Utility of novel body indices in predicting fat mass in elite athletes

Development and Validation of an Anthropometric Equation to Predict Fat Mass Percentage in Professional and Semi-Professional Male Futsal Players

This study aimed to (i) characterise the body composition of professional and semi-professional male futsal players, (ii) assess the validity of commonly used equations to estimate FM%, (iii) develop and cross-validate a futsal-specific FM% prediction equation. In a cross-sectional design, 78 adult male futsal players were assessed for body mass, stature, skinfolds, and girths as per the International Society for the Advancement of Kinanthropometry protocol and completed a dual-energy X-ray absorptiometry (DXA) scan for reference body composition data. Using paired-sample t-tests, the FM% from the DXA and nine published equations were compared. New sport-specific models were developed by stepwise multiple regression. Existing equations were cross-validated using the least squares regression, concordance correlation coefficient, and the Bland−Altman analyses. New equations were further cross-validated using the PRESS approach. None of the existing equations accurately predicted the DXA-derived FM% (p < 0.001; R2 ≤ 0.76, SEE ≥ 1.59; CCC ≤ 0.83; bias = −8.2% to −1.3%, limited agreement, and varying trends). The novel Bettery® equation: −0.620 + (0.159 ∗ Σ4SKF [triceps, abdominal, iliac crest, and front thigh (mm)]) + (0.120 ∗ waist girth (cm)), demonstrated a high accuracy (R2 = 0.85, SEE = 1.32%), a moderate strength of agreement (CCC = 0.92), no bias (0.2%), good agreement (±2.5%), and no trend (r = −0.157; p = 0.170) against the DXA. The Bettery® equation is the first to allow for a valid and sport-specific assessment of FM% in male futsal players.

Anthropometric Indices as Predictive Screening Tools for Obesity in Adults; The Need to Define Sex-Specific Cut-Off Points for Anthropometric Indices

Due to the lack of full agreement as to the best indicators for obesity diagnosis and type, the aim of this study was to assess the comparative classification capabilities with the use of BIA results and selected anthropometric indices in individuals aged 20–60 years. This was a cross-sectional observational study among 368 Caucasian subjects aged 20–60 years. Body size and four skinfolds measurement were taken. To assess individual body composition, the bioelectrical impedance (BIA) method was applied. The results of fat mass (FM, kg) and fat-free mass (FFM, kg) were taken to calculate FM/FFM, fat mass index (FMI), and fat free mass index (FFMI). Receiver-operating characteristic (ROC) curve analysis was employed to compare the predictive power of different anthropometric indices in differentiating the classification of obesity in adults. The results of this study demonstrated and confirmed the need to change the approach to commonly used indicators such as BMI (body mass index) or WHtR (waist-to-height ratio), which should lead to the establishment of new criteria for the diagnosis of obesity that will also be sex-specific, in the adult population. The measurement of body fat content should become a generally accepted indicator for effective diagnosis, as well as for screening, of obesity.

Inhabiting the Body(ies) in Female Soccer Players: The Protective Role of Positive Body Image

In a social and sports world dominated by weight-centred beliefs and highly exigent and gendered athletic and beauty body standards, the vulnerability for eating pathology, i.e., disordered eating and eating disorders (EDs), is elevated among women athletes. The aim of this study was to explore body image facets and ED risk among female athletes in masculinised sports such as soccer. Forty-five federated amateur female soccer players from Spain participated in this study, voluntarily complying with an extensive evaluation protocol on attitudes towards body and appearance and eating practises. The participants overall reported self-representations of their bodies that corresponded to their reality as athletes, but their body ideals were also more demanding in terms of low fat and muscularity, in association with the functionality of their body and the physical demands of their athletic activity. Despite having a fairly high positive body image and body satisfaction, they also expressed negative attitudes towards their bodies. Around 2 out of 10 players were at risk of suffering from an ED. Players with negative attitudes towards their bodies had an odd 12 times likely to develop an ED compared to those with lower self-devaluation, after adjusting for BMI and body perceptions (OR = 12.3, p < 0.01). On the contrary, players who appreciate their bodies and hold a positive body image had an odd 83% lower to suffer from eating pathology, after adjusting for BMI and body satisfaction (OR = 0.17, p < 0.05). Our findings support the healthy and protective role of positive body image in sports contexts. Body attitudes should be addressed in preventive and therapeutic efforts for reducing the prevalence of EDs in women's sports, within both a "negative" and a "positive" paradigm of body image.

Assessment of Body Composition in Athletes: A Narrative Review of Available Methods with Special Reference to Quantitative and Qualitative Bioimpedance Analysis

Body composition is acknowledged as a determinant of athletic health and performance. Its assessment is crucial in evaluating the efficiency of a diet or aspects related to the nutritional status of the athlete. Despite the methods traditionally used to assess body composition, bioelectric impedance analysis (BIA) and bioelectric impedance vector analysis (BIVA) have recently gained attention in sports, as well as in a research context. Only until recently have specific regression equations and reference tolerance ellipses for athletes become available, while specific recommendations for measurement procedures still remain scarce. Therefore, the present narrative review summarizes the current literature regarding body composition analysis, with a special focus on BIA and BIVA. The use of specific technologies and sampling frequencies is described, and recommendations for the assessment of body composition in athletes are provided. Additionally, the estimation of body composition parameters (i.e., quantitative analysis) and the interpretation of the raw bioelectrical data (i.e., qualitative analysis) are examined, highlighting the innovations now available in athletes. Lastly, it should be noted that, up until 2020, the use of BIA and BIVA in athletes failed to provide accurate results due to unspecific equations and references; however, new perspectives are now unfolding for researchers and practitioners. In light of this, BIA and especially BIVA can be utilized to monitor the nutritional status and the seasonal changes in body composition in athletes, as well as provide accurate within- and between-athlete comparisons.

Body roundness index is a superior indicator to associate with the cardio-metabolic risk: evidence from a cross-sectional study with 17,000 Eastern-China adults

Background

To investigate the ability of body shape index (ABSI), body roundness index (BRI), waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body adiposity index (BAI) for predicting non-adipose cardio-metabolic risk.

Methods

A total of 17,360 Chinese subjects aged 18–95 years old who escaped cardiovascular disease (CVD) or diabetes were recruited in the cross-sectional study. Anthropometric and biochemical parameters were assessed. Receiver operating characteristic curve (ROC) and multinomial logistic regression were conducted to examine the association of anthropometric indicators with cardio-metabolic risk factors.

Results

The mean age of subjects were 53.7(13.1) years, 41.6 % were males. The areas under the curve (AUC) demonstrated that WC, BMI, WHR, WHtR and BRI were able to predict high cardio-metabolic risk (AUC > 0.70). Meanwhile, multinomial logistic regression showed BRI was significantly associated with high cardio-metabolic risk (OR 3.27, 95% CI 3.01–3.55). The optimal cut-off values of BRI for high cardio-metabolic risk were (< 60 y: 3.49 vs. ≥60 y: 3.46) in males and (< 60 y: 3.47 vs. ≥60 y: 3.60) in females.

Conclusions

WC, BMI WHR, and WHtR were potential obesity indicators in discriminating high cardio-metabolic risk, while BAI or ABSI was not. Moreover, BRI revealed superior predictive capacity and significant association with accumulated cardio-metabolic risk factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-01905-x.

Body fatness in sedentary and active students with different body mass index

Study aim: Numerous data have indicated that body fat stores undergo complicated regulation by genetic and environmental factors, including physical activity. However, the majority of studies did not take into account this aspect of lifestyle in proposed body fat limits. In this context it seems that a more precise and reliable classification of body fat is provided by the American Council on Exercise (ACE), which distinguishes individuals not only with respect to sex but also activity level.

Material and methods: A total of 793 students (312 sedentary and 481 active) volunteered to participate in the study. Among sedentary participants 147 were male and 165 female. Among active subjects 206 were male and 275 were female. Active subjects were engaged in different modes of physical activity according to the study program. In all participants body mass index (BMI) was calculated. In participants with BMI 18.5–24.9 and BMI ≥ 25 body fat was determined using four skinfold measurements. Thereafter participants were classified according to the percentage of body fat using ranges for males and females provided by the American Council on Exercise (ACE) (essential fat, athletes, fitness, average and obese fatness).

Results: None of the sedentary and active males with BMI 18.5–24.9 had high (obese) fat. In contrast, in sedentary males with BMI ≥ 25 16.4% were obese vs. 1.8% of obese active ones. In sedentary females BMI from 18.5 to 24.9 did not exclude obesity, which was found in 16.9% of participants. In sedentary females with BMI ≥ 25 most of the subjects (97.1%) were obese. In contrast, in active females with BMI ≥ 25 a similar percentage of participants had average and obese fat (53.3% and 46.7, respectively).

Discussion: Our study clearly demonstrated that BMI as a simple measure of body composition provides false information concerning true adiposity in physically active male and female students. A similar BMI did not exclude marked differences in the percentage of body fat in sedentary and active students.

Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis

Body roundness index (BRI) is a new anthropometric index developed to predict both body fat and the percentage of visceral adipose tissue. Our aim was to investigate whether BRI is superior to traditional anthropometric indices in predicting metabolic syndrome (MetS). This systematic review and meta-analysis was conducted using Pubmed, Scopus and Web of Sciences databases. The estimated pooled areas under curve (AUCs) for BRI predicting MetS was higher than body mass index (BMI), waist-to-hip ratio (WHR), body shape index (ABSI) and body adiposity index (BAI), similar to waist circumference (WC) and lower than waist-to-height ratio (WHtR). However, the difference between BRI and BMI, WC and WHtR predicting MetS was statistically non-significant. Similar results were found with the summary receiver operating characteristic curve (AUC-SROC). In addition, the non-Chinese population had pooled AUCs greater than the Chinese population for all indices. Pooled ORs showed that BRI is associated with an increased MetS risk. In conclusion, BRI had good discriminatory power for MetS in adults of both sexes from diverse populations (AUC > 0.7; AUC-SROC>0.7). However, WC and WHtR offer the best performance when screening for MetS, and non-significant differences were found with BRI. In contrast, BRI was superior to BMI, WHR, ABSI and BAI in predicting MetS.

Novel anthropometric parameters to define obesity and obesity-related disease in adults: a systematic review

Context

Obesity is defined as an abnormal or excessive accumulation of body fat. Traditionally, it has been assessed using a wide range of anthropometric, biochemical, and radiological measurements, with each having its advantages and disadvantages.

Objective

A systematic review of the literature was conducted to identify novel anthropometric measurements of obesity in adults.

Data Sources

Using a combination of MeSH terms, the PubMed database was searched.

Data Extraction

The current systematic review was conducted in accordance with the PRISMA guidelines. The data extracted from each study were (1) details of the study, (2) anthropometric parameter(s) evaluated, (3) study methods, (4) objectives of the study and/or comparisons, and (5) main findings/conclusions of the study.

Data Analysis

The search yielded 2472 articles, of which 66 studies were deemed eligible to be included. The literature search identified 25 novel anthropometric parameters. Data on novel anthropometric parameters were derived from 26 countries. Majority were descriptive cross-sectional studies (n = 43), while 22 were cohort studies. Age range of the study populations was 17–103 years, while sample size varied from 45 to 384 612.

Conclusions

The novel anthropometric parameters identified in the present study showed variable correlation with obesity and/or related metabolic risk factors. Some parameters involved complex calculations, while others were derived from traditional anthropometric measurements. Further research is required in order to determine the accuracy and precision.

The Female Athlete Body project study: 18-month outcomes in eating disorder symptoms and risk factors

OBJECTIVE

To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors.

METHOD

This study was a community participatory three-site, two-arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a behavioral ED risk factor reduction program, or a waitlist control condition. Primary analyses examined 18-month effects for ED pathology. Secondary analyses examined risk factors and correlates (e.g., thin-ideal internalization, negative mood, Female Athlete Triad knowledge, and body mass index [BMI]).

RESULTS

Linear mixed effects models with team as a cluster level variable and study condition as a between-subjects variable revealed significantly reduced dietary restraint in FAB teams relative to control teams. FAB teams also reported significantly fewer objective and subjective binge episodes than control teams. Finally, FAB teams showed significantly lower thin-ideal internalization and increased BMI at 18-months. No other significant differences were found.

DISCUSSION

This RCT examined the effects of a short intervention on ED pathology and risk factors in female collegiate athletes through 18-month follow-up. This trial is one of only three trials with female athletes that have shown long-term reductions in any ED symptoms or produced positive effects on ED risk factors. The present study is the first to find such effects with athletes using a brief (i.e., 4 hr) intervention at 18-month follow-up. Although small effects were found, the current trial provides valuable lessons about future design and implementation of similar trials with athletes.

TRIAL REGISTRATION

Clinical trials NCT01735994.

Utility of the Z-score of log-transformed A Body Shape Index (LBSIZ) in the assessment for sarcopenic obesity and cardiovascular disease risk in the United States

Body mass index (BMI) has limited accuracy for predicting cardiovascular diseases (CVD) and is not capable of identifying sarcopenic obesity, the combination of sarcopenia (an age-associated decline in muscle mass and physical function) and obesity. To overcome this, the z-score of the log-transformed A Body Shape Index (LBSIZ) was recently introduced as a measure of obesity using waist circumference, height, and weight. We aimed to investigate the association of LBSIZ with sarcopenic obesity and CVD, and propose appropriate cut-off values using the National Health and Nutrition Examination Survey 1999–2016 data. Of 92,062 participants, 40,468 adults (≥20 years) were included. Overall area under curve (AUC) of LBSIZ was 0.735 (95% confidence interval [CI]: 0.716–0.754) for sarcopenic obesity, and 0.695 (95% CI: 0.687–0.703) for CVD. The subgroup analysis of ethnicity/race showed similar results. Waist circumference (WC), BMI, conicity index, body roundness index (BRI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), new BMI, and waist to height ratio (WHtR) showed a negative association with sarcopenic obesity, while LBSIZ and conicity index showed a positive association. The AUC of LBSIZ was significantly higher for sarcopenic obesity than that of conicity index (p < 0.001). The AUC of LBSIZ was significantly higher for CVD than those of parameters including WC, BMI, BRI, CUN-BAE, new BMI, and WHtR (p < 0.001). The AUC for conicity index alone was comparable to that of LBSIZ for CVD. Overall LBSIZ cut-off was 0.35 for both sarcopenic obesity (sensitivity, 65.3%; specificity, 71.5%) and CVD (sensitivity, 63.3%; specificity, 66.6%). These results may be useful not only to identify sarcopenic obesity, but also to conduct CVD risk assessment in the clinical setting.

Adipose-to-muscle area ratio at the knee is superior to BMI in predicting post-operative outcome following arthroscopic meniscectomy

PURPOSE

To determine if measurement of leg adipose tissue area by MRI is a better predictor of post-operative clinical outcome compared to body mass index (BMI) following arthroscopic meniscectomy.

METHODS

Patients that underwent an arthroscopic partial meniscectomy between 2011 and 2016 were identified and a retrospective chart review was performed. Patients with additional knee pathology other than a meniscal tear with or without associated articular cartilage injury were excluded. Leg adipose tissue and muscle area measurements at the level of the knee joint were performed for patients on their preoperative axial magnetic resonance imaging (MRI) study and adipose-to-muscle area ratio (AMR) was calculated. Correlations among AMR, BMI, and post-operative clinical outcomes were compared.

RESULTS

A total of 74 patients (32 females and 42 males) were included (mean age 50.0 years, std. dev. 12.3 years). 35 patients underwent a partial medial meniscectomy, 15 underwent a partial lateral meniscectomy, and 24 underwent both. Linear regression analysis showed that the AMR, compared to BMI, had a significantly stronger correlation to both mean post-operative Knee Injury and Osteoarthritis Outcome Score (KOOS) across all 5 subscales (KOOS₅) and Tegner Current score. Patients that had cartilage damage and concurrent chondroplasty tended to be older and have lower post-operative KOOS₅ compared to those with no cartilage damage. AMR was also significantly correlated to age and BMI.

CONCLUSIONS

The current study demonstrates that compared to BMI, leg adiposity as determined by the ratio of adipose tissue to muscle area on axial MRI (AMR), is a stronger predictor of functional outcome following meniscectomy. This suggests a role of obesity in the progression of OA beyond the increased joint forces associated with increased BMI.

LEVEL OF EVIDENCE

IV, retrospective case series.

Anthropometric prediction of DXA-measured body composition in female team handball players

Background

The relevance of body composition (BC) to performance in sport has long been appreciated with special concern on the total and regional proportion of fat and muscle. Dual-energy X-ray absorptiometry (DXA) is able to accurately measure BC, but it may not be easily available in practice; anthropometry has long been used as a simple and inexpensive field method to objectively assess BC. The aim of this study was twofold: first, to develop and validate a sport-specific anthropometric predictive equation for total body fat mass (FM) and lean mass components in female handball players to be used in the sport setting; second, to cross-validate in female team handball players several independently developed, predictive equations for BC in female athletes.

Methods

A total of 85 female team handball players (30 wings, 31 backs, 14 pivots, 10 goalkeepers) of different competitive levels underwent anthropometry and a whole-body DXA scan. Multiple linear regression analysis was used to develop predictive equations in a derivation sample (n = 60) of randomly selected players using demographic and anthropometric variables. The developed equations were used to predict DXA outcomes in an independent validation sample (n = 25).

Results

Statistically significant (P < 0.001) models were developed for total body FM (adjusted R² = 0.943, standard error of the estimate, SEE = 1,379 g), percentage FM (adjusted R² = 0.877, SEE = 2.00%), fat-free soft tissue mass (FFSTM) (adjusted R² = 0.834, SEE = 2,412 g), fat-free mass (FFSTM + bone mineral content; adjusted R² = 0.829, SEE = 2,579 g). All models were robust to collinearity. Each developed equation was successfully validated in the remaining 25 players using correlation analysis, mean signed difference, t-test, and Bland–Altman plot. The whole dataset of team handball players (n = 85) was used to cross-validate several predictive equations independently developed by others in female athletes. Equations significantly (P < 0.001 for all; t-test) over- or underestimated the corresponding DXA measurements.

Discussion

It is concluded that in team female handball players the anthropometric equations presented herein are able to estimate body fat and FFSTM with accuracy. Several BC predictive anthropometric equations developed in different female athletic populations revealed inaccurate when tested in team handball players. These results should be of use for coaches, physical trainers, and nutritionists when evaluating the physical status of female team handball players.

Associations of body adiposity index, waist circumference, and body mass index in young adults

BACKGROUND & AIMS

The Body Adiposity Index (BAI) is an anthropometric measure developed to estimate body composition in field settings. Although this novel measure has been validated against clinical measures of adiposity (%Fat), the relative accuracy of other anthropometric measures, such as Body Mass Index (BMI), and waist circumference (WC), have not been assessed in comparison to the BAI using a 4-compartment (4C) model.

PURPOSE

The primary aim of this study was to examine the association between BMI, WC, BAI, and %Fat in young adults, and determine the relative accuracy of each anthropometric measure when predicting %Fat.

METHODS

BMI, WC, and BAI were assessed in a sample of young adults (n = 188, 48.4% female, 21.8 ± 4.8 years). %Fat assessed using the 4C model was derived from underwater weighing for body density, dual-energy X-ray absorptiometry for bone mineral content, and bioimpedance spectroscopy for total body water. Bivariate associations were assessed using Pearson's r, with the relative accuracy of each measure assessed using multivariate linear regression and compared using Akaike's information criterion, R² and ΔR² statistics.

RESULTS

BMI, WC, and BAI were associated with %Fat (r = 0.192, 0.194, and 0.668, respectively, all p < .01). WC and BAI collectively explained 46.3% of the variation in %Fat, and removing BAI significantly reduced model fit (p < .001). When stratified by sex, BAI provided greater accuracy when predicting %Fat beyond WC in men (ΔR² = 2.6%, p = .022), but not women (ΔR² = 2.1%, p = .078).

CONCLUSION

WC and BAI are more strongly associated with %Fat as measured by the 4C model than BMI in young adults.

Anthropometric Indicators of Adiposity Related to Body Weight and Body Shape as Cardiometabolic Risk Predictors in British Young Adults: Superiority of Waist-to-Height Ratio

Frequently reported poor dietary habits of young adults increase their risk of metabolic syndrome (MetS). Excess adiposity is the most established predictor of MetS, and numerous anthropometric measures have been proposed as proxy indicators of adiposity. We aimed to assess prevalence of MetS in young adult population and to make comparison between weight- and shape-oriented measures of adiposity to identify the best index in association with measured body fat and as a risk predictor for MetS. Healthy males and females aged 18-25 years from the Northwest of England were recruited using convenience sampling (n=550). As part of the assessment of the overall health of young adults, the biochemical variables and adiposity measures BMI, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), new BMI, Body Adiposity Index (BAI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), and A Body Shape Index (ABSI) were assessed. Linear regression analysis was used to investigate the association between the proxy indices of adiposity and measured percentage body fat. The odds ratio with 95% confidence interval was used to investigate the relationship between cardiometabolic (CM) risk factors and proxy measures of adiposity. The discriminatory power of these measures for diagnosis of MetS was investigated using area under the receiver operating characteristic curve. Body weight-related indicators of adiposity, particularly CUN-BAE, had stronger association with measured body fat compared with body shape-related indices. In relation with MetS, body shape-related indices, particularly elevated WC and WHtR, had stronger associations with CM risk compared with body weight-related measures. Amongst all indices, the best predictor for CM risk was WHtR, while ABSI had the weakest correlation with body fat, MetS, and CM risk. Indices directly associated with WC and specifically WHtR had greater diagnostic power in detection of CM risk in young adults.

Comparison of the ability to identify cardiometabolic risk factors between two new body indices and waist-to-height ratio among Chinese adults with normal BMI and waist circumference

OBJECTIVE

Waist-to-height ratio (WHtR) has been reported to be more strongly associated with cardiometabolic risk factors among non-obese individuals than BMI and waist circumference (WC). A body shape index (ABSI) and body roundness index (BRI) have been proposed recently to assess obesity-related disorders or mortalities. Our aim was to compare the ability of ABSI and BRI with that of WHtR to identify cardiometabolic risk factors in Chinese adults with normal BMI and WC.

DESIGN

Receiver-operating characteristic curves and areas under the curve (AUC) were employed to evaluate the ability of the indices (WHtR, BRI, ABSI) to identify metabolic risk factors and to determine the indices' optimal cut-off values. The value of each index that resulted in maximization of the Youden index (sensitivity + specificity - 1) was defined as optimal. Differences in the AUC values between the indices were also evaluated.

SETTING

Individuals attending a voluntary health check-up in Beijing, China, July-December 2015, were recruited to the study.

SUBJECTS

Non-obese adults (n 1596).

RESULTS

Among both genders, ABSI exhibited the lowest AUC value for identifying each risk factor among the three indices; the AUC value of BRI for identifying each risk factor was very close to that of WHtR, and no significant differences were observed between the AUC values of the two new indices.

CONCLUSIONS

When evaluating cardiometabolic risk factors among non-obese adults, WHtR was a simple and effective index in the assessment of cardiometabolic risk factors, BRI could be used as an alternative body index to WHtR, while ABSI could not.

Body roundness index and body adiposity index: two new anthropometric indices to identify metabolic syndrome among Chinese postmenopausal women

OBJECTIVES

Body roundness index (BRI) and body adiposity index (BAI) have been recently proposed to assess obesity. The objectives of this cross-sectional study were to compare their potential for identifying metabolic syndrome (MetS) with traditional obesity indices in Chinese postmenopausal women.

METHODS

A total of 817 participants were involved in this study. Odds ratio and corresponding 95% confidence intervals (CI) between MetS and all indices were evaluated by binary logistic regression analysis. Receiver operating characteristic curve and area under curve (AUC) were employed to evaluate the abilities to identify MetS among all the indices. The differences in the AUC values between traditional indices and BAI as well as BRI were also evaluated.

RESULTS

The upper values of all indices were significantly associated with the presence of MetS after adjusting for potential confounders, except for BAI. There were no significant differences in the AUC values between BRI and the traditional indices; however, the AUC values of all the traditional indices were significantly larger than that of BAI.

CONCLUSIONS

Neither BAI nor BRI was superior to traditional obesity indices for predicting MetS. BAI showed the weakest predictive ability, while BRI showed potential for use as an alternative obesity measure in assessment of MetS.