The purpose of this study is to investigate and compare the relationship between the various adiposity measures, namely Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR) and the recently proposed Body Adiposity Index (BAI) and cardiovascular disease (CVD) risk factors such as hypertension, diabetes mellitus and dyslipidemia in an adult population in Singapore, a South-East Asian country.
This is a cross sectional study involving 1,891 subjects (Chinese 59.1% Malay 22.2%, Indian 18.7%), aged 21-74 years, based on an employee health screening (2012) undertaken at a regional hospital in Singapore. Anthropometric indices and CVD risk factor variables were measured, and Spearman correlation, Receiver Operating Characteristic (ROC) curves and multiple logistic regressions were used in the analysis.
After adjusting for BMI, BAI did not further increase the odds of CVD risk factors unlike WC and WHtR. WC and WHtR consistently had the higher estimated areas under ROC curve and odd ratios, although the differences were often small with overlapping 95% confidence intervals. Comparing between WC and WHtR, WHtR ≥ 0.501 was found to be generally more sensitive than WC ≥ 80 cm for females, and ≥ 90 cm in males. When a combination of measures were included in the evaluation, a BMI of ≥ 23.5kg/m2 and/or WHtR ≥ 0.5 yielded the highest proportion who would have been identified amongst those with the various CVD risk factors for all the CVD risk factors in both gender.
BAI may function as a measure of overall adiposity but it is unlikely to be better than BMI. While BMI, WC and WHtR seem comparable in their association with CVD risk factors, a combination of BMI and WHtR would have the best clinical utility in identifying patients with CVD risk factors in an adult population in Singapore.