted in Nanchang, Jiangxi province, China. Questionnaire, anthropometric and laboratory tests were conducted. The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) criteria were used to define high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia and dyslipidemia. The overall prevalence of high TC, high LDL-C, low HDL-C, hypercholesterolemia, hypertriglyceridemia and dyslipidemia were 15.68%, 27.98%, 20.12%, 44.01%, 21.98% and 49.06% respectively. Multiple logistic regressions showed only BMI (per quartile increment) increased risks for prevalent high LDL-C, low HDL-C, hypercholesterolemia, hypertriglyceridemia, and dyslipidemia. Regardless of sex, age and prevalent metabolic syndrome, increasing BMI was persistently independent risk factor for having low HDL-C, hypercholesterolemia and dyslipidemia, however was not associated with high TC.

CONCLUSIONS

In non-obese Chinese population aged more than 40 years, increasing BMI may better identify the prevalent dyslipidemia than other anthropometric measurements. However, due to the different meanings, both BMI and WC should be measured and monitored for metabolic risk assessment.

Waist-to-Height Ratio Compared to Standard Obesity Measures as Predictor of Cardiometabolic Risk Factors in Asian Indians in North India

OBJECTIVE

The aim of this study was to compare the discriminatory ability of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) in identifying the presence of cardiometabolic risk factors in Asian Indians.

METHODS

This cross-sectional study involved 509 subjects (278 males and 231 females) aged 20-60 years from New Delhi, India. Measurements included complete clinical examination, blood pressure, weight, height, WC, BMI, WHR and WHtR, fasting blood glucose, lipid profile, and fasting insulin levels. Receiver operating characteristic curve analyses were performed to compare predictive validity of various adiposity measures against the cardiometabolic risk factors (dyslipidemia, hyperinsulinemia, impaired fasting glucose, hypertension, and metabolic syndrome). The odds ratio for the presence of individual cardiometabolic risk factors in the presence of overweight, abdominal obesity, and high WHtR were calculated using logistic regression analysis.

RESULTS

WC had the highest area under ROC for all other cardiometabolic risk factors except hyperinsulinemia in males and for dyslipidemia, metabolic syndrome and presence of at least one cardiometabolic risk factor in females. For metabolic syndrome, WC, followed by WHtR, was observed to be the better predictor than other measures of adiposity, and WHtR appeared to be the best predictor for hypertension in both genders, particularly in women.

CONCLUSIONS

In the northern Asian Indian population with high prevalence of cardiometabolic risk factors, a combination of WC and WHtR appeared to be having better clinical utility than BMI and WHR in identifying individuals with cardiometabolic risk factors.

CT-based compartmental quantification of adipose tissue versus body metrics in colorectal cancer patients

PURPOSE

While obesity is considered a prognostic factor in colorectal cancer (CRC), there is increasing evidence that not simply body mass index (BMI) alone but specifically abdominal fat distribution is what matters. As part of the ColoCare study, this study measured the distribution of adipose tissue compartments in CRC patients and aimed to identify the body metric that best correlates with these measurements as a useful proxy for adipose tissue distribution.

MATERIALS AND METHODS

In 120 newly-diagnosed CRC patients who underwent multidetector computed tomography (CT), densitometric quantification of total (TFA), visceral (VFA), intraperitoneal (IFA), retroperitoneal (RFA), and subcutaneous fat area (SFA), as well as the M. erector spinae and psoas was performed to test the association with gender, age, tumor stage, metabolic equivalents, BMI, waist-to-height (WHtR) and waist-to-hip ratio (WHR).

RESULTS

VFA was 28.8 % higher in men (p_VFA<0.0001) and 30.5 % higher in patients older than 61 years (p_VFA<0.0001). WHtR correlated best with all adipose tissue compartments (r_VFA=0.69, r_TFA=0.84, p<0.0001) and visceral-to-subcutaneous-fat-ratio (VFR, r_VFR=0.22, p=<0.05). Patients with tumor stages III/IV showed significantly lower overall adipose tissue than I/II. Increased M. erector spinae mass was inversely correlated with all compartments.

CONCLUSION

Densitometric quantification on CT is a highly reproducible and reliable method to show fat distribution across adipose tissue compartments. This distribution might be best reflected by WHtR, rather than by BMI or WHR.

KEY POINTS

• Densitometric quantification of adipose tissue on CT is highly reproducible and reliable. • Waist-to-height ratio better correlates with adipose tissue compartments and VFR than BMI or waist-to-hip ratio. • Men have higher a higher visceral fat area than women. • Patients older than 61 years have higher visceral fat area. • Patients with tumor stages III/IV have significantly lower adipose tissue than those in stages I/II.

Association between the abdominal obesity anthropometric indicators and metabolic disorders in a Chinese population

BACKGROUND

Obesity has become a major health problem in contemporary society and it is closely related to many chronic diseases, so it is an important issue for measuring adiposity accurately and predicting its future. Prevention and treatment of overweight and obesity has become one of the key prevention and treatment of metabolic disorders.

OBJECTIVE

In this study, we compared the ability of the four anthropometric indicators (body mass index, waist circumstance, waist-height ratio, waist-to-hip ratio) to identify metabolic disorders (hypertension, hyperlipidaemia, hyperglycemia and hyperuricemia) by receiver operating characteristic (ROC) curve analyses and to provide evidence for clinical practice.

METHODS

In this large scale cross-sectional study, 13,275 Han adults (including 7595 males and 5680 females) received physical examination between January, 2009 and January, 2010 in Xuanwu Hospital of Capital Medical University were investigated by the means of questionnaire, Meanwhile, the physical examination and serological results were recorded. A package known as Statistical Package for Social Scientist (SPSS) was employed to analyse the responses while t-test, one-way analysis of variance (ANOVA), ROC analysis and chi-square statistical methods were used to test the hypotheses.

RESULTS

WC, WHtR, WHR and BMI were all significantly (P < 0.001) correlated with all metabolic risk factors regardless of gender. And the area under the curve (AUC) of WHtR was significantly greater than that of WC, BMI or WHR in the prediction of hypertension, hyperlipidaemia, hyperglycemia and hyperuricemia.

CONCLUSION

Our data show that WHtR was the best predictor of various metabolic disorders. The diagnostic value in descending order was WHtR > WHR > WC > BMI. Therefore we recommend WHtR in assessment of obese patients, in order to better assess the risks of their metabolic diseases.

Characterization of metabolically unhealthy normal-weight individuals: Risk factors and their associations with type 2 diabetes

OBJECTIVE

A proportion of type 2 diabetes cases arise from normal-weight individuals who can therefore be considered to be "metabolically unhealthy normal-weight" (MUH-NW). It remains unclear which factors account for this access risk. Our aims were to identify risk factors for type 2 diabetes in normal-weight individuals and to compare the strengths of their associations with type 2 diabetes to that observed in overweight and obese participants.

METHODS

A case-cohort, including 2027 sub-cohort participants and 706 incident type 2 cases, was designed within the population-based European Prospective Investigation into Cancer and Nutrition Potsdam study. Adjusted means and relative frequencies of anthropometric, lifestyle and biochemical risk factors were calculated in groups stratified by BMI and incident diabetes status. Cox regressions were applied to evaluate associations between these variables and diabetes risk stratified by BMI category.

RESULTS

MUH-NW individuals were characterized by known diabetes risk factors, e.g. they were significantly more likely to be male, former smokers, hypertensive, and less physically active compared to normal-weight individuals without incident diabetes. Higher waist circumference (women: 75.5 vs. 73.1cm; men: 88.0 vs. 85.1cm), higher HbA1c (6.1 vs. 5.3%), higher triglycerides (1.47 vs. 1.11 mmol/l), and higher levels of high sensitive C-reactive protein (0.81 vs. 0.51 mg/l) as well as lower levels of HDL-cholesterol (1.28 vs. 1.49 mmol/l) and adiponectin (6.32 vs. 8.25 μg/ml) characterized this phenotype. Stronger associations with diabetes among normal-weight participants compared to overweight and obese (p for interaction<0.05) were observed for height, waist circumference, former smoking, and hypertension.

CONCLUSIONS

Normal-weight individuals who develop diabetes have higher levels of diabetes risk factors, however, frequently still among the normal range. Still, hypertension, elevated HbA1c and lifestyle risk factors might be useful indicators of risk.

Predicting percentage body fat through waist-to-height ratio (WtHR) in Spanish schoolchildren

OBJECTIVE

To analyse the association between waist-to-height ratio (WtHR) and body fat and to develop predictive adiposity equations that will simplify the diagnosis of obesity in the paediatric age group.

DESIGN

Cross-sectional study conducted in Spain during 2007 and 2008. Anthropometric dimensions were taken according to the International Biology Program. The children were classified as underweight, normal weight, overweight or obese according to national standards of percentage body fat (%BF). WtHR differences among nutritional status categories were evaluated using ANOVA. Correlation analysis and regression analysis were carried out using WtHR as a predictor variable for %BF. A t test was applied to the results obtained by the regression model and by the Siri equation. The degree of agreement between both methods was evaluated by estimating the intra-class correlation coefficient.

SETTING

Elementary and secondary schools in Madrid (Spain).

SUBJECTS

Girls (n 1158) and boys (n 1161) from 6 to 14 years old.

RESULTS

WtHR differed significantly (P < 0.001) depending on nutritional status category. This index was correlated (P < 0.001) with all adiposity indicators. The mean %BF values estimated by the regression model (boys: %BF = 106.50 × WtHR - 28.36; girls: %BF = 89.73 × WtHR - 15.40) did not differ from those obtained by the Siri equation. The intra-class correlation coefficient (0.85 in boys, 0.79 in girls) showed a high degree of concordance between both methods.

CONCLUSIONS

WtHR proved to be an effective method for predicting relative adiposity in 6-14-year-olds. The developed equations can help to simplify the diagnosis of obesity in schoolchildren.

Comparison of body mass index, waist circumference, and waist-to-height ratio for predicting the clustering of cardiometabolic risk factors by age in Japanese workers--Japan Epidemiology Collaboration on Occupational Health study

BACKGROUND

Waist-to-height ratio (WHtR) has been suggested as a better screening tool than body mass index (BMI) and waist circumference (WC) for assessing cardiometabolic risk. However, most previous studies did not consider age.

METHODS AND RESULTS

Participants were 45,618 men and 8,092 women aged 15-84 years who received periodic health checkups in 9 companies in Japan. Clustering of cardiometabolic risk factors was defined by the existence of 2 or more of high blood pressure, hyperglycemia, and dyslipidemia. In both men and women, unadjusted area under the curve (AUC) of the receiver-operating characteristic curve for WHtR in detecting the clustering of cardiometabolic risk factors was significantly higher than that for either BMI or WC; the AUCs for WHtR, BMI, and WC, respectively, were 0.734, 0.705, and 0.717 in men and 0.782, 0.762, and 0.755 in women. After adjustment for age, however, such differences were not observed; the corresponding values were 0.702, 0.701, and 0.696 in men. In women, the age-adjusted AUC for BMI was slightly higher than for other indices (WHtR, 0.721; BMI, 0.726; WC, 0.707).

CONCLUSIONS

The screening performance of WHtR for detecting the clustering cardiometabolic risk factors was not superior to that of BMI.

Predicting cardiometabolic risk: waist-to-height ratio or BMI. A meta-analysis

BACKGROUND AND OBJECTIVES

The identification of increased cardiometabolic risk among asymptomatic individuals remains a huge challenge. The aim of this meta-analysis was to compare the association of body mass index (BMI), which is an index of general obesity, and waist-to-height ratio (WHtR), an index of abdominal obesity, with cardiometabolic risk in cross-sectional and prospective studies.

METHODS

PubMed and Embase databases were searched for cross-sectional or prospective studies that evaluated the association of both BMI and WHtR with several cardiometabolic outcomes. The strength of relative risk (RR) with 95% confidence interval (CI) was calculated using the optimal cutoffs of BMI and WHtR in cross-sectional studies, while any available cutoff was used in prospective studies. The pooled estimate of the ratio of RRs (rRR [=RRBMI/RRWHtR]) with 95% CIs was used to compare the association of WHtR and BMI with cardiometabolic risk. Meta-regression was used to identify possible sources of heterogeneity between the studies.

RESULTS

Twenty-four cross-sectional studies and ten prospective studies with a total number of 512,809 participants were identified as suitable for the purpose of this meta-analysis. WHtR was found to have a stronger association than BMI with diabetes mellitus (rRR: 0.71, 95% CI: 0.59-0.84) and metabolic syndrome (rRR: 0.92, 95% CI: 0.89-0.96) in cross-sectional studies. Also in prospective studies, WHtR appears to be superior to BMI in detecting several outcomes, including incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality. The usefulness of WHtR appears to be better in Asian than in non-Asian populations. BMI was not superior to WHtR in any of the outcomes that were evaluated. However, the results of the utilized approach should be interpreted cautiously because of a substantial heterogeneity between the results of the studies. Meta-regression analysis was performed to explain this heterogeneity, but none of the evaluated factors, ie, sex, origin (Asians, non-Asians), and optimal BMI or WHtR cutoffs were significantly related with rRR.

CONCLUSION

The results of this meta-analysis support the use of WHtR in identifying adults at increased cardiometabolic risk. However, further evidence is warranted because of a substantial heterogeneity between the studies.

Obesity index that better predict metabolic syndrome: body mass index, waist circumference, waist hip ratio, or waist height ratio

AIM

The aim was to compare body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), and waist height ratio (WHtR) to identify the best predictor of metabolic syndrome (MetS) among Qatari adult population.

METHODS

A cross-sectional survey from April 2011 to December 2012. Data was collected from 1552 participants followed by blood sampling. MetS was defined according to Third Adult Treatment Panel (ATPIII) and International Diabetes Federation (IDF). Receiver operating characteristics (ROC) curve analysis was performed.

RESULTS

Among men, WC followed by WHR and WHtR yielded the highest area under the curve (AUC) (0.78; 95% CI 0.74-0.82 and 0.75; 95% CI 0.71-0.79, resp.). Among women, WC followed by WHtR yielded the highest AUC (0.81; 95% CI 0.78-0.85 & 0.79; 95% CI 0.76-0.83, resp.). Among men, WC at a cut-off 99.5 cm resulted in the highest Youden index with sensitivity 81.6% and 63.9% specificity. Among women, WC at a cut-off 91 cm resulted in the highest Youden index with the corresponding sensitivity and specificity of 86.5% and 64.7%, respectively. BMI had the lowest sensitivity and specificity in both genders.

CONCLUSION

WC at cut-off 99.5 cm in men and 91 cm in women was the best predictor of MetS in Qatar.

Association between waist-to-height ratio and metabolic risk factors in Korean adults with normal body mass index and waist circumference

There is little consensus on the best obesity index associated with metabolic risk factors among the population with normal both body mass index (BMI) and waist circumference (WC). We therefore evaluated the association between anthropometric indices and metabolic risk factors in a Korean population with normal BMI and WC. This cross-sectional study involved 2,952 participants aged 20-79 years who had normal BMI and WC, based on the Fourth Korea National Health and Nutrition Examination Surveys conducted in 2008. The receiver operating characteristic (ROC) curves were generated to identify the optimal measurement of obesity for the prediction of metabolic risk factors in this population. The area under the ROC curve value for waist-to-height ratio (WHtR) in prediction of metabolic syndrome (MetS) and its components was higher than that for BMI and WC. Among individuals with normal BMI and WC, prevalence of all metabolic risk factors and MetS significantly increased across the quartiles of WHtR in both men and women. After adjustment for potential confounders, the Odds Ratios (95% confidence intervals) for MetS in the second, third, and fourth quartiles of WHtR compared to the first quartile of WHtR were 3.53 (2.12-5.89), 6.06 (3.52-10.43), and 7.11 (4.08-12.38) in men, and 1.66 (1.01-2.72), 2.79 (1.81-4.30), and 2.82 (1.76-4.52) in women, respectively. In conclusion, WHtR has the best predictive value for evaluating the metabolic risk factors compared to BMI or WC alone among subjects with normal BMI and WC.

Anthropometric measures and lipid coronary heart disease risk factors in Korean immigrants with type 2 diabetes

OBJECTIVES

The purposes of this study were to (1) describe anthropometric measures among Korean immigrants with type 2 diabetes mellitus (T2DM) and (2) examine the relationships between measures of obesity with several forms of dyslipidemia in this group.

BACKGROUND

Obesity and dyslipidemia are commonly associated with T2DM, and they are risk factors for coronary heart disease (CHD), the leading cause of death for people with diabetes. Asians are predisposed to abdominal obesity and experience significant CHD risk at lower body mass index (BMI) levels. Despite high prevalence of diabetes among Korean immigrants, relationships among anthropometric measures and lipid-related CHD risk factors have not been examined.

METHODS

A convenience sample of 143 adult Korean immigrants with T2DM between the ages of 30 and 80 years participated in the study. Body mass index, waist circumference (WC), and waist-to-hip ratio (WHR) were obtained using standardized procedures. Total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were assessed using a fingerstick blood test. Hierarchical linear regressions were conducted to identify which of the anthropometric measures was significantly related to individuals' cholesterol levels.

RESULTS

Central obesity measures, not BMI, were significantly associated with dyslipidemia in Korean immigrants with T2DM independent of potential confounds such as hemoglobin A1C, cigarette smoking, age, and cholesterol medication. Different central obesity measures were associated with different cholesterol types for diabetic Korean men and women. In men, WHR was positively associated with low-density lipoprotein cholesterol and total cholesterol levels. In women, WC was negatively associated with high-density lipoprotein cholesterol.

CONCLUSIONS

Central obesity measures (WC and WHR) are better indicators for assessing lipid-related CHD risk factor among Korean immigrants with T2DM than BMI. Gender difference in the association between central obesity measures and lipid types should be considered in CHD risk assessment of Korean immigrants with T2DM.

Relation of anthropometric variables to coronary artery disease risk factors

BACKGROUND AND OBJECTIVES

Anthropometric variables and their relation to conventional coronary artery disease (CAD) risk factors in railway employees have been inadequately studied in India. This cross-sectional survey was carried out in the Solapur division of the Central railway in the year 2004, to assess the anthropometric variables in railway employees and their relation to conventional CAD risk factors.

MATERIALS AND METHODS

A total of 995 railway employees, with 872 males and 123 females participated in this cross-sectional study. All subjects underwent anthropometric measurements, fasting lipid profile, and blood sugar level. Various anthropometric indices were calculated for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and abdominal volume index (AVI). Statistical analysis was done by EPI Info 6 statistical software.

RESULTS

Compared to all other obesity indices, WHtR was most prevalent in both genders. High WHtR was present in 699 (80.16%) males and 103 (83.73%) females. Age ≥45 years, high systolic BP, high diastolic BP, low HDL, high triglyceride, and diabetes mellitus were positively correlated with high BMI, high WC, high WHR, high WHtR, and high AVI. High BMI, high WC, high WHR, high WHtR, and high AVI were negatively associated with physical inactivity.

CONCLUSIONS

Over all, anthropometric variables in both genders were significantly deranged in subjects with coronary risk factors. Compared to all other anthropometric variables, WHtR was statistically significantly associated with a majority of coronary artery risk factors. Hence we recommend inclusion of WHtR as a parameter of obesity to predict coronary artery disease risk factor along with WC, WHR, and BMI in epidemiologic studies.