Waist-to-height ratio: An accurate anthropometric index of abdominal adiposity and a predictor of high HOMA-IR values in nondialyzed chronic kidney disease patients

Body Roundness Index Is Better Correlated with Insulin Sensitivity than Body Shape Index in Young and Middle-Aged Japanese Persons

Aims: The present study aimed to clarify the relationships between novel and traditional anthropometric indices and insulin sensitivity (SI) in young and middle-aged Japanese persons with normal glucose tolerance (NGT), and middle-aged Japanese persons with NGT and glucose intolerance. Methods: Plasma glucose and insulin levels were measured in 1270 young (age <40 years) and 2153 middle-aged persons with NGT (n = 1531) and glucose intolerance (n = 622) during a 75-g oral glucose tolerance test. Height (Ht), weight, and waist circumference (WC) were measured. The body mass index (BMI), WC, and the WC/Ht ratio were used as traditional anthropometric indices. A body shape index (ABSI) and the body roundness index (BRI) were calculated as novel indices. Indices of SI (Matsuda index and 1/homeostasis model assessment of insulin resistance) were calculated and compared with anthropometric indices. Results: The ABSI showed a weak correlation with SI indices in all groups. The BRI showed almost the same correlation with SI indices as the BMI, WC, and WC/Ht in all groups. The inverse correlation between each of the anthropometric indices other than ABSI and SI indices was weak in young persons, at 0.16-0.27 (Spearman's ρ values), but strong in middle-aged persons, at 0.38-1.00. On receiver-operating characteristic (ROC) curve analysis for detection of insulin resistance, the ABSI had a lower area under the ROC curve (AUC) than the other anthropometric indices, and the BRI and the WC/Ht ratio showed similar AUCs. The AUCs for the BRI and WC/Ht ratio were the highest in middle-aged men with NGT and glucose intolerance. Conclusions: The BRI, not the ABSI, was better correlated with SI in young and middle-aged Japanese persons. The BRI and WC/Ht ratio were comparable in their correlations with SI and the detection of insulin resistance in the participants of the present study.

A new anthropometric model for body composition estimation: Comparison with a bioelectrical impedance consumer device

Background

The present study refers to an anthropometric model, Dahlmann-Body-Analysis (DBA), based on formerly developed weight-height-frame tables. Including the anthropometric variable abdomen circumference (AC), a further differentiation into muscularity and fat mass could be realized. This enables to calculate the individual percentage fat mass (%FM), providing a cost-effective method for epidemiological studies. The present work sets out to investigate, whether %FM computed by the DBA model compares to BIA measurements, notably under conditions of heavy obesity.

Subjects/methods

In 103 adults (37 males, 66 females, age 42.5 ± 12.5 years, BMI 38.2 ± 4.8 kg/m²) %FM was estimated by a tetrapolar BIA device and compared to results derived by the DBA system. Bland-Altman and simple linear regression analyses were used to determine agreement between methods.

Results

The mean %FM estimates of men (women) ± standard deviation were 36.1 ± 4.8 (49.7 ± 4.5) for BIA and 36.7 ± 4.2 (49.1 ± 4.9) for DBA measurements. Pearson correlation coefficients (r) and Lin’s concordance correlation coefficient (CCC) were r = 0.86 and CCC = 0.84 for men and r = 0.85 and CCC = 0.83 for women, respectively. Bland-Altman plot showed limits of agreement between DBA and BIA %FM that ranged from 5.5% to -4.3% for men and 4.6% to– 5.7% for women, respectively. Correlations between values measured by both methods were high and the observed confidence interval (SD of the difference between DBA and BIA result multiplied by 2) was low. No systematic error was found. The DBA system overestimates FM by 0.63 ± 4.98 (2SD) % for men and underestimates FM by -0.56 ± 5.28 (2SD) % for women, respectively, compared to the BIA results. The result for both genders is -0.066 ± 5.17 (2SD) %FM. Over all, there is a strong concordance and reproducibility between the DBA and BIA data sets.

Conclusions

The implementation of the abdomen circumference (AC) into the DBA model as a proxy for body fat (%FM) resulted in a strong concordance with BIA measurements. These findings indicate that the DBA model may reflect the body shape of severely obese white European patients with regard to body composition.

Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study

OBJECTIVE

This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal.

STUDY DESIGN

The study was a nationwide population-based cross-sectional study.

SETTING AND PARTICIPANTS

Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression.

RESULTS

The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3).

CONCLUSION

This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it.

Association between Body Mass Index and Chronic Kidney Disease in Asian Populations: A Participant-level Meta-Analysis

Obesity and chronic kidney disease (CKD) are major public health problems worldwide. However, the association between body mass index (BMI) and CKD is inconclusive in Asians. In this meta-analysis, eight population-based studies, from China, India, Russia (Asian), Singapore and South Korea, provided individual-level data (n=50037). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². BMI was analyzed both as a continuous variable and in three categories: <25kg/m², normal; 25-29.9kg/m², overweight; and ≥30kg/m², obese. The association between BMI and CKD was evaluated in each study using multivariable logistic regression models and individual estimates were pooled using random-effect meta-analysis to obtain the pooled odds ratio (OR) and 95% confidence interval (CI). Associations were also evaluated in subgroups of age, gender, smoking, diabetes, and hypertension status. Of 50037 adults, 4258 (8.5%) had CKD. 13328 (26.6%) individuals were overweight while 4440 (8.9%) were obese. The prevalence of any CKD ranged from 3.5% to 29.1% across studies. In pooled analysis, both overweight and obesity were associated with increased odds of CKD, with pooled OR (95% CI) of 1.15 (1.03-1.29) and 1.23 (1.06-1.42), respectively. In subgroup analyses, significant associations between BMI and CKD were observed in adult males, non-smokers, and those with diabetes and arterial hypertension (all p<0.05). When evaluated as a continuous variable, BMI was not significantly associated with CKD. If confirmed in longitudinal studies, these results may have clinical implications in risk stratification and preventive measures, given that obesity and CKD are two major chronic diseases with substantial public health burden worldwide.

Waist-to-height ratio and BMI as predictive markers for insulin resistance in women with PCOS in Kolkata, India

PURPOSE

Polycystic ovarian syndrome (PCOS) is most commonly presented with insulin resistance (IR). Simple anthropometric indices may serve as surrogate markers of these conditions with population-based cut-off values. The present study suggests the cut-off values of waist-to-height ratio (WHtR) and body mass index (BMI) in early prediction of PCOS and IR in PCOS women based in Kolkata, a major metropolitan city in India.

METHODS

This cross-sectional study included 66 women (aged 16-30 years) from Kolkata, India, with confirmed PCOS, using Rotterdam criteria. IR was defined following the homeostasis model assessment (HOMA). Anthropometric and biochemical data were obtained using standard protocol and compared among the PCOS subjects grouped as per IR prevalence, BMI, and WHtR values. The receiver operating characteristics (ROC) curve was applied to evaluate and compare the cut-off values of WHtR and BMI in the prediction of PCOS and IR in women with PCOS.

RESULTS

As per ROC analysis, WHtR showed significantly higher AUC in the detection of PCOS and IR in PCOS subjects respectively, than that of BMI. The cut-off values of WHtR and BMI for PCOS were 0.560 and 28.47 respectively, and for IR in PCOS patients, were 0.620 and 29.14 respectively.

CONCLUSIONS

The present study suggests a cut-off value of WHtR to be used as an inexpensive and noninvasive screening tool for early prediction of PCOS and IR among PCOS afflicted women based in Kolkata, India and for this prediction, the study also claims WHtR as a better index than BMI.

Central obesity and incident atherosclerotic cardiovascular disease events in hemodialysis patients

BACKGROUND AND AIMS

Waist circumference and waist-hip ratio have been shown to predict atherosclerotic cardiovascular disease (ASCVD) in the general population, but the association is less clear in patients with CKD. Both anthropometric measures of central obesity are surrogates for underlying fat and are prone to measurement error. The aim of this study was to investigate the association between central obesity determined by dual-energy X-ray -absorptiometry (DXA) and ASCVD among patients undergoing maintenance hemodialysis.

METHODS AND RESULTS

We prospectively analyzed a cohort of 166 prevalent hemodialysis patients (60 ± 12 years of age). Total adiposity (total fat mass) and central adiposity (android and gynoid fat mass) were assessed by using DXA. Central obesity was defined as a sex-specific android to gynoid fat mass ratio (A/G ratio) above the median. The main outcome measure was incident ASCVD events. Patients with central obesity had significantly higher BMI, total fat mass, high-sensitivity C-reactive protein, and triglycerides but significantly lower high-density lipoprotein cholesterol than patients without central obesity. During a median follow-up of 4.3 years, 40 patients had an incident ASCVD event. Patients with central obesity did not display a significantly higher risk of ASCVD in multivariate Cox regression analysis (hazard ratio 1.03, 95% confidence interval 0.54-1.97). A/G ratio, when examined as a continuous variable, was not an independent predictor of ASCVD in either sex.

CONCLUSIONS

Hemodialysis patients with central obesity, as measured by the A/G ratio, had less favorable plasma lipid profiles and higher levels of inflammation but not an increased risk of ASCVD.

Prevalence and Related Factors of Metabolic Syndrome in Beijing, China (Year 2017)

OBJECTIVE

Metabolic syndrome (MetS) is one of the major public health problems worldwide. The aim of this study was to investigate the prevalence and associated risk factors of MetS in Beijing to formulate targeted policies.

METHODS

Data from the 2017 Beijing Chronic Disease and Risk Factors Surveillance were used in this study, in which multistage stratified cluster sampling was adopted to collect a representative sample of 12,597 Beijing residents aged from 18 to 79 years. According to the definition of the International Diabetes Federation, the weighted prevalence of MetS and clustering of MetS components were estimated. The Rao-Scott adjusted χ2 test was used to test differences in MetS and components rates, and complex sampling unconditional logistic regression was used to explore influencing factors of MetS.

RESULTS

The prevalence of MetS was 25.59% (95% CI 23.77-27.41), and the proportion of men and women was 30.53% (95% CI 28.32-32.75) and 20.44% (95% CI 18.29-22.58), respectively. The proportion of central obesity, high fasting plasma glucose, high triglyceride, low high-density lipoprotein cholesterol, and high blood pressure (BP) was 42.02, 27.96, 32.87, 27.25, and 43.06%, respectively. A total of 29.60% (95% CI 27.55-31.74) participants presented at least three components of MetS. The results from complex sampling unconditional logistic regression revealed that the risk factors for having MetS included being 45-59 years old, being 60-79 years old, being male, living in a rural area, education with junior middle school level, education with primary school or below level, harmful use of alcohol, inappropriate sleep time, and having an unhealthy waist-to-height ratio (WHtR); the OR values were 1.55 (95% CI 1.32-1.81), 1.94 (95% CI 1.62-2.31), 1.51 (95% CI 1.34-1.70), 1.27 (95% CI 1.06-1.52), 1.38 (95% CI 1.13-1.68), 1.44 (95% CI 1.13-1.84), 1.50 (95% CI 1.14-1.99), 1.23 (95% CI 1.10-1.37), and 238.20 (95% CI 92.54-613.12), respectively.

CONCLUSIONS

The prevalence of MetS is still in a rising trend in Beijing. Strategies aimed at prevention and control of high BP should be prioritized to reduce the occurrence of MetS. WHtR is more important to evaluate MetS. Health education and personalized lifestyle intervention should be promoted to keep a healthy WHtR and waist circumference. An appropriate sleep time should be kept, and harmful alcohol drinkers should limit or abstain from alcohol.

Utilization of anthropometric parameters as a novel tool for detection of insulin resistance

BACKGROUND

Anthropometric parameters have been widely applied in evaluating muscle mass, insulin resistance (IR), and cardiometabolic diseases. Arm circumference (AC) and calf circumference (CC) are used as informative markers for sarcopenia. However, few studies concern the correlation between AC, CC and IR. The aim of the present survey is to investigate the relationship between AC, CC and homeostatic model assessment of insulin resistance (HOMA-IR).

METHODS

This cross-sectional observational study included 11,527 participants aged 40-85 years from the National Health and Nutrition Examination Survey (NHANES), 1999 to 2006. We divided the participants into male and female groups. Each group was then divided into four subgroups depending on their AC and CC levels.

RESULTS

After adjustment for multiple covariates, we observed a significant negative correlation between the CC and HOMA-IR. This study showed a significant positive correlation between the AC and HOMA-IR after multiple adjustments. Subjects in the highest CC quartiles tended to have the lowest HOMA-IR in both male and female group (P for trend <0.001 in all models).

CONCLUSIONS

CC may be a novel tool to guide public health policy and clinical predictor of IR in middle-aged and older people.

Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance

OBJECTIVE

Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents.

METHODS

This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8-14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥ 3.16.

RESULTS

Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves ware similar between waist-to-height ratio and biochemical markers.

CONCLUSION

The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, we suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.

Body fat anthropometric indexes: Which of those identify better high cardiovascular risk subjects? A comparative study in Spanish population

Aim

To determine the association of body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtr) and Body Shape Index (ABSI) with high cardiovascular risk (CVR), as well as to determine whether how strong are these relationships.

Material and methods

A cross-sectional study was carried out in Spanish Caucasian adults. 3,456 subjects completed the study, 45.78% males, aged < 65 years and non-diabetic subjects. Anthropometric/biochemical variables were measured. We determined ABSI based on WC adjusted for height and weight. High CVR was defined as ≥ 20% according to the Framingham chart, ≥ 5% with the SCORE chart, and ≥ 7.5% with the ACC/AHA guide. Areas under the receiver operating characteristic curves (AUCs) were estimated for each anthropometric measure.

Results

Most significant AUCs in males were: WHtr and ABSI for Framingham ≥ 20% and SCORE ≥ 5%. Also significant were WHtr, WC and ABSI for ACCA/AHA ≥ 7.5%. On the other hand, most significant AUCs in females were: WHtr and WC for Framingham ≥ 20%; and WHtr and WHR for SCORE ≥ 5%, WHtr, and WC for ACC/AHA guide ≥ 7.5%.

Conclusions

Overall, the best anthropometric index identifying Spanish males and females who are at high risk for CV events is WHtr. ABSI was also found to be a good anthropometric index to predict high CVR in Spanish males according to FR, SCORE and ACC/AHA charts. For Spanish females, WC is a good anthropometric index according to FR and ACC/AHA guide, while WHR is better according to SCORE.

[Association of waist-to-hip ratio with insulin resistance in non-diabetic normal-weight individuals: a cross-sectional study]

OBJECTIVE

To explore the relationship between waist-to-hip ratio (WHR) and insulin resistance(IR) in non-diabetic normal-weight individuals and investigate how this association differs between male and femalesubjects.

METHODS

From June to October, 2012, we performed a cross-sectional survey among 2142 community-based non-diabetic Chinese participants, who were divided into 4 groups according to the gender-specific quartiles of WHR. Homeostatic model assessment of insulin resistance (HOMA-IR), calculated as the product of fasting plasma glucose (mmol/L) and fasting insulin (mU/L) divided by 22.5, was used as the indicator of insulin resistance. Logistic regression models were used to explore the association of WHR with IR in these subjects.

RESULTS

In the unadjusted model, WHR was significantly associated with IR in women (OR=6.60, 95%CI: 2.86-15.26, P<0.001); the association was still significant (OR=3.28, 95%CI: 1.34-8.04, P=0.009) after adjustment for the potential confounders including the history of hypertension, coronary heartdisease, current smoker, physical inactivity, and body mass index.

CONCLUSION

WHR is independently associated with IR in non-diabetic Chinese women with normal body weight.

Optimal Cutoff Points for Anthropometric Variables to Predict Insulin Resistance in Polycystic Ovary Syndrome

BACKGROUND

Insulin resistance (IR) is a major cardiometabolic risk factor in females with polycystic ovary syndrome (PCOS). The euglycemic clamp is the gold standard method to measure IR. However, considering the time and cost that it takes, surrogate markers of IR are now widely used. The current study aimed at evaluating the cutoff points of even less invasive anthropometric and body composition variables to predict IR in females with PCOS.

METHODS

The current cross sectional study selected 224 females with PCOS, using Rotterdam criteria, referred to reproductive endocrinology research center; 88 of which were diagnosed with insulin resistance. Receiver operating characteristics curve was used to explore the best cutoff values of each anthropometric and body composition measures. IR was defined as homeostasis model assessment formula greater or equal to 2.6: HOMA-IR = fasting insulin (mU/L) × fasting plasma glucose (mM/L)/22.5.

RESULTS

The highest area under the curve (0.751) was for the multiplication of waist circumference (WC) by body mass index (BMI), as a single index. The highest sensitivity and specificity were for body water (BW) percentage (82% for values greater than 32.85%) and WC (79% for values greater than 88 cm), respectively.

CONCLUSIONS

It was concluded that there were simple anthropometric variables; e.g., WC × BMI, percentage of BW, and WC that could help to estimate IR in clinical settings especially when the gold standard or surrogate markers of IR were unavailable.

The association of chronic kidney disease and waist circumference and waist-to-height ratio in Chinese urban adults

This study aims to investigate the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with chronic kidney disease (CKD).A cross-sectional survey was conducted in a nationally representative sample of 123,629 Chinese urban adults who participated in health examinations between 2008 and 2009. BMI, WC, and WHtR were measured, as well as serum and urine biochemical tests. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m or urine protein positivity (proteinuria)≥1+ with dipstick testing.WHtR had the largest areas under ROC curve for CKD in men and women, followed by WC and BMI. Higher levels of BMI, WC, and WHtR were each associated with an increased odds for CKD among men. For per unit size change, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of CKD were 1.19 (95% CI, 1.13-1.25) for BMI, 1.12 (95% CI, 1.08-1.16) for WC, and 1.13 (95% CI, 1.10-1.17) for WHtR. The corresponding values were significant in multivariable models among women aged 40 years and above. Using Chinese-recommended cutoffs for BMI (≥24 kg/m), WC (≥85 cm for men, and ≥80 cm for women), and WHtR (≥0.05), WHtR was superior in the association with CKD than BMI for men, whereas WC was superior for women.Increased obesity indices were positively associated with the odds of CKD. Central obesity, defined by WC and WHtR, may be more closely correlated with CKD for Chinese urban adults.

The Relationship Between Hemodialysis Modality and Insulin Resistance in Non-Diabetic Hemodialysis Patients

Background: Although various modalities of hemodialysis (HD) are presumed to have different effects on insulin resistance (IR), the relationship between hemodiafiltration (HDF) and IR has not been fully evaluated. Methods: In a cross-sectional study, 82 non-diabetic HD patients were enrolled. The patients were divided into two groups according to the median homeostasis model assessment index (HOMA-IR) value of 1.685. Clinical and biochemical data were compared, and multivariate logistic regression analysis was performed to identify the independent factors associated with higher HOMA-IR. Results: The higher HOMA-IR group had increased body mass index (BMI), decreased HDL cholesterol, and lower beta-2 microglobulin reduction rate (β2-MG RR) compared to the lower HOMA-IR group. HOMA-IR was significantly correlated with β2-MG RR. In addition, HDF patients had lower HOMA-IR levels compared with low flux hemodialysis patients. On multivariate logistic regression analysis, BMI and HDF treatment were independent factors associated with higher and lower HOMA-IR, respectively. Conclusion: This study suggests that HDF treatment may reduce IR in non-diabetic HD patients.

Insulin Resistance of Normal Weight Central Obese Adolescents in Korea Stratified by Waist to Height Ratio: Results from the Korea National Health and Nutrition Examination Surveys 2008-2010

Background. To evaluate insulin resistance of normal weight central obese 13-18-year-old male and female adolescents stratified by waist to height ratio (WHR). Methods. Data were obtained from the Korea National Health and Nutrition Examination Survey (K-NHANES) conducted during 2008-2010. Central obesity was defined as that in the upper quartile of age and sex specific WHR. Subjects were classified into no central obesity normal weight (NW), central obesity normal weight (CONW), no central obesity overweight (OW), and central obesity overweight (COOW). Results. The prevalence of CONW was 9.6% (83/832) in female and 7.0% (61/909) in male. CONW showed higher levels of insulin (P < 0.006), HOMA-IR (P < 0.006), and ALT (P < 0.001) than NW in female. CONW had higher levels of insulin (P < 0.0001), HOMA-IR (P < 0.0001), and WBC count (P < 0.021) and lower level of HDL (P < 0.0001) than NW in male. WHR and BMI had similar significant correlations with MS components. CONW showed 2.5 times (95% confidence interval, 1.21-5.00) more likelihood to have high insulin resistance than NW in male. Conclusions. Screening for central obesity using WHR in clinical setting is recommended.